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Inspection on 05/05/09 for 72a Broad Street House 2

Also see our care home review for 72a Broad Street House 2 for more information

This inspection was carried out on 5th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The service has a friendly and welcoming atmosphere. People who use the service are have personalised rooms to make it their home: bedroom decor and furnishings reflect their tastes and we observed that they run their house as they wish giving direction to the staff. Staff have a good insight into individual needs we observed a good rapport between staff and people who use the service. Each side of 2 Broad Street has its own character and it is clear that Cedar and Douglas have clear identities despite sharing a building. People are able to follow their own interests and are supported by staff to do so.

What has improved since the last inspection?

The requirements made at the previous inspection have been met. The service is transferring all documentation onto the new computer system to ease the process for both staff and service users. Agency staff now bring evidence that the required checks have been carried out by the Agency that employs them,. All staff records were available for inspection and copies are kept at the Area Office. Agency staff would receive supervision if employed over a period of time. The manager discusses any concerns and provides feedback to the Agency. Some decoration has taken place. Holidays have been arranged and ongoing training has continued for staff.

What the care home could do better:

Some requirements have been made. The care plans need to be consistent in their quality. Some care plans provide more comprehensive information in an organised manner. One of the two care plans we inspected was disorganised and it was difficult to follow how needs were being met. There were not always definite sections were information could be recorded especially with regard to health needs. It was unclear how staff identified whether a health or social need had improved or deteriorated as the only way of doing this was to read through a proportion daily notes. Some guidance was missing - an example being how to manage epilepsy. Some attention is needed with regard to the medication system. Improvements are needed to ensure that medication is stored correctly and that records are clear and easy to read. A maintenance plan is needed to identify when improvements that have been identified will commence.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 72a Broad Street House 2 Cedar And Douglas Units 72a Broad Street Clifton Shefford Bedfordshire SG17 5RP     The quality rating for this care home is:   one star adequate 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: Angela Dalton     Date: 0 5 0 5 2 0 0 9 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. 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. 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 72a Broad Street House 2 72a Broad Street Cedar And Douglas Units Clifton Shefford Bedfordshire SG17 5RP 01462813824 01462813824 Kathryn.chainey@hft.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home Farm Trust Ltd Name of registered manager (if applicable) Ms Jeanette Kay Marling Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Cedar and Douglas was one of two homes run by the Home Farm Trust in the small town of Clifton. The building was divided into two units to support 8 adults with learning disabilities; the units catered for 8 service users with complex needs and autism. The units were designed to accommodate four service users independently from the other unit. As a result of this, each unit had its own kitchen, lounge, and bathing facilities and was linked by the laundry room on the ground floor and the staff room on the top floor. There were separate entrances to each unit and service users communally shared the garden facilities. The home was situated close to local amenities including shops and pubs. The service users were able to access other towns such as Bedford, Biggleswade, and Shefford with the use of their local transport or route cars and the homes own transport facilities. Care Homes for Adults (18-65 years) Page 4 of 30 care home 8 Over 65 0 8 Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection was conducted in April 2007. One inspector conducted this unannounced site visit on 6th May 2009 between 11.25am and 6.40pm. Two people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross references all the information gathered to confirm that what we are told is happening is actually occurring, and, reflects the Statement of Purpose, which contains the aims and objectives for the service. We spoke to the people who use the service, members of the staff team and the manager. We were present for lunch and dinner preparations and observed interaction between staff and people who use the service. We toured the building and examined Care Homes for Adults (18-65 years) Page 6 of 30 documentation to check that what was happening in the service was being recorded. The services weekly fees are under review but currently range from 919.19 pounds to 1806.65 pounds. This does not include toiletries and private chiropody and other personal expenses. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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 30 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 30 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. Evidence reflected that individual needs are assessed to ensure that they can be met by the service Evidence: There have been no changes to the number of people living at the service since the previous inspection. The manager was aware of the assessment process and the considerations that would need to be made if someone new moved in to Cedar or Douglas. A review would be held after 6 weeks and again after 12 weeks to ensure that the person had settled into their new home. Copies of individual contracts are held on file. Each person has a copy of their contract and this in a user friendly format. The manager is looking for a lockable cabinet to better display service user documents. Some service users remove paperwork and documents cannot be displayed resulting in people not being aware of information. The manager will return the previous registration certificate as it is displaying out of date details. Care Homes for Adults (18-65 years) Page 10 of 30 Care Homes