Inspection on 02/01/09 for Bellevue

This inspection was carried out on 2nd January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bellevue 04/12/09

Bellevue 27/10/08

Bellevue 21/07/08

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bellevue 78 Bushey Hall Road Bushey Watford WD23 2EQ 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: Claire Farrier Date: 0 2 0 1 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 36 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Bellevue 78 Bushey Hall Road Bushey Watford WD23 2EQ 01923490570 01923332540 mo@portlandcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Portland Care Homes Ltd Name of registered manager (if applicable) Mr Mohammad Nooranny Dookhun Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 7 0 0 care home 7 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home fall within the following categories: Learning Disability - Code LD Mental Disorder, Excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is 7 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home Bellevue is a terraced house. It is in a busy road, and it looks like all the other houses in the road. Some shops are nearby, and the home is close to the town centre is nearby. Everybody who lives at the home has their own bedroom. Nobody has to share a room. Care Homes for Adults (18-65 years) Page 5 of 36 Everyone shares the lounge, dining room and kitchen. The accommodation charges for Bellevue range from £800 to £1400 per week. The Statement of Purpose and the Service Users Guide tell people about the home. The manager will give a copy the CSCI inspection report to people who want to see it. Care Homes for Adults (18-65 years) Page 6 of 36 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: 1 star adequate Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home The last key inspection was on 21st July 2008. We also visited Bellevue on 27th October 2008, to check what had got better in the home. When we visited Bellevue this time, the people who live in the home and who work in the home did not know we were coming. Care Homes for Adults (18-65 years) Page 8 of 36 We talked to some of the people who live at the home. We looked at some care plans and other papers. We looked around the home. We talked with the manager and some staff who work at the home.  Care Homes for Adults (18-65 years) We decided to give the home 1 star. This means the people who live there have adequate care and support. Page 9 of 36 What the care home does well The staff and residents have all been at the home for a long time. They know each other well. The home is very clean and tidy. The care plans tell the staff how people like to be supported with the help that they need. Care Homes for Adults (18-65 years) Page 10 of 36 What has got better from the last inspection Everyone has a Person Centred Planning Book. Everyone says in their book what they like to do and how they like to do it. The staff only work in Bellevue, and do not also work in Bel-Air. This means that they can support the people in Bellevue properly. There is a new kitchen, with new cupboards and cooker. It is clean and hygienic, and some people can cook their own meals there. Care Homes for Adults (18-65 years) Page 11 of 36 One person told us about the support the staff provide so that they can buy and cook their own food. People can choose what they like to do. One person likes to go to the social club at the church. They also go to a day centre one day a week. Care Homes for Adults (18-65 years) Page 12 of 36 One person would like to do more in the garden. They can do this when the weather is better. What the care home could do better One person has put on a lot of weight, and one person has lost a lot of weight. They could have poor health. Care Homes for Adults (18-65 years) Page 13 of 36 The manager must check that everyone has the right amount of medication so that they stay well. People cannot read and understand the complaints procedure. Everyone should know how to tell someone if they are unhappy. Staff must have good training so that they know how to support people properly. The manager must know that the training for staff is good. Care Homes for Adults (18-65 years) Page 14 of 36 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Claire Farrier CSCI CPC1 Capital Park Fulbourn Cambridgeshire CB21 5XE 01223 771350 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 15 of 36 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 16 of 36 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 . The home has sufficient information on the needs of the people who live there and access to appropriate services to enable their needs to be met. Evidence: No-one has moved into the home since the last inspection. We looked at the care plans and information for two of the five people who live in the home. An evaluation of each persons care needs has been completed since our last visit to the home, which provides comprehensive information on their history and up to date information on their interests and needs. The evaluation of needs provides the basis of each persons care plan (see Individual Needs and Choices), and provides good information for the staff so that they know how to support each person appropriately. Each persons file contains a copy of the service agreement with Hertfordshire Adult Care Services. The support staff who we spoke to said that the care plans contain sufficient information so that they can meet each persons needs, and the staff have had training to improve their skills. (But see Staffing for our concerns about the quality of the training.) Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: The Statement of Purpose and Service Users Guide have been revised, and we saw the new documents when we visited the home in October 2008. Both these documents now contain all the information that people need to help them to choose whether to live in Bellevue. The Service Users Guide could be improved further, so that it is easier for people to read and understand, and so that it shows what the home is like for the people who live there. Care Homes for Adults (18-65 years) Page 18 of 36 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 . The people who live in the home are involved in their own care planning and are consulted on their lives in the home. Evidence: We met three of the people who live in the home, and one person told us about their life in the home. This person told us about the support the staff provide so that they can buy and cook their own food. They said that they are able to make decisions and choose what they want to do, and they are able to make their views known. One example of this was that the person said that the sitting room is cold, and the manager provided an additional heater. They then told us, Its alright here. Portland Care Homes has a Person Centred Planning Book that involves each person in writing their own care plan and making decisions and choices about their lives in the home and the support that they need. We looked at two care plans, and used them to track the care and support that is provided for the people who live in Bellevue. All the care plans have been reviewed and revised since the last inspection. The care plans are clearly written, with good details of each persons needs and procedures and Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: guidelines for meeting those needs. They are written in a more positive and person centred manner than previously. For example, one person has a care plan for managing their behaviour which is clearly written , and was agreed by the person concerned. The format of the care plans describes the need to be met, the persons goal for meeting the need, and the route and actions for the staff to follow to support them to achieve their goal. The risk assessments that we saw include a management plan for supporting the person to achieve the activity and manage any risk involved. Examples of the risk assessments we saw were for epilepsy, road safety and smoking. There is also a missing person procedure for each person, with individual protocols for the actions to follow if they do not return to the home when they are expected. Care Homes for Adults (18-65 years) Page 20 of 36 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 people who live in the home are encouraged to make choices for their activities, and the staff support them to develop their skills for independence. Evidence: Three of the five people who currently live in the home attend day care during the week. No one attends college or any other form of education. One person has no programme of daytime activities in the home or in the community by their own choice, and the staff support them with skills for independence in the home. Another person has started to attend a day centre one day a week since the last inspection, and to be involved with social activities at a church social club. The care plans include a section on independent living skills, and people are asked what they would like to do. One person said in their annual review that they would like to do more in the home, and specifically in the garden of the home. The manager reported that this is planned for when the weather improves. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: Everyone is encouraged to keep in touch with their families. One person was away from the home, staying with a relative, at the time of this inspection. The staff liaise with the relatives of the people in the home, and encourage and support them to be involved in their relatives activities. The menus on display in the kitchen show that there is a cooked meal in the evenings, and at lunchtime on Sunday, and people choose individually what they would like for lunch and breakfast. Two people buy their own food, and they are given a budget by the home for this. One of these cooks the ready made meals that they have chosen, and the staff cook the main meals for the other people in the home. This person told us that they can choose whether to join in the communal meal or to cook their own choice of food. On the day of the inspection Fishermans Pie was on the menu, but instead everyone decided to have take-away fish and chips. Care Homes for Adults (18-65 years) Page 22 of 36 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 staff support people to maintain their health needs and to consult other medical professionals. However they are not proactive in promoting good healthcare for the people in the home. Evidence: The care plans contain good details of each persons care needs. The healthcare records seen included references to hospital visits, and contact with GPs and other health professionals. These include the psychiatrist and community nurses. Everyone who has contact with the psychiatric services has regular CPA (Care Planning Assessment) meetings. The CPA report for one person stated that there had been a positive outcome to their care plan since moving to Bellevue. This improvement has meant the person is no longer under the restrictions of a Guardianship Order. Although the care plans contain good records of the care and medical assistance that everyone has, the practices in the home are not proactive in addressing any health needs. When we visited the home in October 2008 we saw evidence that peoples weight was monitored regularly as a tool for monitoring good health. One person was encouraged to eat more healthily, and did not buy and eat so many sweets. They were also encouraged to walk in the park or garden, and they lost some weight due to this Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: programme. However during this inspection we noticed that the person had put on weight again. The manager said that the weather has not been good enough for them to walk in the garden, but they were planning to join a gym in January. However in the meantime the persons increase in weight may cause a risk to their health. Another person had lost 9lb in weight over two months, but there were no actions in place to address this. The manager said that their weight would be checked at the diabetic clinic soon. There was no recognition in either of these situations of the duty of care of the service towards actively promoting their good health. The home has systems in place to manage peoples medication safely. All the staff have training in administering medication, followed by supervision until they are judged to be competent to administer medication without supervision. We checked the medication records for the people who we were case tracking. The records were free of errors, with no signature gaps found on the MAR (medication administration record) charts. However one medicine did not tally with the amount recorded on the MAR chart. The stock of the medicine was not clearly recorded on the MAR chart, which meant that it was not possible to carry