Inspection on 12/05/09 for 4 - 6 Cavendish Road

This inspection was carried out on 12th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 - 6 Cavendish Road 29/04/08

4 - 6 Cavendish Road 24/05/07

4 - 6 Cavendish Road 28/04/06

4 - 6 Cavendish Road 09/01/06

4 - 6 Cavendish Road 11/10/05

4 - 6 Cavendish Road 10/03/05

4 - 6 Cavendish Road 22/11/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 4 - 6 Cavendish Road 4 - 6 Cavendish Road Felixstowe Suffolk IP11 2AX     The quality rating for this care home is:   zero star poor 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: Deborah Kerr     Date: 1 3 0 5 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 40 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 40 Information about the care home Name of care home: Address: 4 - 6 Cavendish Road 4 - 6 Cavendish Road Felixstowe Suffolk IP11 2AX 01394286990 01394284878 cavendishroad@together-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Together: Working for Wellbeing care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users must be under 65 years of age at the time of admittance to the home. Date of last inspection Brief description of the care home The home is situated in a residential area of Felixstowe within easy reach of the beach and local amenities, such as shops. The home is in two linked adapted domestic houses, providing accommodation on three floors. Cavendish Road has a small back garden, which is accessible to residents and is attractively designed. The home is registered for thirteen residents with mental disorder. Residents are aged below 65 years of age at the time of admission, but may remain at the home over 65 years of age, so long as the home is still able to meet the residents physical and mental health needs. The home is owned by Together, working for well-being. The Registered Manager post is vacant. 13 Over 65 13 Care Homes for Adults (18-65 years) Page 4 of 40 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which focused on the core standards relating to adults aged 18-65. The inspection was unannounced over two days, which lasted fourteen hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained in the Annual Quality Assurance Assessment (AQAA) issued by the Care Quality Commission (CQC). This document gives the provider the opportunity to inform CQC about their service and how well they are performing. We, CQC also assessed the outcomes for the people living in the home against the Key Lines Of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. We also spoke to two staff and three people living in the home. The manager and deputy manager were present during the inspection and fully contributed to the inspection process. Care Homes for Adults (18-65 years) Page 5 of 40 What the care home does well: What has improved since the last inspection? What they could do better: Staff working in the home do not provide personal care, therefore people who require support to help them manage their personal hygiene are not receiving the support they need to promote their self esteem and dignity. Peoples health needs are being monitored, however appropriate action is not always taken at early signs and symptoms to ensure the wellbeing of the person. Discussion with staff and training records showed that staff responsible for administering medication have not received formal accredited training for administering medication, so that they have knowledge of how medicines are used and how to recognise and deal with problems. There was insufficient information available at the inspection to reflect staff have received other sufficient or recent training to enable them to work safely and to ensure they are able to meet peoples needs, in particular those whose mental health can some times involve behaviour that can be challenging. Care Homes for Adults (18-65 years) Page 6 of 40 Although the managers and staff demonstrated a good understanding of abuse and protection of vulnerable adults, issues that arise, affecting the welfare and safety of people living in the home, need to be recognised and reported to the appropriate people and safeguarding teams at an earlier stage to ensure they are protected, from abuse or the risk of abuse. There had been improvement made to ensure the appropriate documents had been obtained when recruiting staff, however the references for the deputy manager were unavailable for inspection. There needs to be a review of staffing levels against the assessed needs of the people residing in the home to ensure there is sufficient staff available to meet peoples specific needs. There is insufficient monitoring from the oprgansiation and the management team to ensure the welfare of people using the service, which is being jepardised through a lack of ongoing maintenance, poor hygiene and management of heath and safety. There remains no on going maintenance programme and work is carried out as issues arise. Of particular concern was the lack of progress made to repair and decorate a bathroom and toilet which was to be given high priority following the inspection in April 2008, this work has yet to be completed. Domestic cleaning arrangements are not satisfactory, the home employs a cleaner for two hours a day, care staff and people living in the home are required to do the cleaning at other times. There are strong odours in certain parts of the home, in particular on the first and second floors. The flooring in bathrooms and toilets on both floors are stained and had puddles of urine on the floor, which had not been cleaned after use. The manager was left an immediate requirement to address concerns that people living in the home are at risk of sustaining burns and scolds from exposed hot radiator surfaces and hot water temperatures, which were found to be in excess of safe recommended temperatures. The manager has provided us with information of the actions they have taken to minimise these risks and have advised us that where risk assessments indicate an individual is at risk, thermostatic valves will be fitted to taps and radiator covers provided. During a tour of the home, it was noted that the intumescent strip on one internal door was missing. Additionally, none of the bedroom doors have intumescent strips or self door closures fitted and would not automatically close behind an individual in event of an emergency exit. The fire service has visited the home since our inspection, apart from replacing the missing intumescent strips and fitting self closing devices on bedroom doors, they have informed us, they are satisfied with the fire safety arrangements in the home. Records required for inspection, including outcomes of the homes most recent quality assurance and certificates to ensure the home are complying with relevant health and safety legislation, for example, gas safety certificate, electrical certificate and record of Portable Appliance Testing (PAT) were unavailable therefore we, were unable to ensure these records are current and up to date. Additionally, the AQAA reflects there has been two complaints made about the service in the last twelve months, both upheld, however the complaints log could not be located and therefore there was no information available to examine if these had been dealt with, in line with the homes Care Homes for Adults (18-65 years) Page 7 of 40 complaints procedures and if the complainants were satisfied with the outcome. 