Inspection on 24/09/09 for Wellington Road (51)

This is the latest available inspection report for this service, carried out on 24th September 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wellington Road (51) 22/06/06

Wellington Road (51) 08/02/06

Wellington Road (51) 20/09/05

Wellington Road (51) 10/03/05

Wellington Road (51) 24/09/04

Wellington Road (51) 27/02/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Wellington Road (51) 51 Wellington Road New Brighton Wallasey Wirral CH45 2ND     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: Daniel Hamilton     Date: 2 4 0 9 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 31 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 31 Information about the care home Name of care home: Address: Wellington Road (51) 51 Wellington Road New Brighton Wallasey Wirral CH45 2ND 01516395685 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: dmilligan@btinternet.com Mrs Patricia Pauline Milligan care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 The maximum number of service users who can be accommodated is: 8 Date of last inspection Brief description of the care home 51, Wellington Road provides accommodation and personal care for 8 service users with a learning disability. The service has two large sitting rooms and a dining area on the ground floor. There are single and shared bedrooms on the upper floors. The service is provided in a large semi-detached house in the New Brighton area of Wallasey. The property is located within a short walking distance of the promenade and a local bus service, train station and shops. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 8 2 4 0 9 2 0 0 8 Brief description of the care home A statement of purpose and service user guide has been developed to provide information on the service and copies are available in the office area for reference. Care Home Fees are £393.89 per week Care Homes for Adults (18-65 years) Page 5 of 31 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 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over one day and lasted approximately 7 hours. Eight people were being accommodated in the home at the time of the visit. A partial tour of the premises took place and observations were made. A sample of two care records were case tracked (this involves looking at the support a service user gets from the manager and staff including their care plans and medication) and a selection of staff and service records were viewed. The registered manager, deputy manager, two support staff and all the people using the service were spoken with during the visit. Prior to the inspection, the manager completed an Annual Quality Assurance Assessment (AQAA) which provides key data and numerical information on the service. Care Homes for Adults (18-65 years) Page 6 of 31 Reference is made in the body of the report to the information contained within the AQAA document. All the key standards were assessed and action taken in response to the previous requirements and recommendations from the last key inspection in September 2008 was reviewed. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? Since the last visit, a new assessment and care planning system had been introduced to enable staff to deliver person-centered care in response to the changing needs and personal goals of the people using the service. Furthermore, risk assessments had been completed to safeguard the independence and wellbeing of the people using the service. Action had been taken to improve recruitment practice and records confirmed that new staff had not commenced employment until two satisfactory references and a Protection of Vulnerable Adult or Criminal Record Bureau Certificate had been received. Records had been established to monitor the temperature of hot water outlets throughout the premises however further work is needed in this area. A record of the date that medication was received into the service had been recorded on Medication Administration Records to ensure a clear audit trail. Furthermore, staff had completed medication refresher training and workbooks to develop knowledge, skills and understanding. Systems had been established to ensure new staff completed induction training that was compliant with the Skills for Care - Common Induction Standards. Care Homes for Adults (18-65 years) Page 8 of 31 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 9 of 31 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 10 of 31 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. Policies and procedures are in place to ensure the needs of prospective service users are assessed prior to moving into 51, Wellington Road. Evidence: A Statement of Purpose and Service User Guide had been developed in a standard format to provide information on the service provided at 51, Wellington Road. Since the last inspection, a copy of the document had been produced using large print and the manager reported that he was in the process of developing a copy using a pictorial format. Progress will be reviewed at the next inspection. Examination of the documentation confirmed the Statement of Purpose and Service User Guide had been updated to include the name and correct contact details of the Care Quality Commission and a summary of the complaints procedure as recommended at the last inspection. Personal files viewed also contained a signed copy of a Residents Contract or Statement of Terms and Conditions. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The Annual Quality Assurance Assessment detailed that policies were in place for referral and admission and the manager reported that two people had moved into 51, Wellington Road since the last visit. Discussion with the manager and examination of records highlighted that the service had purchased a new assessment system since the last visit in order to improve quality and ensure consistency. Records viewed provided evidence that people had been admitted to 51 Wellington Road following an assessment of their needs and copies of assessments completed by health and / or social services care managers had also been obtained for staff to reference. The manager and staff spoken with were able to demonstrate knowledge and understanding of the needs and support requirements of the people they cared for and service users spoken with were complimentary of the care provided. Care Homes for Adults (18-65 years) Page 12 of 31 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 living at 51, Wellington Road are supported to have as much choice and control over their lives as possible, in order to promote independence and wellbeing. Evidence: The Annual Quality Assurance Assessment for 51, Wellington Road detailed that policies and procedures had been developed for Individual Planning