for Adults (18-65 years) Page 11 of 30 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 no consistency in the quality of information in care plans. Evidence: We looked at care plans for 2 people. There were contrasts in the level of information recorded. One care plan was detailed and fully explained how individual needs were met. We were able to see how personal care, behaviour, communication and health needs were met as clear records were kept and any changes were recorded. A communication book has been developed to support the person to identify which activity is to be completed to provide reassurance and reduce anxiety. However, there is a folder available in the medication room to provide staff with information on how to manage or monitor Epilepsy. The second care plan we viewed was more disorganised. There was a lot of historical information from the persons previous home that had not been updated or reviewed. It was clear that support from professionals was being received but it was not possible Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: to identify when deterioration or improvement in health or behaviour had occurred. There were guidelines from the community nurse about monthly injections but no easy to follow records of changes in the amount of prescribed medication. Amounts had been increased and decreased but it was unclear why the injection was being given and when amounts had changed and if this had been to good effect. The kitchen is locked because the person takes large amounts of specific food and there is a risk of cross infection but there was no care plan to explain how staff support the person and how often this decision is reviewed. There are guidelines in place but it was not recorded when the guidelines were written. There is also no evidence to reflect who the decision was made by. The manager stated that there would be a review in line with the Deprivation of Liberty section of the Mental Capacity Act. Vital information on managing Transient Ischaemic Attacks (mini strokes) was hidden behind an identification sheet in a plastic folder. There was no evidence of any attacks being recorded. There was a diagnosis of epilepsy but no information on types of seizures and how to tell the difference between a suspected mini stroke or epileptic seizure. There was information on a stomach bacterial infection but no associated guidelines on action required or how the condition was being monitored and managed. Weights were being recorded but there was no documented reason why this was occurring and what action was taken if there was weight loss and what a baseline weight should be. There were swallowing precautions from the Speech and Language Therapy Team but it was unclear why they were in place. The guidance stated food should be cut into small pieces but it did not state how small and why this was advised. There was no risk assessment for choking. Each visit to a GP or Psychiatrist is recorded. The recent visit to a Psychiatrist reflected that a referral had been made to the Speech and Language Therapy Team and Psychology department but there was no explanation to reflect why the referrals had been made. Falls were being recorded and body maps reflected whether injury was sustained but it was unclear how the information was being analysed and what action and precautions was being taken. Staff have received Moving and Handling Training but there were no assessments evident to reflect whether there were any individual requirements. There was a request noted that an additional family member would like to be kept up to date with any developments but no telephone number was recorded and it was unclear how recent this request was. Home Farm Trust use a specific system for care plans called SPARS - Support, Planning, Assessment and Recording system. Staff are in the process of entering information electronically and ensure a paper copy is available.The manager confirmed that the care plans that were available were the most up to date Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: version. A user friendly format is currently being developed. The service also has software to enable text to be translated into pictorial or symbol forms. Existing information can be scanned into the system so that information is not lost. Each person has a person centred planning diary. This enables each person to record what they would like to do and plan it with staff. It also enables people to have hopes and aspirations that staff can assist in realising. People have the opportunity to meet with an Advocacy Alliance representative each month as an independent contact. Care Homes for Adults (18-65 years) Page 14 of 30 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. The leisure and occupational requirements of people who use the service are met in a flexible way. Evidence: There are some staff vacancies at the moment and Agency staff are being employed. One member of Agency staff was working on the day of inspection. This may have a bearing upon the in house activities in Cedar as there was little happening with people who did not go out during the inspection. There was evidence that service users have a varied leisure programme. This is devised in conjunction with people and changes as necessary. Some service users attend college and others go to Home Farm Trusts resource centre which is provides occupational and recreational sessions. A peripatetic support worker has been employed to work in several services to promote individual interests. This has been successful at Broad Street and has provided Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: opportunities for people to go swimming and play snooker. 