Inspection on 29/04/10 for Whitby Drive (8)

This is the latest available inspection report for this service, carried out on 29th April 2010.

CQC found this care home to be providing an Excellent 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

Whitby Drive (8) 25/07/06

Whitby Drive (8) 13/10/05

Whitby Drive (8) 18/05/05

Whitby Drive (8) 07/12/04

Whitby Drive (8) 01/06/04

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22 Sandown Road

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Dilston College Of Further Education

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Blenheim House

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Park View (15)

Craigmore House

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Whitby Drive (8) Whitby Drive (8) Biddick Washington NE38 7NW     The quality rating for this care home is:   three star excellent 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: Elsie Allnutt     Date: 2 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 29 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 29 Information about the care home Name of care home: Address: Whitby Drive (8) Whitby Drive (8) Biddick Washington NE38 7NW 01914172448 P/F01914172448 c.i.c@whitbydrive.uk www.c-i-c.co.uk Community Integrated Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Tammy May Thompson Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 5 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, maximum number of places: 5 Physical disability - Code PD, maximum number of places: 3 Date of last inspection Brief description of the care home 8 Whitby Drive is a home that provides a service for 5 people with learning disabilities all of whom have high dependency levels. The home is situated in a cul-de-sac of detached houses and bungalows. It is close to a school, pub and local shops and is close to local transport that provides access to Sunderland and Newcastle City centres. The building is a bungalow with a large Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 5 3 Brief description of the care home conservatory at the back that accommodates a ball pool. There is an overhead tracking system and several other mobility appliances, which meet the needs of the service users. Each person living at the house has a single bedroom with the facility to lock the door for added privacy. There are also shared facilities that include a large lounge/ dining area, conservatory, kitchen, utility room, bathroom and toilets. Attractive well-kept gardens are accessed via, a ramped decking area through French windows from the conservatory and a ramped access via the side of the building. The home has developed a Service User Guide that informs prospective service users about the service, the aims and how these are met and a copy of the recent inspection report is available in the home for anyone to read. The fees charged by the home are 1,024:57p per week. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out 29th April 2010 and was a scheduled key inspection. The inspection included a separate look at the Annual Quality Assurance Assessment (AQQA) completed by the registered manager prior to the inspection when we also looked at; Information we received since the last visit. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. Care Homes for Adults (18-65 years) Page 6 of 29 The views of people who use the service, staff and other professionals. During the visit we; Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the manager what we found. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? Staff records are kept in an orderly way and improvements have been made to the way recruitment application forms are monitored. Gaps evident in the job history section are now followed up and reasons for any gaps in employment are noted. This means that a persons job history is now transparent and the home know prior to a person starting work that they have a clear job history and that they are suitable and fit to work with service users. The bathroom has now been completely refurbished replacing the floor and all bathroom appliances. This area is now kept clean and therefore protects service users from any possible risk of the spread of infection. Care Homes for Adults (18-65 years) Page 8 of 29 Service users where appropriate, have been assessed for the use of bedrails. These are integral to their beds and risk strategy plans and monitoring records are in place and kept as part of their care plan. This means that every effort is being made to protect service users from any risks connected to the use of bedrails. All service users have had their care and social needs reviewed and reassessed and as a result appropriate additional resources have been accessed and put in place. This means that service users now receive the appropriate amount of support needed to support them to live the life of their choice. A safe exit has been constructed from the conservatory into the garden so that service users can access the garden independently. Risk assessments and risk strategy plans are in place to guide staff to monitor and support service users where needed, so that any identified risks are minimised. Staffing resources have been reviewed and addressed so that service users have the amount of support their needs dictate. This means that there is enough staff on duty each day to effectively support service users. Time has been allocated to the manager so that she has time away from supporting service users to address her managerial role. This allows her to manage the home in the best interests of the service users. 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 29 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 29 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. A comprehensive assessment process is in place that confirms the home can meet service users needs and service users are made aware of the homes terms and conditions. Evidence: This service has a good assessment process in place and competent work takes place with other agencies to ensure that the needs of service users are effectively addressed. The home uses the assessment process as an ongoing tool and currently it has been instrumental in accessing resources needed to support service users changing needs. Clear assessments are also received from the contracting agency and other agencies involved in a persons care and these are stored in well ordered care files and used as a base from which care plans are developed. Prospective service users are only offered a service by the home when the full assessment process has taken place, which includes visits to the home by the person and when the home is confident that they are able to meet their needs. Contracts that explain the terms and conditions of the service are also kept in Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: individual service users care files, so that they can be referred to if needed. The contract includes the homes terms and conditions and an explanation of how the fees charged by the home are to be paid, clearly identifying the individuals responsibility. Care Homes for Adults (18-65 years) Page 12 of 29 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. Care plans, that are the outcome of ongoing assessment, guide staff to appropriately support