Inspection on 22/10/08 for 52 Porthcawl Green

This inspection was carried out on 22nd October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

52 Porthcawl Green 25/03/09

52 Porthcawl Green 08/01/09

52 Porthcawl Green 31/10/07

52 Porthcawl Green 28/12/06

52 Porthcawl Green 04/05/06

52 Porthcawl Green 15/11/05

52 Porthcawl Green 05/07/05

52 Porthcawl Green 13/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 52 Porthcawl Green 52 Porthcawl Green Tattenhoe Milton Keynes Buckinghamshire MK4 3AL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Schwarz     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 52 Porthcawl Green 52 Porthcawl Green Tattenhoe Milton Keynes Buckinghamshire MK4 3AL 01908507149 01908508900 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The Disabilities Trust Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). Date of last inspection Brief description of the care home Porthcawl Green provides accommodation and support for three service users with Autistic Spectrum Disorders. The house is situated in a quiet residential area of Milton Keynes, close to the Westcroft centre where there are several shops and supermarkets. Local bus networks provide regular access to central Milton Keynes and Bletchley. There are main line rail stations in Milton Keynes and Bletchley giving access to London, the Midlands and the North. The home has three bedrooms, one en-suite, a staff sleep-in room, office and a bathroom on the first floor. On the ground floor there Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 Brief description of the care home is a large lounge, dining room, space to use the computer, laundry and kitchen. There is a small enclosed back garden and parking at the front of the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 unannounced key inspection was conducted by Chris Schwarz over the course of a day and covered all of the key National Minimum Standards for younger adults. The last key inspection of the service took place on 31st October 2007. Prior to the inspection, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were sent to people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, Care Homes for Adults (18-65 years) Page 6 of 31 observation of practice and a tour of the premises. Equality and diversity needs were taken into account throughout. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: Management of peoples finances needs improving through production of a policy which supports the arrangements at the service, and by rectifying discrepancies in peoples money tins and achieving and maintaining accurate records of financial transactions to make sure that appropriate safeguards are in place. Medication practice requires some attention. Accurate records need to be maintained of medicines administered to people and hand written medication administration records need to make clear the name, strength and dose of medicines to be given and include the full date, to ensure that safe practice is consistently followed. Complaints need better management by producing a procedure which is adapted for local use and available in formats appropriate to the needs of people using the service, to make sure that they have the necessary information to hand to voice their concerns. A record of any complaints or safeguarding issues needs to be kept at the home to show how these were dealt with. Monitoring by the provider and quality assurance need attention. A requirement from the last inspection to carry out a quality assurance exercise had not been dealt with Care Homes for Adults (18-65 years) Page 8 of 31 and records of visits by the provider showed that these had not been taking place regularly to assess care provision and make sure it is meeting peoples needs. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. Evidence: A statement of purpose was in place for the service, updated recently to reflect changes in management. It provided useful information about the service and would provide prospective users with details of what to expect of life at the service. There had not been any new admissions to the service for some time. There was no admissions policy or procedure in place although a flow chart was faxed across from the administrative offices which outlines a typical procedure to be followed in the event of people being considered for a placement. The manager said that she and the clinical psychologist would undertake separate care needs assessments to make sure that the service would be suitable and a series of introductory visits and overnight stays would be offered before a trial period was offered. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Fees for the service ranged from 1400 to 2000 pounds per week. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Attention is needed to management of peoples money to make sure appropriate safeguards are in place. Evidence: Each person had care plan files. These contained a photograph of the person and essential information such as their religion, next of kin, doctor and gender. Information was provided on the level of support needed and there was evidence of service users being involved in what was recorded about them. Peoples family and social contacts were noted and each file contained identified goals and aspirations that they wanted to work towards. Each file also contained minutes of review notes for this year. Guidelines were in place to support people with daily living tasks such as cooking, Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: walking in the local area, managing money and using taxis with accompanying risk assessments to support acquiring greater independence. Care and support plans were divided into various sections such as likes and dislikes, an individual development plan, information on personality, behaviour and emotion, people who