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Inspection on 15/01/09 for British Home and Hospital for Incurables

Also see our care home review for British Home and Hospital for Incurables for more information

This inspection was carried out on 15th 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 7 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

Residents were observed to be treated with respect by staff and to have their privacy and dignity respected. Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them. The home has a training plan and intends to train its staff in health care to achieve accreditation. The home`s recruitment procedures protect the residents through vigorous staff vetting. Comments from residents were generally positive, with indication that staff are kind and helpful in meeting their care needs.

What has improved since the last inspection?

All care plans have been reviewed and updated accordingly including the risk assessments. The health needs of the residents are now being reviewed regularly. A wide range of activities is provided within the home to interest and stimulate residents. By attending training in a number of areas staff have refreshed their skills and knowledge to ensure they meet the needs of people using the service. The current recruitment practices are robust, and should ensure the safety and well being of people who use the service.Progress has also been made with regards to staff supervision.

What the care home could do better:

The practice for administration,recording,storage and disposal of medication is inadequate and potentially places residents at risk and this must be improved. There must be sufficient staff on duty at all times to meet the assessed needs of people who use the service. The health, safety and welfare of residents must be promoted and protected so far as is reasonably practicable.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: British Home and Hospital for Incurables Crown Lane Streatham London SW16 3JB     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: Mohammad Peerbux     Date: 1 5 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. 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 03000 616161 (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: British Home and Hospital for Incurables Crown Lane Streatham London SW16 3JB 02086708261 02087666084 chris.morland@britishhome.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): British Home and Hospital for Incurables Name of registered manager (if applicable) Christine Lilian Morland Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 127 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home The British Home & Hospital for Incurables (BHHI) is a voluntary care home for 127 people. It is a registered charity with a Board of Management. BHHI provides purpose built accommodation for people who are chronically sick and physically disabled. The aim of the home, highlighted in the statement of purpose is: to provide high quality nursing care with high levels of clinical and recreational support thereby assisting each resident to achieve maximum possible independence. BHHI is 5 minutes from local shops and near to all the local transport facilities. It is close to Streatham Common Care Homes for Adults (18-65 years) Page 4 of 30 care home 127 Over 65 0 127 Brief description of the care home and a short drive from all the amenities in Streatham. This a large Victorian building, which has a distinctive presence in the area. It is maintained to a high standard and an extension, which was built in 1996, is in keeping with the existing building. There are two units on each floor known as East and West Wing. The newer wing created 48 single rooms all en suite. A kitchen was completely rebuilt in 2001 where the food is cooked and brought to each floor in portable Bain Maries. The Home has a physiotherapy department with two full-time physiotherapist and two full-time physiotherapy assistants who see all people who use the service. 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: This unannounced visit to the home was undertaken by three regulation inspectors as a part of the inspection process for the year 2008/2009. In writing the report, consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints.Some of the residents were spoken to and they commented positively on the care they were receiving. One resident stated Its alright living here the people are nice,the food is very good, there is always something that I like.Another comment from a resident was Theres nothing I dont like about this place. They are all thanked for their time and all of those who provided feedback for their support in the inspection process. A tour of the building was also carried out. Care Homes for Adults (18-65 years) Page 6 of 30 All registered adult services are now required to fill in an annual quality assurance assessment (AQAA) .It is a self-assessment that the provider (owner) must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. Some information from this AQAA is included in the report. 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 –03000 616161. Care Homes for Adults (18-65 years) Page 8 of 30 Care Homes for Adults (18-65 years) Page 9 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 10 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. People are only admitted into the home after a full assessment of their needs has been undertaken. Evidence: The people who come to live in this home are admitted because they have a chronic illness or disability,which means that they could not be supported to live independently. Many of them live here for some years, in one case up to forty, so it is important that the placement is suitable for their needs. The home recognises the impact that this admission will have on the lives of the residents and there are procedures in place to ensure that the placement will be suitable. Residents and their families are able to visit the home,meet the manager and staff and discuss various aspects of the home to help them decide if they would be happy there. One resident told us that they were able to spend a night there saying I came for the night and have stayed for 10 years .No one is offered a place until a full assessment has been carried out either by the hospital or the placing authority. We saw these in the care plans that we looked at, they were comprehensive and identified not only physical Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: needs but social and spiritual needs as well. Once the resident has been admitted to the home a senior nurse draws up a care plan with them. Their families or relatives are also involved in this process so that the resident is able to receive support according to their personal preferences. We could see that they were reviewed regularly so that any changes would be identified. Care Homes for Adults (18-65 years) Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents all have an individual plan of care reflecting their needs and choices, which is reviewed regularly. They