service users care needs, promote their independence by safely addressing risks and enable staff to support service users to make choices about their lives. Evidence: An effective care planning system that is based on service users assessed needs and that is service user led, is in place. The care plans are written is such a way that empowers service users to guide staff to support them in their preferred way when meeting their assessed personal, healthcare and social care needs. Although service users living at this home have diverse complex needs, it is acknowledged that through effective and varied ways of establishing non verbal communication, a way has been found to confirm individual preferences and furthermore to empower service users and to promote their independence effectively. So that service users can have access, as far as possible, to their care plans, pictures are used to illustrate the written word. Service users are projected in a very positive Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: way and this is clearly illustrated in the way the file All about me is recorded. This is where individuals likes, dislikes, interests, daily routines and aspirations are recorded. Service users independence is promoted safely and so staff have guidance to follow, risk assessments and risk managment plans are in place. Both the care plans and risk strategy plans are reviewed and updated as part of a comprehensive monitoring system. A key worker system is in place and such monitoring, reviewing and recording is a part of the key worker responsibilities. Care Homes for Adults (18-65 years) Page 14 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to live appropriate and fulfilling lifestyles both in their own home and the local community, while at the same time they are supported to maintain relationships with family and friends. Furthermore meals are healthy, nutritious and attractive, and are prepared to meet service users individual dietary needs. Evidence: As part of the person centred planning process service users are supported to develop individual activity programmes and as a result individual daily activity planners give service users a structure to their day. However these are used flexibly and so that service users have the support needed regarding individual activities, the staff rota is organised to suit. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: By trying different experiences and finding new opportunities has resulted in service users developing new and positive relationships. This has proved to make a marked difference to the social and cultural lives of the people living at Whitby Drive. Service users now take part in a variety of activities including biking, swimming, bowling and attending the cinema and theatre and as a result this has had a positive effect on the development of the individual. Service users were joined for a midday meal which was nutritious and attractively served. During the meal service users, some with the assitance of staff, discussed a recent holiday and different places they liked to visit. Service users were sensitively assisted to eat and drink to reflect the guidance in their care plan, while at the same time they were made to feel a valued member of the group. Care Homes for Adults (18-65 years) Page 16 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users personal and healthcare needs are met in a flexible but consistent manner, reflecting a healthy lifestyle. The medication arrangements in place are appropriate to the needs of service users. Evidence: There are good arrangements in place to support service users to register and attend community based healthcare appointments and good relationships between the home, service users and healthcare practioners have developed. Clear records are in place to record the appointment date, the need and the outcome of appointments and visits. Currently service users continue to enjoy good healthy lifestyles that reflect their good health and individuality. All service users healthcare needs are recorded and monitored in Healthcare Action Plans that are written with a person centred approach. This not only empowers the service user but also promotes their dignity and self worth. The manager and staff have worked hard to establish and record how individual service users prefer to be supported and assisted and this has been successful by confirming and recording the diverse ways service users communicate. A section of the care plan records individual communication methods and clear descriptions of how Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: facial expressions, body language and behaviour relates to a persons wishes and preferences are recorded. A healthcare student recently working at the home had, as part of the reflection of their placement, described how they were impressed with the amount of information recorded describing individiual service users communication needs. They also commented that how from this they had learned so much about non verbal communication. A small file entitled My Health Action Plan, that is easily transportable, has been developed. This records information related to individual service users healthcare needs, ways of communicating, moving and handling and preferences so that if the person is to be admitted to hospital or is attending a hospital appointment, the healthcare professionals who may not know the person well, have important information about the person to work from. When supporting service users to attend medical appointments, staff are encouraged to support the rights of service users and to act as their advocate, ensuring that the best possible care and treatment is received. Healthcare professionals have recently commended the home for the support given to one service user when a medical condition was established as a result of the homes consistent persistance for further tests to be carried out. As a result the person has now been given a diagnosis and relevant medication has been prescribed, to reduce the impact that the condition could have. This promotes the persons general well being, comfort and safety. The person is now experiencing an improved lifestyle with reduced challenging behaviour. The home is commended for this action and result. Staff work directly with healthcare professionals and take advice when needed to improve the care of the people they support. When advice is given, for example related to dealing with challenging behaviour, it is used as guidelines in individual care plans and as a tool to guide staff to approach and deal with behaviours demonstrated by individual service users. Special appliances are available for service users who need them and an occupational therapist carries out assessments in relation to their need. Recently one of the bathrooms in the home has been refurbished and now offers an overhead hoist that enables service users to receive support with their bathing needs in an enviroment that promotes their independence, dignity and privacy. Risk assessments are in place and these inlcude for the use of bedrails. The bedrails Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: used are integral to the beds and their need has been assessed by an occupational therapist. To ensure the safety of their use, detailed risk