and Review and the values of the service as previously noted. Discussion with the manager and examination of records highlighted that the service had purchased a new care planning system since the last visit, in order to improve quality and ensure consistency. The personal files of two people who had moved into 51, Wellington Road since the last inspection were viewed during the visit. Each file was found to contain a range of personal care and care planning documentation that was linked to assessed needs. Care plans viewed also outlined objectives, action required and review dates however Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: they had not been signed or agreed by service users or their representatives. The manager agreed to address this issues. Since the last visit action had also been taken to ensure personal records were updated twice each day. The people using the service confirmed they were encouraged to actively participate in their local communities and a range of risk assessments had been completed to provide evidence that potential hazards and risks had been assessed and appropriate action taken to safeguard the welfare of the people using the service. Staff were observed to communicate and engage effectively with the people using the service during the inspection process and were seen to treat service users with dignity and respect. Likewise, the people using the service appeared relaxed and comfortable in their home environment and confirmed they were encouraged to make decisions about their lives with assistance from staff when required. Comments included: The staff are nice and friendly; We can do what we want and I like living here as I can do as I please. Care Homes for Adults (18-65 years) Page 14 of 31 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. Meals, activities and routines are flexible and varied to enable service users to follow their preferred lifestyle. Evidence: The people living at 51, Wellington Road were supported to follow their preferred lifestyle and to engage in a range of activities to maintain and develop their social, communication and independent living skills. For example, some service users attended colleges whilst others preferred to visit relatives or stay at home, to assist in day to day household tasks such as cleaning and shopping. Service users spoken with confirmed they could follow their preferred daily routines and spend time in the lounge areas or in the privacy of their own room as seen on the day of inspection. The people using the service were assisted by staff to socialise and participate in a range of leisure, social or recreational activities subject to individual Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: need. The usual home entertainment was available in the home such as videos, DVD, music and a football game table. A holiday away from 51, Wellington Road is also included in the weekly fee and service users choose where to go each year. The last holiday was in October 2008 when service users decided to visit a hotel in Scotland with pre-paid excursions with the support of staff. The people using the service reported that they were also planning another holiday away towards the end of the year. Service users confirmed they were able to maintain contact with family and friends and there were no restrictions around visitors coming to the house. Some people reported that they also attended the Latin Quarter Club, where they were able to socialise and maintain contact with other friends. Feedback from two service users included I often visit my mum and I like going to college. A menu planning system had not been developed as the people using the service wanted the flexibility to vary their choice of meals on a daily basis. A record of meals provided each day was in place which provided evidence of a varied and balanced diet. A record of individual meals served to each service user had not been established as previously recommended, to provide a record of the meal choices and the dietary intake for each person. The manager agreed to address this matter. The people using the service reported that they were encouraged to participate in shopping for the home and confirmed that they were encouraged to assist in household tasks such as cleaning, washing up and tidying the kitchen. The mealtimes at 51, Wellington Road continued to be flexible in order to respond to the needs of service users and the evening meal remained an opportunity for the people living in the home to socialise. Feedback on the standard of catering remained good. For example, comments included: I like the food and We get plenty to eat here and its always nice food. Care Homes for Adults (18-65 years) Page 16 of 31 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 people using the service are supported to maintain their personal care and have access to healthcare services to maintain independence and general wellbeing. Evidence: The people living at 51 Wellington Road required minimal assistance with personal care and support. All of the service users were able to transfer independently and did not require any aids to promote their independence or safety. Information on the personal care needs of the service users had been recorded in care plans and the manager and staff spoken with were able to demonstrate knowledge and understanding of the personal care needs and support requirements of the people living in the home. Examination of health care records confirmed that the people using the service were supported to attend appointments with a range of health practitioners. Records viewed detailed that service users had accessed the chiropodist, psychiatrist, dentist, doctor and / or opticians subject to individual needs. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: The Annual Quality Assurance Assessment for the service confirmed staff had access to a policy on the Control, Storage, Disposal, Recording and Administration of Medicines. Since the last visit, a copy of guidance issued by the Royal Pharmaceutical Society of Great Britain had also been obtained for staff to reference. Furthermore, a service user identification system and a record of staff responsible for administering medication, together with sample signatures had been established. At the time of the inspection none of the people using the service self-administered their medication. Medication was dispensed in a monitored dosage system by a local pharmacist and stored in a cabinet that was fitted to a wall in the office as previously noted. A sample of Medication Administration Records (MAR) were viewed during the visit and all accounted for medication administered. Advice was given regarding the use of codes for medication refused and to record the date that medication boxes were opened