out an accurate audit and to judge whether an error had been made. Care Homes for Adults (18-65 years) Page 24 of 36 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 complaints procedure is not written in a format that the people who live in the home can understand and follow. This means that they may not be confident that their concerns will listened to. The procedure for whistle blowing does not encourage the staff to carry out their responsibility for reporting their concerns. As a result, the people in the home may not be fully protected from the risks of abuse and neglect. Evidence: When we visited the home in October 2008 we saw Portland Care Homes new procedure for safeguarding vulnerable people. It contained clear guidelines, including the Hertfordshire interagency procedures and contact details for reporting allegations. On this occasion we saw the whistle blowing policy (Making a protected disclosure) in the staff handbook. This contains the procedure for reporting any concerns to the manager or to an appropriate external organisation. However it also states that, if the procedure has not been invoked in good faith (eg for malicious reasons or in pursuit of a personal grudge) then it will make you liable to immediate termination of engagement or... lesser sanction. This is a punitive attitude that nay not encourage people to carry out their responsibilities of reporting concerns. However the staff who we spoke to confirmed that they would report any concerns to the manager. All the staff have had a full days training on safeguarding vulnerable people within the last nine months as part of the Portland Care Homes three day mandatory training course. No complaints have been made to the home since the last inspection. We looked at Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: Portland Care Homes new complaints procedure. It has been written as procedure for staff, and needs to be rewritten with clear procedures for the people who live in the home. It needs to be provided in an easy read format so that the people in the home can understand and follow it. Care Homes for Adults (18-65 years) Page 26 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provides a comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene that protects people from the risks of the spread of infection. Evidence: Bellevue is a mid terrace family style house. It looks no different from the other family houses in the street. It is within walking distance of local shops and services and is not far from Watford town centre. The home employs a part time cleaner and the home appears to be clean and well maintained. The kitchen has been refurbished since the last key inspection, and there is a rolling programme of redecoration throughout the home. The laundry is outside of the home, in an outbuilding in the garden. It contains suitable equipment, including a washing machine with a sluice programme. Liquid soap and paper towels have been provided in all the toilets and bathrooms, to prevent any risks of spread of infection. Care Homes for Adults (18-65 years) Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who live in the home are supported by a stable staff team. The training provided by the company may not provide them with sufficient skills to understand and meet the needs of the people who use the service. Evidence: When we visited the home in October 2008 we found that there was a separate staff team for Bellevue, and no one also worked next door in Bel-Air. The staffing rota showed that there were two staff on duty throughout the day, and one at night. No one worked excessive shifts or hours. One of the support workers had been promoted to deputy manager, and the manager was not included in rota, but was available to assist if needed. The deputy manager left the home two days before this inspection, and the manager was included on the staffing rota. Some staff worked day duties and night duties in the same week. The manager said that this was a temporary measure until they could recruit more staff. Four new staff were recruited in December, but for various reasons three had withdrawn. The member of staff who we spoke to said that they are offered overtime, but they can refuse it if they wish to. We discussed with the manager the need to maintain the levels of staff, if necessary by using agency staff, in order to avoid the risks of staff working excessive hours, as they have in the past. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: We did not look at staff files on this occasion, because no new staff have started to work at the home since the last inspection. When we visited the home in October 2008 we saw the file for a new member of staff. It contained all the information that is required to confirm that the person is suited to work in the home. However there was no evidence of a photo ID, and no photograph of the person. The manager said that there are no current photographs of any of the staff in the home. This is required as a confirmation of their identity. Photographs can also be used to help the people who live there to know who is working there. Four of the seven staff in the home have a qualification at NVQ level 2 or above. Since March 2008 everyone has completed a three day training for Portland Care Homes that covered all the mandatory health and safety training. It also included training in safeguarding and in basic first aid. The certificates for the most recent training sessions have not yet been sent to the home, and the manager was not able to confirm that the training, particularly in moving and handling and food hygiene, was properly certificated and carried out by people who were qualified to do so. He said that he would give us the details of the training, but we have not yet received this information. The home has no qualified First Aiders on the staff, although everyone has training in basic first aid as part of the mandatory training. As Bellevue is a small home, it may not be necessary to have a qualified First Aider on duty at all times. However in this case, a first aid risk assessment must be carried out that includes the needs of the people who use the service, how likely it is that first aid will be needed, and what kind of first aid will be required. Four of the seven staff have completed a two day training in mental health and learning disabilities, and one is booked for the training in March 2009. All the staff who work in the home