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 8 of 40 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 9 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using or proposing to use this service are provided with information in a suitable format to help them decide where to live and are given the opportunity to try out the service on an introductory basis before making a decision to move there. Evidence: A copy of the statement of purpose and service users guide were provided at the inspection. Both documents need to be amended to reflect the change in The Commissions details from the Commission for Social Care Inspection (CSCI) to Care Quality Commission (CQC) and that we no longer carry out two inspections of a service annually. Inspections are carried out based on a risk assessment and the current rating of the service. The statement of purpose and service users guide have been updated to provide the required information to inform people using or proposing to move into the home, about the services provided. Although, currently registered as a care home staff do not provide personal care, the statement of purpose clearly states that the home do not provide nursing care, but does not stipulate non provision of personal care. The Care Homes for Adults (18-65 years) Page 10 of 40 Evidence: service users guide is provided in different formats, including where required, interpreted into different languages to meet the needs of the people living in the home. People spoken with confirmed they had been issued with a copy of the service user guide. The AQAA states the service involves other agencies to ensure optimum understanding of peoples needs. They have close links with the Community Mental Health Team (CMHT). Two co-ordinators from CMHT were visiting clients during the inspection and provided feedback about the service. Both co-ordinators stated that their clients have very complex mental health needs and felt staff struggle to meet them. (These issues are further explored in the staffing section of this report). The coordinators reflected staff would benefit from further training and commented on the positive outcomes, for one of their clients following recent training provided by CMHT, Learning Disability colleagues, which has helped to increase staff understanding on aspergers. One of the co-ordinators discussed the placement of a client who now requires a lot more physical support to manage their personal hygiene. Although Cavendish Road is registered as a care home, the staff do not provide this support. The individuals hygiene is becoming an increasing concern. This was observed during the inspection when talking with the individual and observation of their room, which was particularly odorous. The care co-ordinator is looking for an alternative placement, which will better meet the individuals needs. Three peoples files were inspected as part of the inspection process. These confirmed admissions to the home are made through the care management assessment process. Each individual had a copy of the CMHT, care programme Approach (CPA) and an agreed care plan, identifying their needs. Files also contained a license agreement setting out the terms and conditions of residence between the individual and the organisation. These were signed and dated by the individual and the manager of the service. Each person had a Standard Care Contract and a Local Authority Individual Placement Contract (IPC), which reflected the fees payable and the amount the individual is expected to contribute. A previous requirement was made to ensure the service can respond appropriately to requests for emergency placements, where a full assessment is not available, and demonstrate that it can reasonably expect to meet the prospective residents needs. The manager explained this is not usual policy, however they have written a policy outlining the procedures for staff to follow if an emergency admission arises in the future, the statement of purpose however, still reflects the home does not take emergency admissions. Care Homes for Adults (18-65 years) Page 11 of 40 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 using this service know they will have their needs and personal goals reflected in their individual care plans and will be supported to take risks as part of an independent lifestyle. Evidence: Three peoples care pathways and care plans were tracked as part of the inspection process. The care plans are generated from the Care Programme Approach (CPA) completed by CMHT. These are being reviewed on a six monthly basis involving the care co-ordinator from CMHT, the individual and the home to ensure the programme is working for the client, staff and other people, who support the individual. One of the care plans had been developed using a person centered format, which was easy to read and looked at all areas of the individuals life from their perspective. The AQAA states interpreters are used where individuals using the service think this would be appropriate. This was confirmed in one service users care plan who has had the involvement of an interpreter to ensure they understand the content of their plan and associated risk and financial assessments. Each care plan had a photograph in place of Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: the individual to identify and personalise the care plan document. The plans are well laid out and divided into nine sections. These set out the aims and objectives agreed for each individual to achieve optimum levels in all aspects of their physical and mental health and to ensure continuity of staff support to maintain their plan and to maximise their independence. A requirement made at the previous inspection in April 2008 was for a risk assessment to be completed in respect of the behaviour of a resident, who had previously exhibited behaviour, which had potentially serious consequences. This assessment has been completed and identifies signs for staff to know if this behaviour could reoccur and what action they should take. Additionally, care plans contained a range of risk assessments which covered all areas of peoples daily living, mobility, self catering, outings, using cleaning materials, continence, road safety, smoking and self medication. These are very detailed assessments which identify the risk, the likelihood of these occurring and the action staff and the individual need to take to minimise the risk. Support plans are in place to help people whose behaviours can be challenging to others. These plans outline the behaviours and the techniques for staff to use to diffuse the individuals behaviour and to distract them from situations. These provide good strategies to support the individual to manage their