are important to the user, communication profiles, personal care needs, what the person likes doing, managing finances, health care needs and a weekly timetable. Information within care plans had been dated and reviewed where necessary to bring it up to date. People using the service also had an essential lifestyle plan which was more person centred. One person was managing his own money. For the other two users, money was kept in the office safe with individual record books to note transactions. In discussion with the manager, it was said that receipts are no longer being asked for and kept to verify expenditure as money is handed to the user for them to spend themselves (as opposed to staff buying items on their behalf). The transaction records showed that each transaction was being logged and signed by staff although the managers expectation that the service user also signs could not be evidenced on each occasion in one persons records, only 7 of a page of 34 transactions had been countersigned by the service user. The manager was asked if the providers policy on supporting people with their finances endorsed the arrangements in place at Porthcawl Green and she confirmed they do not. The inspector also raised concern after being informed that one person has problems remembering things which has a bearing on the appropriateness of the current arrangements. The balances of both peoples money tins were counted and compared with the recorded balances; errors were found in both cases. One tin contained 5 pence more than the record, the other contained twenty five pounds more than was recorded. Requirements are made to improve this area of practice to better safeguard peoples money. Records showed that four house meetings had taken place at the service. People spoken with said that they had opportunities to contribute to decision making on issues which affect the service overall, as well as with their personal care. People using the service were seen to decide what they wanted to do during the day and whether to be alone or in company. Each person had a key to their bedroom. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported to access the community and to be involved in domestic tasks to be as independent as possible. Evidence: Daily notes and individual timetables provided evidence of people using the service accessing the community and being supported to take part in daily living tasks. Records showed that one person goes to college, one was undertaking the Alpha course and attending church, use was being made of the cinema, a craft fair had been enjoyed, people make use of the library and take part in food shopping, there is a computer in the service which people can use (internet connection is being considered), meals out and going to the pub are enjoyed and good use is made of the piano in the dining room. One person who was away at the time of the inspection is a talented musician who is supported to perform in public. People using the service Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: maintain contact with family and friends and stay with family occasionally. There is another service run by the provider near by and users visit each other. There are public transport links close to the service as well as a pool car shared with the near by service - mention was made that the service would be getting its own car soon. Routines within the home were flexible to tie in with what people using the service would like to do. A member of staff and a service user went into the city centre to the cinema and to have a meal out and were expected back around 6.00 pm. Staff rotas have been designed to make sure that people can be supported effectively and are not bound by staff needing to go off duty at traditional shift end times. Food is well prepared at the home with people using the service choosing the menus. The service has a bread maker and makes meals from fresh ingredients. Vegetables were being purchased from a farm shop and there were plans to buy locally sourced meat as well. Emphasis was being placed on eating healthily and eating well and daily notes provided a clear record of meals. One person said he was doing cookery as part of his college attendance. Another service user was seen making his own snack in the kitchen. There was plenty of fresh fruit for people to help themselves to. In the garden, winter and spring vegetables were being grown. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are being met to promote well being. Medication administration needs to be improved to ensure that safe practice is followed. Evidence: Peoples care plans noted their personal care requirements. Aids and adaptations to bathrooms, showers and toilets were not necessary as no one living at Porthcawl Green had an physical disabilities and all had good mobility. A record was being kept of medical appointments attended and encouragement given where people refuse routine screening. People using the service have access to regular clinical psychology support and are referred for other specialist advice as needed. A good working relationship with the local psychiatrist was described which includes him attending peoples reviews. Medication was being managed using a monitored dose system. Only two of the people living at the service required any medication. Storage of medicines was secure in a metal cabinet mounted on the wall. It was kept locked when not in use. Medication Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: administration records showed gaps alongside prescribed dose times. One persons Clozaril had not been signed on five occasions on the current record sheet, another persons Fybogel had not been signed on three occasions. A requirement is made to achieve and maintain accurate records of medicines administered to people using the service. The lack of accuracy regarding the Clozaril is a particular concern. A hand written medication record had been produced and used by staff - the record did not say which month it related to and did not contain full instructions for the medication. A second requirement is made to improve medication practice. A recommendation is also made to obtain and make use of the Royal Pharmaceutical Society medication guidelines. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Corporate complaints procedures have not been adapted for local use and produced in forms appropriate to the needs of people using the service; there were no records of how complaints and a safeguarding matter had been responded to. This could mean that people have not been listened to and that their concerns have not been appropriately handled, placing them at risk of harm. Evidence: The pre-inspection self-assessment showed that there had been one complaint and one safeguarding referral at the service. The manager did not have any record of the complaint and was not able to describe the substance of it. She advised that it was being handled by someone else within the organisation. The safeguarding referral was said to relate to the same matter. The manager was unable to provide any evidence that it had been referred to Milton Keynes council or that it was being dealt with appropriately. The inspector asked to look at the complaints log. It contained a front sheet which noted five complaints being made since May 2006. There was a note to say that four of these had been investigated by the regional manager who covered the home at the time but no details of what the complaints were about and the outcomes. Since this visit to the service, the inspector has spoken with the external line manager Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: for Porthcawl Green who verbally confirmed that the complaints and the safeguarding referral had been investigated and that records could be produced to verify this. These had not however been received in time for the production of this draft report. At the last inspection a recommendation had been made to ensure that the complaints procedures had been adapted for local use, as a corporate version had been in the policies file, and that it was in a form appropriate to the needs of people using the service. An out of date version of a local procedure was found but this would not have been of any use to service users. Requirements have been made to improve practice in relation to complaints. A recommendation made at the last inspection to obtain the local authority multi agency safeguarding guidance had been addressed. The organisations own safeguarding procedure included the need to notify the Commission for Social Care Inspection and Social Services Department of any allegations or incidents. Staff training records showed that they receive input on safeguarding. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for peoples needs. Evidence: Porthcawl Green is located at the end of a cul de sac and is a detached two storey residence in the Tattenhoe area of Milton Keynes. There are transport links to the city centre close by where there are numerous facilities, shops and attractions for people to make use of and wider transport links. Each person using the service had their own bedroom and a key to lock their room. One of the bedrooms is en suite. There is one upstairs bathroom with a toilet and a shower room on the ground floor with toilet. The kitchen is a good size and has plenty of storage space. The laundry is located in a room next to the kitchen and contained the necessary equipment. People using the service have a lounge and separate dining room and there is a space next to the kitchen for using the computer. The office and separate staff sleeping room are located upstairs. Outside there is an enclosed garden where vegetables were being grown. There are a few spaces for staff and visitor parking at the front of the building. The home was clean and well maintained throughout. The pre-inspection self-assessment identified some improvements made in the past year such as redecoration, new curtains, new light fittings and kitchen equipment. Care Homes for Adults (18-65 years) Page 21 of 31 Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides staff cover to meet needs and provides effective training to ensure carers have the right skills and competencies to support the people. Evidence: The pre-inspection self-assessment showed that the staff team is made up of eight carers and that one person had left in the past year. Where needed, temporary or bank staff had been used to cover gaps in the rota. Two staff had achieved National Vocational Qualification at level 2 or above. Staff rotas reflected flexibility in providing support to people using the service and to enable them to access the community and achieve personal goals. Two staff are typically on duty during the waking day with the managers hours supernumerary. Staff spoken with described a good sense of team work and a supportive environment. They said there was good back up support when they needed it and saw promoting peoples independence as a high priority. Training and induction were described as good and they said staff meetings take place to discuss practice issues. The files of two new staff were looked at. There was evidence of Criminal Records Bureau checks being undertaken and uptake of references. Proof of identification had Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: been sought and medical questionnaires completed. Application forms had been completed - in one case two gaps to employment history were noted, each covering five year periods. There was nothing on the application or within the recruitment file to explain the gaps which should have been explored and recorded. A recommendation is made to address this. Staff