need to have this training so that they have the knowledge to understand and meet the needs of the people who live in the home. We made a requirement to this effect in the last inspection report, and we have extended the deadline for meeting this. The manager carries out supervisions with each member of staff every two months. We saw a supervision record that showed that supervision includes discussion of current work and training needs. Care Homes for Adults (18-65 years) Page 29 of 36 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 . The manager is not sufficiently aware of the quality of training provided for the staff, and of possible risks to the health of the people in the home. This may result in a poor quality of care for the people who live in the home. Evidence: The manager has worked at Bellevue for many years and he has a level 4 NVQ in management and in care. He is also the Registered Manager for Bel-Air, the sister home next door to Bellevue. When we visited the home in October 2008 we found that the manager and staff had worked hard to improve the quality of care provided in the home, and we were satisfied with the progress that had been made towards meeting all the requirements from the last key inspection. However the proprietors did not attend a meeting that had been agreed, to discuss the outcomes from the inspection report with CSCI. On this occasion the manager was unaware of the quality and outcomes of the training that the company provides for his staff (see Staffing). In October one of the support workers had been promoted to deputy manager, and the manager was not included in rota, but was available to assist if needed. The deputy manager left the home two Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: days before this inspection, and the manager was included on the staffing rota. The manager said that this is a temporary measure due to staff shortage (see Staffing), and that the process of recruitment for a new deputy manager would be starting in the near future. The home maintains appropriate records for the health and safety of the residents and staff in the home, including monitoring hot water temperatures, checks of fire equipment and regular fire drills. All the staff have training in moving and handling, fire safety, food hygiene and infection control. (But see Staffing for our concerns about the quality of the training.) The fire service visited the home in October 2008 and recommended additional equipment for some areas of the home that were unprotected. This equipment has been put in place. Portland Care Homes has introduced a procedure for monitoring the quality of the services it provides. Questionnaires will be sent to residents, relatives and other stakeholders in January 2009, and the manager will analyse the returns and write a report on the outcomes. This report should be sent to CSCI. The questionnaire for the people who live in the home has detailed questions on all aspects of life in the home. However it is not written in an easy read format so that people can understand and complete it independently or with minimal support. The manager said that key workers will assist people to complete the questionnaire. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  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 35 18(1)(c)(i) All staff who work in Bellevue 02/04/2009 must have an appropriate training in understanding mental health needs and learning disabilities, so that they can provide a good quality of care and support for the people who live there. Care Homes for Adults (18-65 years) Page 32 of 36 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 Description 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 Description Timescale for action 1 19 12 There was no evidence seen 02/03/2009 that action is taken on recorded changes in weight. Appropriate actions must be taken following a recording of abnormal weight change, and the actions and results must be recorded in the care plan. Monitoring of weight is an indicator for maintaining good nutrition and good health. Loss of weight and increases in weight may be indicators of a change in the persons health. 2 20 13 Measures must be put in place to ensure that medication is audited effectively, and that any errors in medication are noted and rectified without delay. 02/03/2009 Care Homes for Adults (18-65 years) Page 33 of 36 This will make sure that everyone has the care and medication that they need in a safe and effective way. 3 22 22 Arrangements must be made 02/04/2009 to produce an appropriate complaints procedure for the service. This should provide details of how the people who use the service and their families can make any concerns or complaints known, and the procedures for investigating and acting on any complaints. The complaints procedure must be produced in a format the the people who use the service can understand. The people who use the service should be sure that they can make their concerns known, and that their concerns will be acted on. 4 34 19 A recent photograph of each member of staff must be kept in the home, as required by Schedule 2 of the Care Homes Regulations 2001. 02/03/2009 Photographs of the staff provide evidence of their identity. This provides assurance that they are fit to work with the vulnerable people who live in the home. 5 35 13 The manager must carry out 02/03/2009 a first aid risk assessment to decide how many first aiders should be on duty and the kind of training they need. All training in first aid must Page 34 of 36 Care Homes for Adults (18-65 years) be provided by a person who is qualified to do so. The risk assessment and training will make sure that the staff can provide appropriate first aid when the people who live in the home need it. 6 35 13 All staff must have a certificated training in moving and handling. 02/04/2009 This will make sure that the staff practice good techniques so that there is no risk of injury for the staff or for the people they support. 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 23 The company should provide clear procedures on whistle blowing that encourage members of staff to report any concerns about the the safety and welfare of the people who use the service. Care Homes for Adults (18-65 years) Page 35 of 36 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. 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. 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