behaviour and to maintain their well being. However, the majority of the assessments identified that one to one staff support is required to achieve this, the current staffing ratio does not always permit this to happen. Information provided in the AQAA and verified at the inspection confirmed people using the service are supported and encouraged to take part in the daily running of the home. People were observed, menu planning, shopping, making their own tea, coffee and snacks as well as cooking their main meal of the day, washing up and putting away the dishes. People were observed freely moving about the home completing these tasks and choosing what they wanted to do. The AQAA states each person in the home has time with their key worker to discuss various topics, promote choice and support them in their decisions to achieve their goals and to ensure they know their rights and responsibilities. Detailed notes of key work sessions were seen in the three care plans examined, confirming these are taking place monthly or weekly depending on the individual and provided a very detail account of the meeting and the areas discussed, including their physical and mental well being, updates on diet, medication, social interaction, daily living skills and personal. Care Homes for Adults (18-65 years) Page 13 of 40 Evidence: Nine of the people living in the home manage their own budgets including payment of their rent, the remaining four people require support. To help them manage their money financial support plans have been implemented and agreed by the individual. Staff do not have access to residents bank accounts, some have cards but staff do not have access to pin numbers, there only input is to support people to access their accounts, to with draw money and to rationalise with the bank with regards to financial issues. Audit checks are completed daily by a senior from each shift at hand over to ensure cash held balances with recording sheets. Two staff signatures are required to confirm these are correct. All four peoples money was checked and found to be accurate The AQQA states people living in the home have the opportunity to attend residents weekly meetings which are facilitated by staff. This is an opportunity for residents to discuss general issues, the minutes of these meetings are then read and actions taken where appropriate. Staff use this forum to give relevant information to residents. This was confirmed in discussion with people using the service, one individual said they had been involved in a Service User Forum meetings held at the organisations Head Office in London to discuss how de registration of the service will affect the people using the service. Care Homes for Adults (18-65 years) Page 14 of 40 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. People using this service told us they are supported in the way they want to be and have the freedom to choose a lifestyle, which meets their needs. Evidence: People were seen to come and go from the house as they chose and move freely around the home, using different parts of it, including the paved garden area, the sitting rooms and the dining room, affording them lots of options as to where their spent time. The AQQA states people using the service are encouraged to be as independent as possible and given lots of opportunities to try something new and different. This was supported by written comments provided to us, CQC during the inspection, from a service user about my life here at The Haven. They told us, life here at the home is OK, there is a lot of things to do and I like living here a lot and I take part in Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: household chores and during the day I am supported by the staff and others to help me make sense of my every day living. They also told us, staff support me to improve my life skills, and I have access to adult college courses to study computers. Peoples care plans reflect they are able to access social activities of their choice within the local community, including clubs, pubs and shops. The first week in March residents took part in a well being week, which included day trips out to places of interest, every day of the week. These included Alton water, a farm and Christchurch Park. One person living in the home showed us some examples of some artwork and photographs they had exhibited in Felixstowe library, during the well being week. They also told us, they had recently been to the Spa Pavilion to watch a ballet, Swan Lake. A structured activities plan had been developed for one individual, which included regular access to Gateway club, and to encourage physical fitness a walking and badminton programme. Entries seen in the office diary confirmed the individual attends badminton sessions on a weekly basis. Additionally, their plan encourages greater social interaction, such as going to the cinema and theater. Correspondence seen in another individuals care plan reflects people are supported to develop their education and develop new skills. A letter from the adult and community services confirmed their acceptance for creative skills and crafts and introduction to floristry courses. Discussion with a person residing in the home told us, I have lived in the home for about four years and feel that during this time I have made significant improvement and I am now looking to move into my own flat, they also told us, I have every confidence in the staff who have helped and encouraged me and I am now desperately wanting my own independence, as I find communal living difficult, as other peoples behaviour is disruptive and I try to avoid people I do not get on with. They confirmed that they have no restrictions in place and have been able to manage their own behaviour and have been supported and encouraged to undertake daily living tasks and stated, living in the home is like living in supported living already, I am able to cook and prepare my own meals, I have my own fridge and tea and coffee making facilities in my own room. Six of the people living in the home are self or part self catering, the remaining seven people require their meals to be prepared by a member of staff. Those who are self catering have been allocated an individual cupboard for their provisions, as had part of a fridge. Although the kitchen has been equipped with two cookers, there is limited space in the kitchen for staff and self catering residents to prepare their meals all at the same time. Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: At the last inspection one of the fridges was found to have high temperatures. The homes records reflect the fridge continues to run in excess of the safe recommended temperature of 4 degrees centigrade. The inspector was informed this is due to the number of people accessing the fridge, which is in constant use. Records reflected the fridge temperature is being checked twice daily. Additionally, records seen and discussion with staff confirmed the fridge is being sanitised daily, as well as checking the contents of the fridge for freshness and to ensure food has not passed its expiry date. Residents spoken with confirmed they planned the menu together, with input from the carers on healthy eating, and are assisted with food shopping and preparation. Additionally, the home respects the cultural needs of individuals in the home and has arranged access to Cantonese cultural activities, food, clubs and shows. Care Homes for Adults (18-65 years) Page 17 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are not always receiving the personal support they need and can not be sure that their physical health needs will be met at an early stage to prevent further ill being. Evidence: Three peoples care pathways and care plans were tracked as part of the inspection. Information in the care plans confirmed people using the service are supported to access health care services. Dates and outcomes of visits to health professionals were clearly documented. Records show peoples health care treatment and the interventions taken to manage their physical and mental health needs. Their health needs are being monitored however, appropriate action is not always taken at early signs and symptoms. A recent issue with an individuals high lithium levels was not responded to immediately as staff were not familiar with the symptoms and thought the individual to be generally unwell. Following contact with the GP and care coordinator an appointment has been made for a full medical review. No plan, despite being provided with a link to website for information from the care co-ordinator from CMHT has been developed following this episode to provide information to staff, should this happen again and the actions they should take. Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: The activities of daily living included in an individuals CPA plan, last reviewed in February 2009, covers their diet, which states this needs to be monitored to ensure they are provided with a high fibre diet, and to ensure they have a good fluid intake. A weekly menu plan, of a suggested diet, including foods to have and those to avoid, is in place. Their weight record showed a gain of 7lbs in 4 months between October 2008 and January 2009. However, there were no further entries on their individual weight chart following a review of their care plan in February 2009, to reflect how their weight was being monitored. The same individual was observed informing a member of staff they were unable to see when they woke in the morning. Neither of these issues appeared to be being monitored in accordance with the individuals care plan, which sates that early warning signs of a decline in their health and well being and behaviour is that they may experience a return to psychotic symptoms, experience auditory and visual hallucinations and will eat more food as a source of comfort. The majority of the people living in the home are able to manage their own personal care, however as previously mentioned in the individual needs section of this report, staff do not provide personal care, therefore people who require support to help them manage their personal hygiene are not receiving the support they need to promote their self esteem and dignity. An individual spoken with, who is able to meet their own personal care needs was more positive about the support they receive, they told us, I feel that my problems are being managed, with the correct medication and staff support, without this support I could be very bad indeed. I hope to remain healthy and active and to continue to improve my lifestyle, staff are supporting me to manage my weight through a strict diet. The practice of administering medication is being generally well managed. The home uses the Monitored Dosage System (MDS). The Medication Administration Records (MAR) charts inspected were found to be completed correctly. Two requirements were made at the previous inspection with regards to the management and recording of medication. The first requirement stated changes must not be made to MAR sheets unless these are signed and supported by a record, preferably by the General Practitioner (GP)to ensure people using the service are protected from being given incorrect medication. The second requirement was made for medication not taken or refused, an appropriate code must be entered in the MAR record, so that it is clear of why it has not been taken, to avoid errors occurring. MAR charts examined confirmed where changes are being made to peoples medication the home have acquired a copy of a letter from the GP making the alterations, which has been signed and dated, with the correct dosage and instructions. Also staff recording has improved, codes are now being used to reflect when medication is not taken, also reflects the number of PRN Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: (as and when required) medication and reflects if medication is taken at later than prescribed times, due to other activities. Discussion with the deputy manager confirmed that in house medication training is provided to staff, which covers administration of medication, recording on MAR charts and possible side effects. There were no training records available to confirm if staff had been provided with training. A member of staff confirmed they had not yet received training, but was observed administering peoples medication during the inspection. Care Homes for Adults (18-65 years) Page 20 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has policies and procedures in place for people to express their concerns and to be protected from abuse, however there are no records available to ensure complaints are dealt with appropriately and incidents of abuse are not always acted on at an early stage to ensure people are protected from abuse. Evidence: Two requirements were made at the previous inspection for the manager to familiarise them self with local procedures for safeguarding adults and to ensure a Protection of Vulnerable Adults (POVA) First check was undertaken and a Criminal Record Bureau (CRB) applied for in respect of the deputy manager. This was to ensure that the provider has knowledge of any relevant offences that may apply and residents can be properly protected. The policies and procedures for dealing with complaints, whistle blowing and safeguarding the people living in the home were examined. These will need to be amended to reflect the change in details of the Care Quality Commission (CQC). The manager had obtained a copy of the local authority safeguarding adults organisational policy and procedure and was advised these have recently been updated and will need to be reflected in their own policies and procedures. The AQAA reflects two complaints have been received in the last twelve months which were both upheld, however there was no information available to examine if these had been dealt with in line with the homes complaints procedures and if the complainants were satisfied with the Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: outcome. The complaints log was requested for inspection, however the deputy manager was unable to locate