assessments and risk management plans are in place that are reviewed 6 monthly. A new medication system is in place that has addressed and reduced the risk of mistakes being made. Each service user has a support plan in place regarding the administration of medication with the support of risk management plans. A new pharmacist now supplies the medication to the home and also provides ongoing training regarding its administration. A mobile medication trolley has been supplied by the pharmacist, however after discussion surrounding institutional type practices, it has been decided not to move the cabinet out of the office when administrating medication. Medication records are fully completed and all staff receive appropriate training regarding the safe administration of medication. The manager monitors the procedures to be followed to ensure they are being complied with. Care Homes for Adults (18-65 years) Page 19 of 29 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. Arrangements are in place that helps to protect service users from abuse and to seriously address complaints and concerns about the service. Evidence: The home has a comprehensive complaints procedure that has been developed into picture format in an attempt to make it more accessible to the service users. Although all of the people who live in this home have either no or little verbal communication, as a result of having good records in place all staff are aware of signs given by service users when they are not happy or are showing concern about something. Such occasions are recorded in individual care files and acted upon. Staff receive ongoing training regarding the principles of safeguarding and all have attended training regarding the local authoritys safeguarding procedures. The procedures, a copy of which is kept in the home, are also regularly discussed in staff meetings and supervision sessions. During their induction period staff are made aware of the GSCC Codes of Practice, so that they know the principles that they are expected to work to. If staff do not follow these priniciples their performance is monitored and the homes disciplinary procedures are followed if needed. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The manager has attended training regarding the Mental Capacity Act and the Deprivation of Liberty and with representatives from the safeguarding team has carried out assessments, using the Kingsley deprivation of liberty assessment tool, for all service users. The home keeps clear records of service users financial affairs. These are appropriately kept, up to date and show clearly how service users monies are spent. Each service user has a bank account for the deposit and withdrawal of personal money. All staff receive training regarding challenging behaviour and guidelines are in place regarding how individual service users challenging behaviours are to be addressed. Care Homes for Adults (18-65 years) Page 21 of 29 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 homely, comfortable, clean and decorated and furnished to a good standard. It provides service users with spacious, private and communal spaces that are safe in which to live. Evidence: The standard of the furnishings and fittings in this home are good, presenting an attractive and comfortable environment for service users to live and the wood flooring that is in many areas of the home, make it easy to manoevre wheelchairs. The home communal areas and three of the bedrooms have been redecorated and one of the bathrooms has been completely refurbished. A gradual ramp in the form of decking has been made at the exit of the conservatory and this now enables everyone to access the garden safely. The gardens are neatly kept and flower pots surround the house. Care Homes for Adults (18-65 years) Page 22 of 29 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. Robust recruitment and selection procedures, regular training opportunities and supervision ensures that service users are appropriately supported and protected by a competent and qualified staff team. Evidence: Staff work with service users in a sensitive and competent way, showing respect and promoting individuals dignity. Signed declarations show that at the induction stage staff are issued with a copy of the GSCC Codes of Practice and their practice reflects their awareness of the principles set out. An adequate number of staff are available on each shift to address the needs of the service users. When service users needs have increased or changed the home has reviewed their staffing resources and when necessary has applied for extra funding to access more staffing hours. For one person this meant that their increased needs are effectively and safely supported and their rights to remain in their own home are recognised. This achievement was due to the ongoing persistance of the manager and staff who worked closely with other agencies to reveal the persons original resettlement contract. This confirmed that if changing needs were identified the Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: person would stay in the home and resources would be increased to reflect the requirement of any changing needs. Staff are up to date with mandatory training and all staff are qualified in at least NVQ2. Care Homes for Adults (18-65 years) Page 24 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager, who works hard to develop an informed and supportive staff team, provides excellent leadership and runs a service that has effective monitoring systems that are focused on the best interests of the service users. Evidence: The manager is now registered with the Care Quality Commission and has achieved the Registered Managers Award (RMA) and NVQ 4 in Care. With a consistent and open approach she has developed a staff team that is empowered to take responsibility and carry out their roles competently. The manager continues to be passionate about her job and works hard with staff to establish the homes policies and to ensure that they are carried out following set procedures, so that the best outcomes for service users are achieved. She is up to date with mandatory training and attends training relevant to her role. The manager keeps up to date with changes in legislation, new ideas and policies regarding supporting people with learning disabilities via the website and discussions Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: with the provider and this information is cascaded to staff at staff meetings. The manager interacts with service users and staff positively and in a supportive way. Staff feel well supported and that they can go to the manager for guidance and advice when needed. The policies and procedures are regularly reviewed and brought up to date when necessary. They are discussed in staff meetings and in individual supervision sessions where staffs understanding can be confirmed. There is a good quality assurance system in place, the outcomes of which are recorded. The system is monitored internally monthly by the manager and annually by an external person. An up to date insurance certificate is displayed and risks indentified throughout the home are recorded, monitored and addressed well. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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