to ensure a clear audit trail. The Manager reported that all staff had completed accredited medication training since the last visit and certificates were viewed to verify this. Furthermore, training workbooks had been completed by staff to monitor and assess staff knowledge and understanding. Care Homes for Adults (18-65 years) Page 18 of 31 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. Systems had been developed to listen and respond to complaints and to safeguard and protect vulnerable people from abuse. Evidence: A Complaints procedure had been developed in a standard format, a copy of which was displayed in the dining room for service users to view. Since the last inspection the procedure had been updated to include the name, address and contact details of the Care Quality Commission. The manager reported that he was also planning to produce the complaints procedure in a pictorial format for the benefit of service users. The Annual Quality Assurance Assessment (AQAA) for the service detailed that no complaints had been received since the last visit. This was verified by examining the complaints record for the service and talking to service users. The Commission for Social Care Inspection had also received no complaints about 51, Wellington Road since the last inspection. Policies and procedures on abuse and whistle blowing had been developed by the service and a copy of the local authority safeguarding adults policy had been obtained for staff to reference as previously noted. Documentary evidence was available to confirm only three of the five staff had completed training in the protection of vulnerable adults however the manager and Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: staff on duty demonstrated a good understanding of how to recognise and respond to suspicion or evidence of abuse. Records detailed that there had been two safeguarding referrals since the last visit which concerned allegations made by one service user which were unfounded. Service users spoken with during the inspection reported that they had no complaints about any aspects of the service provided and confirmed they were happy living in 51, Wellington Road. Care Homes for Adults (18-65 years) Page 20 of 31 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 pleasant and generally well maintained providing the people using the service with a safe, clean and comfortable environment in which to live. Evidence: 51, Wellington Road is a large semi detached property situated in a residential area in the New Brighton area of Wallasey. The premises is in keeping with other properties in the area and there are no outward signs that it is a care home. The home is maintained by the manager and contractors are brought in as and when required for major or specialised work. The service is currently registered to provide accommodation for 8 people. The accommodation comprises a spacious front lounge and an office, lounge dining area and domestic style kitchen to the rear of the premises. Both the lounges on the ground floor have a television and there is also an additional lounge on the first floor, which is used by service users who wish to listen to music. On the day of this visit the home was clean, well maintained and appeared safe. The garden to the rear and front of the premises was tidy and the flower beds maintained. The furnishings in 51, Wellington Road were of good quality and domestic in character. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Service users that are not mobile could not be accommodated in the premises as all bedrooms are on the upper floors and the home does not have a passenger or chair lift to enable service users to access the floors easily. The accommodation is provided in both single and shared bedrooms. The shared bedrooms have a privacy screen to promote service users privacy. Each bedroom is personalised and decorated and furnished according to the individual tastes of the service user. Communal bathrooms and toilets are located on each floor near to service users bedrooms. All bedrooms are equipped with a call system, which is used by service users in an emergency. Since the last visit there have been some minor changes to the use of the property and the manager was advised to relocate a strobe to an area used by a service user that has a hearing impairment. The laundry facility is sited away from the food preparation area and the Annual Quality Assurance Assessment for the service confirmed that policies and procedures are in place to prevent infection and to manage infection control. A cleaner continued to work five days per week and assists the people using the service to maintain and clean their bedrooms. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training is in need of ongoing development and review to ensure best practice and to safeguard the welfare of the people using the service. Evidence: 51 Wellington Road had a team of 4 support staff and a registered manager. The staffing hours in the home were variable between the hours of 8.00 am to 10.00 pm in order to respond flexibly to the needs and routines of the people living in the home. Examination of rotas and discussion with staff and service users confirmed there was normally one or two staff on duty during the day and evening. During the night, one member of staff undertook sleep in duties. The manager reported that only one support worker had commenced employment at 51, Wellington Road since the last visit. The Annual Quality Assurance Assessment (AQAA) for the service did not detail whether a policy on recruitment had been developed but indicated that staff who had worked in the home in the past 12 months had completed satisfactory pre employment checks. The personnel file of the new employee was viewed during the visit and found to contain all the necessary records required under the care home regulations 2001. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Information found to be missing from staff files at the previous inspection had also been rectified. The AQAA for the service detailed that all four of the care staff had a National Vocational Qualification (NVQ) in Care at level 2 or above. At the time of the inspection certificates were available to verify only two of the staff had a NVQ in Care. One employee reported that she had completed the award and was waiting to receive a certificate and another was working towards the qualification. Since the last visit the assistant manager had also completed the NVQ level 4 Registered Managers Award. A training and development plan had not been developed for the home as previously noted. Examination of individual training records revealed that new staff had completed the Skills for Care Common Induction Standards. Progress had also been made in supporting staff to complete safe working practice training since the last visit although some gaps were noted and / or refresher training was required. For example all staff were in need of fire safety and infection control training. It is also recommended that all outstanding staff complete abuse, first aid and moving and handling training despite the people living in the home not presently requiring support in this area. Furthermore, the range of training provided should be expanded to include equality and diversity and other training relevant to the roles and responsibilities of staff. Staff spoken with during the visit demonstrated a good awareness of the value base of social care and the needs and support requirements of the people using the service. Care Homes for Adults (18-65 years) Page 24 of 31 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. Management and administration systems are subject to ongoing development and review to ensure the service is run in the best interest of the people using the service. Evidence: 51, Wellington Road is managed by Mr Darryl Milligan who is registered with the Care Quality Commission as the manager of the service. Previous inspection records confirm that the registered manager had completed a level 4 National Vocational Qualification (NVQ) Registered Managers award. The manager reported that he had also contacted an external training provider regarding commencing a level 4 NVQ programme in Health and or Social Care. Progress will be reviewed at the next inspection. The manager reported that he had completed training in the protection of vulnerable adults, managing autism and challenging behaviour and medication since the last visit - although this training had not been recorded on the managers training record and this should be addressed. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: The manager reported that the Registered Provider continued to visit the home on a regular basis in accordance with Regulation 26 of the Care Home Regulations, however only one report was available in the home for inspection on the day of the visit. Records showed that questionnaires were sent to the people using the service during July 2009 and copies had been retained for reference. The survey covered a range of areas including Food and Catering, Personal care and support, Daily living, Premises and Management. A summary report had been produced however an annual development plan had not been completed as previously recommended. Minutes were available to confirm that staff and service user meetings were coordinated on a monthly basis and staff and service users were able to access the manager and his staff team on a daily basis. Prior to the inspection, the manager completed an Annual Quality Assurance Assessment for the service which provides key data and numerical information on the service. All sections of the document were completed, however there were areas were more supporting evidence would have been useful to illustrate what the service does well, has done in the last year and how it is planning to improve. This issue was discussed in detail with the manager as similar findings were noted at the last inspection. The Annual Quality Assurance Assessment (AQAA) confirmed policies and procedures had been developed for Health and Safety. Likewise, the dataset confirmed that equipment in the home had been serviced and or tested periodically. Fire records were checked during the visit and provided evidence that the fire alarm system had been tested each week and the emergency lighting on a monthly basis. No records were in place to confirm the fire extinguishers had been visually inspected. Examination of service certificates confirmed the fire extinguishers, fire alarm system and emergency lighting had been inspected and maintained. Since the last inspection records had been established to confirm the temperature of each hot water outlet was checked and regulated to 43 degrees centigrade. On the day of the visit it was noted that the temperature in a communal bathroom was excessive and the manager was advised to risk assess the absence of thermostatic valves and to install them in communal bathrooms and areas considered to be high risk. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: A current public liability insurance certificate was displayed and a fire and general risk assessment was in place. It was noted that the risk assessments had not been dated and the manager was advised to review and date the assessments to ensure best practice. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 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 17 A record of the meals served to each service user should be maintained, to provide information on dietary intake and individual meal choices. The correct codes should be used on Medication Administration Records when service users refuse prescribed medication to ensure best practice. Boxes of medication should be dated when opened to provide a clear audit trail. All outstanding staff employed at 51 Wellington Road should complete training in the Protection of Vulnerable Adults to safeguard the welfare of the people using the service. The Strobe light should be relocated to the bedroom used by the service user with a hearing impairment to safeguard her health and safety. A training programme should be established for the service and all staff should periodically complete training and / or refresher training in safe working practice topics i.e. Fire awareness, First Aid, Infection Control, Moving and Handling and other relevant and specialised training, to Page 29 of 31 2 20 3 4 20 23 5 24 6 35 Care Homes for Adults (18-65 years) 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 develop staff knowledge, skills and understanding. 7 37 The manager should continue to undertake training in Safe Working Practice topics and complete a level 4 National Vocational Qualification in Care or equivalent, to ensure he has the necessary qualifications for his role. Copies of all monthly visits undertaken by the Registered Provider should be available at 51, Wellington Road for inspection, to confirm the visits have taken place in accordance with Regulation 26 of the Care Home Regulations. Risk assessments should be dated and kept under reviw to ensure health and safety. The fire extinguishers should be visually checked on a monthly basis and records maintained to ensure safe working practices. The absence of hot water thermostatic valves should be risk assessed and valves should be fitted in communal bathrooms and other areas of high risk to ensure the health and safety of the people using the service is protected. 8 39 9 10 42 42 11 42 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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