this, and stated that they were not aware of any complaints made about the service. On arrival for the second day of inspection the registered manager was in the process of making an adult safeguarding referral to the local authority, customer first team. An incident had occurred in the home between two residents which required a safeguarding referral to be made. An individual living in the home X had used threatening behaviour and verbal aggression towards another resident Y. The incident records reflect there has been a continuing pattern of threatening and bulling towards Y, by service user X, however this had escalated today into physical contact. Additionally, an individual with a tight spending plan in place, as part of the strategy to help manage their behaviour, has been sourcing money from other people living in the home. This was discussed with the manager who was advised this issue also needs to be a safeguarding referral with regards to the individual potentially financially abusing their fellow service users. Staff files seen confirmed all staff are subject to CRB and POVA checks, prior to commencing employment. However, one staff members CRB showed a previous conviction, although this occurred 34 years ago, no risk assessment had been undertaken to assess if they pose a risk to people currently living in home. Staff spoken with could not remember attending Safeguarding of Vulnerable Adults (SOVA) training. However they were clear about what constituted as abuse and their role and duty of care to raise any concerns they may have about other members of staff conduct and in reporting of incidents of poor practice and suspected situations of abuse. Care Homes for Adults (18-65 years) Page 22 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are being disadvantaged and may not be safe, due to the lack of ongoing maintenance, attention to health and safety and cleanliness of the home. Evidence: The Haven, 4 - 6 Cavendish Road is situated in a residential area of Felixstowe, within easy reach of the beach and local amenities. Two domestic houses have been merged to provide accommodation for up to thirteen people over three floors. The home has a small back garden, with wooden seating and chairs, which is accessible to residents and is attractively designed. A requirement was made at the previous inspection in April 2008 for the registered person to ensure the home is maintained to a good state of decorative order. A tour of the home reflects there has been little improvement made since the last inspection. Previously the deputy manager advised that they were highlighting priorities as they went along, and that they did not have a schedule for decorating required. There remains no on going maintenance programme and work is carried out as issues arise. A team of supervised workers from probation service have completed some redecorating and painting in the home, since the last inspection, including the halls, landings, stairways and ceilings, however these are already looking scuffed and Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: chipped in places. Of particular concern was the lack of progress made to repair and decorate a bathroom and toilet, which was to be given high priority following the inspection in April 2008. The inspector was advised that quotes have been obtained to refurbish the bathroom and improve the toilet, however this work has yet to be completed. The toilet in house 6 in the basement, near the laundry, requires new flooring. There has been a leak under the floor, which needs repair, additionally there were concerns about the toilet being raised up and presenting a tripping hazard. This has now been locked and taken out of action. Additionally, a bathroom on a middle floor in house 4 was out of use. The only work carried to refurbish the bathroom has been the re plastering of the ceiling, which was completed by one of the people from the probation service. At the time of the inspection the home had full occupancy of thirteen people, therefore the bathroom and toilet need to be reinstated as soon as possible to ensure there are sufficient facilities for people using the service. Communal rooms are spacious and furnished with modern equipment and comfortable domestic style furniture, carpets and curtains. However, the carpets in the lounge, hallway and in bedroom 11 are dirty and heavily stained. The previous report in April 2008 and information in the AQAA dated March 2008, reflects that carpets in the home (not specific areas) were to be replaced, this has not happened. A number of bedrooms were viewed whilst looking around the home, rooms contained appropriate furniture and fittings, as well as peoples own personal effects. Although bedrooms are suitable for the people occupying them, some were very untidy. The inspector was advised this was the residents choice and that they are encouraged monthly to tidy their room for health and safety reasons. Some people were observed to have their own fridge, tea and coffee making facilities in their rooms. Other rooms seen were decorated to reflect their individual personalities, hobbies and interests, with photographs and ornaments. It was noted that Room 1 had a large crack in wall by door and room 3 the door threshold was loose preventing the door from closing properly. The Fire Officer had visited on 20th February 2007 and had required the replacement of intumescent strips, where these had been painted over. A tour of the home reflected these strips have been replaced, however it was noted that the lower half of the intumescent strip was missing from the door leading from the first to second floor, which would affect the functionality of the door, in an emergency situation. Additionally, none of the bedroom doors have been fitted with automatic self door closures and intumescent strips. Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: The home has one toilet on the basement floor, two toilets, two shower rooms and two bathrooms on the first floor, one toilet, two shower rooms and two bathrooms on the first floor, one toilet, two shower rooms and two bathrooms on the second floor and one bathroom on the top floor, providing residents with choice of bathing facilities. As already mentioned the basement floor toilet facilities are currently out of use and are therefore not accessible from the communal areas, people need to access nearest toilets on first floor. Each toilet, bathroom and shower is provided with a hand washbasin, with the exception of one toilet in house 4. Hand wash gel and disposable hand drying towels are provided in all bathrooms and toilets. Water temperatures were randomly tested in bathroom and toilet facilities and vanity units in peoples bedrooms. These were found to be in excess of 55 degrees centigrade exceeding the safe recommend temperature of 41 degrees for showers and hand basins and 44 degrees for baths. Additionally, it was noted that none of the radiators throughout the home have protective covers in place, therefore people living in the home are at risk of sustaining burns and