2 people went swimming and out to snooker during the inspection. Service users have access to a touch screen computer. One person was spending time on You Tube enjoying music from TV programmes. We saw evidence that people keep photo albums of days out and holidays. Regular house meetings take place. A member of staff is responsible for taking minutes and ensuring any issues are dealt with. The Annual Quality Assurance Assessment told us that people had participated in horse riding, and gone out to a local night club. One person that they went to Gateway club and met up with people they knew from other services. The manager ensures that holidays are booked in conjunction with service users. Where holidays cannot be taken due to health issues an alternative is provided with days out at regular intervals to ensure that people get to go away at a time they wish and enable staff to be given adequate notice. Some people are supported to attend church and everyone goes out regularly to places of their choice. Service users are supported to go shopping for food and decorative items. Menus are in a user friendly format. We observed preparations for lunch and dinner. People told us that they liked the food and sometimes helped in the kitchen. We observed one person being supported to lay the table. Care Homes for Adults (18-65 years) Page 16 of 30 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 medication system does not ensure the safety of people who use the service. Evidence: As detailed in the earlier section care plans do not offer detailed information to assist staff to monitor and manage specific needs. Staff receive training to ensure that they are equipped with adequate knowledge but there is not always a reflection of this. This was evident with regard to managing Epilepsy in both care plans we viewed and other specific needs detailed earlier in the report. People who use the service receive support from members of the multidisciplinary team. Records reflected that staff and individuals were assisted by a Psychiatrist, Speech and Language Therapist, Community Nurse and Psychology Team. Additional support could be accessed where necessary from a Dietician. A chiropodist visits each month but treatment is delivered in a communal lounge. There were no records to reflect that service users were happy with this arrangement which may compromise their dignity. The manager will confirm that a CRB check has been conducted on the Chiropodist although staff accompany them in their visit. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: No-one in Cedar and Douglas manages their own medication. Designated staff are responsible for checking medication in and ensuring that accurate records are kept. In addition to the Medication Administration sheets there are counting sheets and carers notes for omissions and as required medication. This may duplicate records but all medication reconciled. We checked medication for two people who use the service. Amounts of medication are recorded when leaving and returning to the home but no records are completed during the time people spend with their families. The senior who is responsible for medication stated that any problems would be identified when medication was checked in on the persons return to the service. Some improvements in recording on Medication Administration (MAR) sheets are needed - where there had been errors in amounts or dates the information had been scribbled out. Staff must be aware that any changes made must be legible and initialed. One MAR sheet reflected that 1 Lorazepam tablet was given but it was half a tablet. This could result in staff being unsure of the amount of medication required. Lactulose that required storing at 20 degrees Celsius was being stored at 25 degrees Celsius. This means that it was not being stored at the licensed manufacturers recommended temperature and was not suitable for dispensing. The only means of cooling the medication storage room is by an extractor fan. This may not be effective in reducing the temperature if the outside temperature increases. Records reflected that the storage room was regularly 25 degrees Celsius which the optimum storage temperature for most medication. If it goes higher than this medication is not licensed for use and has to be destroyed. the service does not currently have a medication fridge but would purchase one if required. There are currently no controlled drugs prescribed but the storage facility exists if necessary. Copies of prescriptions are not kept so a receipt of the doctors instructions are not recorded. The service has a copy of the most recent Royal Pharmaceutical Guidelines regarding administration of medication in a care home and staff receive medication training. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a clear system in place to enable people to express their concerns. Evidence: There is a complaints policy in place. Each person has a user friendly version and there are plans to display this once a suitable cabinet is purchased. The people we spoke to confirmed that they knew who to raise any concerns with confirming that they would talk to their keyworker or the manager. A member of staff from Advocacy Alliance is available each month and acts as an independent representative for people who use the service. Records reflected that staff had attended Safeguarding training. The manager keeps copies of compliments and is planning to expand the complaints procedure to illustrate how concerns or allegations are dealt with effectively and they do not escalate into complaints. This will also ensure that the process of any investigation or process that takes place is recorded. The manager has also led in house SOVA training to ensure that it is a subject that everyone is familiar with and discuss any questions. Training on the Mental Capacity Act has commenced and the manager plans to incorporate this into peoples care plans. The manager will liaise with the safeguarding team to explore whether further communication is required regarding one person who has hit other service users. We checked two peoples financial records and there were no issues. The service uses Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: a specialised system (Versapak) which has a separate number for a lockable tag. Each time finances are checked a new tag is issued with a corresponding number. Staff are signatories for people but do not have access to their PIN number of cash point facilities. Care Homes for Adults (18-65 years) Page 20 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements are needed to better meet the needs of people who use the service. Evidence: The home was clean and tidy and odour free. The manager has recently submitted a list to the Area Manager identifying the work that requires completing. Some areas require attention as they are worn and do not complement the homely style and atmosphere in Cedar and Douglas. There were toilet roll dispensers and a hand drier to meet the specific needs of people who use the service. The extractor fans had a build up of dirt. A shower room had a leaking shower tap . It was not possible to tell which direction to turn the tap for hot or cold water as the cover had faded making it difficult for people to use the