training records showed that a good range of courses is available to staff including safeguarding and responding to challenging behaviour. Staff spoken with said they are able to consider non mandatory courses as well if they have particular interests. Records showed that training was largely up to date - where the manager was asked about gaps, courses had been booked for the coming months to address them. A detailed induction programme in line with Skills for Care is undertaken by new staff. Staff were observed to let people using the service make decisions and do as much for themselves as they could and were gentle and friendly in their interactions. From surveys that were returned, staff said the service is good at communicating, providing the required training and keeping staff up to date with new ways of working. One person added provides the residents with a homely atmosphere, good committed staff that work well with residents enabling them to feel confident and settled so they feel more able to express themselves and voice their opinions, needs and wishes. Puts the residents first and seeks ways to improve the choices of residents. Another said since working here I have a great deal of job satisfaction. The staff work well together and the service users are generally content I believe. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for health and safety at the service, minimising the likelihood of injury or harm to people. Monitoring and quality assurance need to be developed to make sure that care provision is satisfactory and meets peoples care needs. Evidence: The service had a new manager since the last inspection and she has been registered with the Commission. She also manages a similar service close by. She is undertaking National Vocational Qualification level 4 and will then start the Registered Managers Award. Staff spoken with described her as approachable and available when they need support. People using the service also seemed at ease in her presence. At the last inspection a requirement was made for systems to be established for reviewing and improving the quality of care provided. The manager said this had not been done. The requirement is repeated. Records of monitoring visits by the provider were looked at. For the past year there were only four monthly reports in place. A requirement is made for these visits to be undertaken at least once a month and for Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: reports of the findings to be made available at the home for inspection purposes. Health and safety was being managed well. A certificate was in place to show satisfactory gas safety and portable electrical appliances were due for an annual recheck shortly after this visit. A monthly check was being made of the first aid box and a monthly visual hazard check of the premises was being undertaken regularly. Fridge and freezer and hot water temperatures were being monitored and the service had a fire based risk assessment in place. Accident records were in place - there had not been any accidents in the past year. Behavioural incidents were being recorded. The last record of a check of the electrical installation was dated July 2002. It is recommended that these are carried out at least every five years to maintain electrical safety. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 39 24 The manager must establish 28/02/2008 systems for reviewing and improving the quality of care provided. Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 The discrepancies in peoples 30/11/2008 money tins is to be rectified and accurate records of transactions achieved and maintained. This is to ensure there is proper financial accounting. 2 20 13 Hand written medication administration records must make clear the name, strength and dose of medicines to be given and include the full date. This is to ensure that safe practice is consistently followed. 30/11/2008 3 20 13 Accurate records are to be maintained of medicines administered to people. This is to make sure that a clear audit trail is in place. 30/11/2008 4 22 22 A complaints procedure which is suitable for use at the home is to be put in place and made available in 01/12/2008 Care Homes for Adults (18-65 years) Page 28 of 31 formats appropriate to the needs of people using the service. This is to make sure that they have the necessary information to hand to voice their concerns. 5 22 17 A record of complaints and how they have been responded to is to be kept within the service. This is to show that people using the service and/or their representatives have been listened to and their concerns addressed. 6 39 24 A quality assurance audit of care provision is to be undertaken, incorporating users and other relevant peoples views. This is to ensure that satisfactory care is being provided to meet peoples needs. 7 39 26 Monitoring visits are to be undertaken by the provider at least once a month and reports of the findings made available at the home. This is to show that there is satisfactory oversight of care provision by the provider. 01/12/2008 01/03/2009 01/12/2008 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 29 of 31 1 7 Management of peoples finances is to be improved through production of a policy which supports the arrangements at the service, to make sure that appropriate safeguards are in place. Medication practice is to be improved through obtaining and using the Royal Pharmaceutical Society medication guidelines. Gaps to employment histories are to be explained and the reasons noted before offering prospective applicants a position at the service. A check of the electrical installation is to be undertaken and at least every five years thereafter, to maintain electrical safety. 2 20 3 34 4 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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