scolds from exposed hot surfaces on uncovered radiators and from the hot water outlets. Domestic cleaning arrangements are not satisfactory in the home, the home employs a cleaner for two hours per day, care staff and people living in the home are required to do the cleaning at other times. There is a strong smell of urine in certain parts of the home, in particular on the first and second floors. The flooring in bathrooms and toilets on both floors need replacing, these were stained and had puddles of urine on the floor, which had not been cleaned after use. Additionally, it was noted that a full urine bottle had been left on the floor in bedroom 11, the carpet is heavily stained with a very strong odour eliminating from the room. The bathroom on the top floor was nicely decorated and looked clean and tidy. People living in the home are expected to do their own laundry. Laundry facilities are available and people are allocated set days to do this on a rota basis. These were being kept clean and tidy with appropriate equipment to launder linen, clothing and bedding. A paint roller and paint tray and remains of some paint were seen in the laundry room and the bathroom in house four, the deputy manager was advised these could be a potential hazard to persons living in the home and should be stored correctly in line with Control of Substances Hazardous to Health (COSHH) recommendations. The kitchen is in a good state of repair, clean and tidy. A number of the people living in the home are self-catering, the remainder require their meals to be prepared by a member of staff. There is insufficient space in the kitchen for staff and self catering Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: residents to prepare their meals all at the same time. Care Homes for Adults (18-65 years) Page 26 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are not sufficiently trained, skilled or available in sufficient numbers to ensure people receive the individual support to meet their needs and to maintain a clean and healthy environment. Evidence: Staff employed in the home are referred to as social care workers, lead by senior social workers, a project and deputy project manager. Copies of the job descriptions relating to each of these roles were provided during the inspection, these clearly set out staffs roles. Staff spoken with were clear about their roles and responsibilities, which is to deliver a high support residential service, but not personal care. Information provided in the AQAA and verified at the inspection confirmed the home has a good team of dedicated staff who have a good attitude towards all residents and to promoting independence. This was demonstrated throughout the inspection and confirmed in discussion with staff. Staff felt they do provide people with choices to help them move towards independence, with a policy of do with but not for, however told us, staffing levels do not always allow them to do this. The duty roster reflected there is two staff on duty during the daytime hours. Shift times are from 8.30am to 4pm and 1.30 to 9pm or 1.30 to 10pm if sleeping in. The sleep in member of staff starts again at 7am to 1.30pm. The staffing ratio was discussed with staff who Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: confirmed there are two staff each shift, some days three, if there are appointments or special support, required for a particular resident. Usually, the third member of staff is an agency person. Staff confirmed, agency workers are regularly used and that they also have two relief workers to call on. Staff commented, there are not enough staff, there are 100 things to do and we do not have the time to provide the individual support to the residents, they did however comment, the manager does try hard to make it up to three per shift. Another staff member told us, staffing is not enough, some residents are not satisfied, as there is no time to spend with them and they feel neglected, they need more attention. Staff confirmed there is always someone on call, seniors take in turns, but they are vary rarely used. However, they did use on call recently to support an individual whose relative was very unwell and needed to go to the family home, to visit as a matter of urgency. As previously mentioned in the report, time was spent talking with people visiting the home from the CMHT, who shared their experiences of the service. Both commented there has been a lack of continuity in the service due to high staff turnover. They felt this had impacted on the people using the service, as they had not had sufficient time to build confidence in the staff and therefore triggers to difficult and challenging behaviours were not always identified in their early stages, to avoid behaviours escalating. They did acknowledge there has been improvement recently, with a more stable staff team, but staffing levels remained an issue, as there were often insufficient staff resources to provide one to one support to individuals, as identified in their support plans. This was confirmed in discussion with staff, who commented, if there were more staff available, we would be able to provide one to one support to those who really need it, currently this is difficult to balance who needs this the most. During the inspection a number of toilets and bathrooms were seen with puddles of urine on the floor and waste bins were overflowing. A member of staff was asked who was responsible for cleaning bathrooms after use, once the cleaner had gone home, they commented, normally we encourage residents to do this, if not we do it, but I have had no time today. The cleaner was observed raising concerns with the deputy manager about the state the bathrooms and toilets were being left. Additionally, an entry in the kardex (daily record) of a person living in the home, on 12/05/09 reflects they were unhappy about the state some residents were leaving the bathroom next door to their room. A previous requirement was made for the registered person to ensure all of the records relating to employment and recruitment must be available in the home so that they can be inspected. Information provided in the AQAA states all staff have a Criminal Records Bureau (CRB) check completed and returned before they are offered Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: posts. CRBs were seen for all members of staff. The three staff files examined confirmed all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker, which had been obtained prior to them commencing employment, with the exception of references for the deputy manager, which were unavailable for inspection. Discussion with two staff members confirmed that all their recruitment checks had been carried out prior to their appointment. The staff files did not have a current photograph on file for identification, however photographs were held in a file with the statement of purpose. The care co-ordinator from CMHT felt that the managers and staff rely heavily on them and sometimes feel that they are managing the service. They conveyed that staff do not