shower independently. There is a difference between the communal rooms downstairs and upstairs. Downstairs is warm and friendly and clearly reflects the personalities and choices of people who use the service, whereas upstairs is more stark and has fewer personal touches. Kitchen cupboards and drawers in Cedar and Douglas are missing handles. This does Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: not enable people who use the service to easily participate in kitchen tasks and have to rely on staff assistance to open drawers and doors. Some of the protruding parts that remain from the broken handles may cause a risk to people using the kitchen. A new bath seat has been installed following a recommendation by an Occupational Therapist. The lounge has recently been decorated and outside window frames have been painted. There is garden furniture and a hammock outside the house and access to a field and summerhouse in adjacent land. The laundry meets the needs of people who use the service and there was adequate protective clothing available. There are dissolvable alginate bags for use with soiled laundry if needed. All service users have access to a computer. Care Homes for Adults (18-65 years) Page 22 of 30 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. People who use the service are supported by an effective staff team. Evidence: The service currently has some staff vacancies but they are being covered by agency staff. There is one 30 hour vacancy, two 15 hour vacancies, two 8.5 hour vacancies and 5 night vacancies. The manager has the opportunity to merge the hours. All staff work in both Cedar and Douglas to ensure that they know all service users needs. We checked Agency Staff records The Agency provides the service with a pro forma to evidence that the required checks have been conducted. The manager also completes an induction with new Agency staff to ensure that they are aware of peoples needs. There have been some new staff since the previous inspection in April 2007. We checked 4 staff records which evidenced that the necessary checks had been conducted to ensure the safety of service users. Although staff do not complete the Learning Disability Qualification they obtain the companys equivalent and complete a 3 day induction. Staff complete a wealth of training: SOVA (Safeguarding), Person Centred Planning, Food Hygiene, First Aid, Health and Safety, Moving and Handling, Epilepsy, Nutrition, Loss and Bereavement, Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Dementia, Think Positive, Mental Capacity Act and Medication. Staff are encouraged to obtain an NVQ Award and an assessor was present during the inspection. One senior has an NVQ 3, 2 staff are working towards NVQ 3. 3 staff have NVQ 2 and 7 working towards NVQ 2. Staff receive supervision from the manager every six weeks which enables staff to set their goals with regard to training and performance. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people who use the service are incorporated into the running of the home. Evidence: The manager has worked at 2 Broad Street since January 2008. They are currently awaiting their final evaluation from the Internal Verifier and will have achieved an NVQ. They plan to commence the Leadership and Management Award in September which has replaced the Registered Manager Award. They are awaiting the result of their Registration Interview with the Care Quality Commission (CQC)but had received positive feedback at the end of their interview. We inspected fire records and found them to be in good order and the manager plans to update the fire plan in line with guidance provided by the local fire service. The emergency light in the adjacent bathroom next to the office. This would provide light to the office if the main power supply were to fail. The manager contacted the maintenance department during the inspection to repair the light. Health and safety Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: records are maintained and reflected that necessary safety checks were being conducted. Fire drills were taking place and the manager has plans to conduct a late night drill to ensure sleep in staff know how to respond. The AQAA (Annual Quality Assurance Assessment) was completed prior to the inspection by the manager to demonstrate how the service had reviewed the care they delivered and identified any improvements required. The service sends out a quality assurance questionnaire to families, people who use the service and to professionals. A report is published and sent out to all participants and reflects what action will be taken. The manager plans to incorporate the findings into the statement of purpose as this is reviewed annually. This will ensure that the statement of purpose illustrates how the service is responding to comments that are made by people who use the service and their relatives. The company meets with the Family and Friends Association quarterly, which enables the management team to address any concerns and provide an update of any developments within the service. The manager also attends these meetings. Regular house meetings are held to ensure peoples views are considered and implemented. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 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 6 12 Care plans must reflect how individual needs are monitored, managed and met. Care plans do not provide adequate detail how specific needs have improved or deteriorated. 30/06/2009 2 19 12 Procedures must be in place to meet the assessed needs of people who use the service. Information that is currently in place does not reflect how health needs are monitored, managed or met. 30/06/2009 3 20 13 Medication must be kept at 30/06/2009 the required temperature. Altered records must remain legible. Records must reflect the accurate amount of medication require i.e. half a tablet not one tablet. Copies of prescriptions must be kept. Care Homes for Adults (18-65 years) Page 28 of 30 Where medication is stored at the incorrect temperature it is not suitable for use. Records must reflect the actual medication required to ensure that the correct dosage is given. Records must be legible as they are legal documents and any changes must be evident. 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 18 Records should reflect that service users are happy to receive chiropody treatment in a communal setting with other people present. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!