appear to be adequately trained and do not always manage situations well and will often refer incidents to the crisis team, when staff should be suitably trained to manage peoples behaviours. Whilst feedback from CMHT reflected staff were insufficiently trained to manage difficult behavious, care plans contained detailed behavioural support plans, which provided good strategies and guidance for staff to follow. However, there was insufficient information available at the inspection to reflect staff have received sufficient or recent training to enable them to work safely and to ensure they are able to meet peoples needs, in particular those whose mental health can sometimes involve beahviour that can be challenging. Discussion with a relatively new member of staff, told us they had no experience of working with people with mental health issues, and had previously worked in a residential home for older people. They are finding the work challenging, but felt safe and comfortable working in the home, but did have some concerns about dealing with people with behaviour changes. They have not received training for supporting people with challenging behaviour, but was competent explaining what they would do and was aware of triggers, which could cause residents to become anxious, however stated situations can be quite stressful if residents do not respond to strategies in their care plan. They confirmed they have been booked to attend training for working with people with mental health needs in July 2009. Information provided in the AQAA states the home has access to the head office Training and Development Programme, which is updated annually to reflect the training needs of the staff. The training matrix held by the home had a list of training required to meet the Sector Skills Council workforce targets, however this did not reflect who had completed training or the year training took place, therefore it was not possible to ascertain the level of training that has taken place since the last inspection or to reflect if staff are receiving up to date and relevant training to help them do their jobs. Of the three staff files inspected, there was no record to reflect what training Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: each individual had completed. Staff spoken with said they had completed first aid, health and safety, food hygiene, hearing voices, personality disorders and drug and alcohol advice, however could not remember Safeguarding of Vulnerable Adults (SOVA) training. Additionally, staff told us they have not received formal accredited training for administering medication. The AQAA also states the home employs a total of seven staff two of whom have achieved a National Vocational Qualification (NVQ) level 2 and or above. These figures reflect the home has not achieved the 50 of staff to hold a recognised qualification, in line with the National Minimum Standard (NMS). Staff told us did have an induction and orientation tour of the home as new employees and that they had attended a three day course induction training, within the first six weeks of their employment, which included completion of induction workbooks in line with the Skills For Care Training. The AQAA states supervision of senior social care workers and social care workers is better organised. Supervision records and discussion with staff confirmed that regular supervision is now taking place and that staff find these helpful and supportive. Care Homes for Adults (18-65 years) Page 30 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The continued welfare of people using this service is being jeopardised through the lack of ongoing maintenance, poor hygiene and management of health and safety. Evidence: Jacquelyn Smith is the project manager of service, they have twenty three years experience in social care working with families, residential care home with mental health and working with community health teams, developing services in Suffolk. They have been the project manager for this service since March 2008. They confirmed they have not yet put in an application to be registered manager of the service with us, CQC as they are waiting on the outcome of the consultation to de register the service. Time was spent with the manager and deputy manager discussing the organisations, plans to put in an application to voluntarily cancel registration of the service with CQC, with a view to reducing occupancy and to provide supported living to eight people. Following the last key inspection of the service, the manager was asked to complete an improvement plan to tell us, how they were to address the thirteen requirements made following the inspection. Time was spent discussing with the deputy and the Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: manager of the progress made to meet these requirements. Records seen, discussion with the manager, deputy, staff and people using the service and information provided in the AQAA confirmed the home had complied or made some improvements to meet eleven of these requirements, with issues around staff recruitment, decor and maintenance of the building outstanding. The AQAA states quality performance checks have been in place since 2005 to measure performance across the organisation. All services are required to complete a management report each month, including a health and safety review. Samples of the monthly management reviews were seen. In addition to the monthly management reviews an annual quality assurance review is undertaken between August and October of the service. A copy of the latest report was requested, but could not be found. The deputy manager contacted the organisations human resources department to request a copy, to be forwarded to CQC, for inspection, however this has not been received. As already noted in the environment section of this report people living in the home were identified as being at risk of sustaining burns and scolds from exposed hot radiator surfaces and from hot water outlets in bathrooms, showers and in their own rooms. these were found to be in excess of safe recommended temperatures of 44 degrees for baths and 41 degrees for hand basins and showers. A risk assessment with regards to hot water temperatures completed on the 05/12/08 states all baths and showers are supplied with hot and cold water and that the hot water temperatures should not exceed 43 degrees. The assessment makes reference to recent advice obtained from Health and Safety Executive (HSE). To comply with legislation, the assessment identifies the need for thermostatic valves to be fitted on all outlets to baths and showers. The risk assessment also states that this needed to be reviewed in three months, there was no evidence to show that valves have been fitted or that a review of the risk assessment took place. Additionally, there are no records to reflect that regular checks of hot water temperatures are being made. The deputy manager completed a risk assessment for one individual with regards to hot water, during the inspection. They also arranged a meeting to discuss these issues with staff and service users the same day. The manager was left an immediate requirement to deal with both of these issues, within forty eight hours to protect the people living in the home. They provided us with information of the action they have taken within the set timescales, to reduce the immediate risk. They have informed us that risk assessments have been completed to assess the risks for each individual, with regards to their understanding of hot water and likelihood of scalding from hot water and exposed radiators. Additionally, hot water signs have been situated near Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: the outlets, each resident has been provided with a thermometer and advised how to use it. The have advised us, that where risk assessments indicate an individual is at risk valves will be fitted to taps and radiator covers provided. A requirement was made following the last inspection for action to be taken to ensure all the recommendations made by the fire service in their letter in February 2007, were completed. The deputy manager was unable to find a copy of this letter to check all the recommendations had been carried out. The requirement in our last report did make reference to one of the recommendations, which was to ensure intumescent strips on doors were replaced, where they had been painted over, whilst this has been completed, it was noted that the intumescent strip on one door was missing. Additionally, none of the bedroom doors have intumescent strips or self door closures fitted and would not automatically close behind an individual in event of an emergency exit. There is also a recycling cupboard, for newspapers and other flammable products under the stairs to the front of the house, which is not fire protected and could, affect the exit from the house if there was a fire. The fire service informed us that they have since visited the home on 10/06/09 and have confirmed with us, that they have instructed the home to replace missing intumescent strips and to provide self closures to bedroom doors with intumescent strips, but were satisfied with the fire safety arrangements within the home. The fire log book reflects that the alarm, emergency lighting and fire fighting equipment are being regularly serviced and regular fire drills are taking place. Certificates to ensure the home are complying with relevant health and safety legislation, were requested for inspection, including the most recent gas safety certificate, electrical certificate and record of Portable Appliance Testing (PAT). The deputy and manager were unable to find these records. Care Homes for Adults (18-65 years) Page 33 of 40 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 34 of 40 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 1 42 13 Vulnerable people living in 15/05/2009 this home are being placed at undue risk and could suffer potential harm. The hazards of burns from scolding hot water and exposed hot surfaces have not been thoroughly assessed and action needs to be taken to remove avoidable risks. This will protect the health, welfare and safety of people living in the home. 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 19 12 The registered provider must ensure that the healthcare needs of people using the service are assessed, recognised and appropraite action is taken at the early signs and symptoms of ill being or ill health. This will ensure the well being of the people living in the home. 28/08/2009 Care Homes for Adults (18-65 years) Page 35 of 40 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 2 22 19 The complaints log must be 30/08/2009 available for inspection at all times. This will provide an audit trail to show that complaints are fully investigated and in line with the homes complaints procedure, and if the complainants were satisfied with the outcome. 3 23 13 Where issues arise, which 30/08/2009 affect the welfare and safety of people living in the home, the manager must ensure these are recognised and reported to the appropriate people and safeguarding teams, at an early stage. This will ensure people living in the home are protected, from abuse or the risk of abuse. 4 27 23 Work must be completed to repair and decorate a bathroom and toilet (taken out of action) which was to be given high priority following the inspection in April 2008. This will ensure there are sufficient and available facilities for use by the people living in the home. 30/08/2009 Care Homes for Adults (18-65 years) Page 36 of 40 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 5 30 23 All parts of the home must be kept clean, hygienic, and free from offensive odours. This will ensure people living in the home live in a clean environment, without the risk of infection. 30/08/2009 6 32 18 Staff working in the home 30/08/2009 must receive training appropriate to the work they are to perform. This will enable them to work safely and to ensure they are able to meet peoples needs, in particular those whose mental health can some times involve behaviour that can be challenging. 7 33 18 A review of staffing levels needs to be undertaken to ensure there are sufficient staff available to meet peoples assessed needs and to maintain a clean environment. This will ensure people using the service will recivie the support they need, as specified in their care Programme Assessment (CPA) and care plan. 30/08/2009 8 39 24 The registered person must 30/09/2009 ensure the quality assurance Care Homes for Adults (18-65 years) Page 37 of 40 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 review is completed at least annually and made accessible to people who use the service and other significant people and made available for inspection by CQC. This will ensure people have access to information about the home which tells them how well they are performing and what improvements need to be made. 9 41 17 Records in respect of service 30/08/2009 users and to ensure the home are complying with relevant health and safety legislation must be maintained and available for inspection. This will ensure CQC can be sure these are current and up to date and protect the people living and working in the home. 10 42 23 Following consulaltation with 30/08/2009 the fire service, the registerd person must make adequate preacautions to contain fire. This will minimse the risks of fire spreading throughout the home and ensure the Care Homes for Adults (18-65 years) Page 38 of 40 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 safety and welfare of people living and working in the home. 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 24 To enhance the living accomodation there should be an ongoing plan of maintenance (available for inspection) to ensure the premises are maintained in a good state of decorative order. More staff should be encouraged to complete a NVQ, to achieve the National Minimum Standard (NMS) of 50 of staff to hold a recognised qualification. 2 32 Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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