are encouraged to make decisions regarding their care and the home aims to maximise every opportunity to promote their independence and mobility. Evidence: Previous inspections highlighted shortfalls in the care planning process. At this visit there was evidence to show that a great deal of work has taken place to improve them.We looked at eight care plans of people that we had spoken with during the visit. We also looked at two of residents who had not been able to speak with us due to their disabilities.All of the care plans that we saw were very comprehensive and addressed residents personal and social support needs in great detail. We could see that both they and their families had been involved in compiling them, and that they were being reviewed regularly so that any changes were identified. A named nurse and key Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: worker system is in place and staff told us that this helps them to build relationships with residents and to get to know them better. There was information regarding residents previous employment and family and personal relationships to help staff understand more about them and also about their personal preferences with regard to activities, hobbies and the food that they enjoy. Residents confirmed that they are supported to make choices within their daily lives. Some of them have independent advocates to help them.Regular reviews take place with the sponsoring authority to ensure that the placement remains suitable for the resident and that the resident is happy with the Home. We saw that there are risk assessments in place and any restrictions on choice or freedom are discussed and agreed with residents. Residents have been able to decide who should be able to open their post and also who they agree to share their care plans with. Assessments in place include those for moving and handling, nutrition, continence, and pressure sore development risk. A designated financial department provides assistance for those residents who need it. This ensures that financial affairs are independent of any nursing and care staff and that there is confidentiality with regard to these issues.Staff follow the policy on confidentiality and written information is held in a secure manner. Review meetings and best interest meetings are undertaken in a private room. 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. A wide range of activities is provided within the home to interest and stimulate residents. They are supported to maintain contact with their family and friends and to be a part of the local community. The meals provided are varied and nutritious. Evidence: The home has an activities schedule in place that offers activities to residents on a daily basis in the morning and afternoon. The sessions are run with the help of volunteers and advertised on boards around the home. They take place on the lower ground floor where there is a large amount of available communal space and include quizzes;indoor bowls reminiscence, bingo, karaoke and coffee mornings. Regular entertainers visit, there is a concert hall within the home, and there are celebrations for festivals such as Easter and Christmas. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Residents spiritual needs are met. There is a chapel within the home and there are regular visits from church representatives from all denominations. Some residents are able to attend churches outside the home. There is also a computer room and residents have been able to develop keyboard skills and some are able to do on line shopping. One of the organisers told us that when new people are admitted they allow them a while to settle in and then go and sit and talk with them to see if they have any particular interests. They told us that the bowls sessions are particularly popular and often become very competitive. Personal grooming is also given a high priority, one lady told us that she was able to get manicures, facials, and the hairdresser could even do hair extensions and highlights. She also said that there was a visiting shop to give her the opportunity to buy clothes and shoes. Some residents are able to visit local shops, restaurants and pubs and this is encouraged. Next to the home there is a primary school and the children come into the home from time to time, for example at Christmas to do carol singing and put on their nativity play. Discussions with residents confirmed that staff respected their rights, for example by knocking before entering their rooms. Their post is not opened unless they have given permission and they are able to receive visitors as they wish. The staff that we saw and spoke with seemed to have a good relationship with residents who all spoke very highly of them. All of those residents that we spoke with told us that the food was very good and that there were always alternative choices available. Cultural needs are considered and dishes associated with nationalities other than British are also served regularly. 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. Residents healthcare needs are being addressed and they are supported in the way that they prefer. However the practice for administration,storage,recording and disposal of medication is not always consistent and could potentially place residents at risk. Evidence: The people that we spoke with told us that they are supported in the way that they prefer and that staff are very kind and caring. As far as possible personal care is delivered in residents own rooms and they choose how and when this happens. There is a range of equipment available help staff to maintain personal hygiene and to prevent the incidence of pressure sores. The care plans provide details of residents preferences and care is provided by both care staff and trained nurses. There is a key worker /named nurse system in place to help to promote continuity and consistency and many of the staff have been employed in the home for some time and are familiar with residents needs. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: The care plans provide evidence that all aspects of residents lives are considered and are being addressed. They are supported to attend appointments in hospital to access specialists such as neurologists and psychiatrists and there is also input from nurses from the Primary Care Trust who provide expertise and training as well as chiropodists, dentists and opticians. Most residents attend regular physiotherapy sessions, which are provided on site. The majority of residents are reliant on wheelchairs and these are maintained and adjusted regularly. It was positively noted that the home actively promotes the residents right of access to the health and remedial services that they need, however there were concerns with regards to medication standard which could have an impact on the residents health. The medication administration records were audited. There were several instances where prescribed medication had been omitted or administered but signed or not signed for. In all cases where medication is not given as prescribed, staff must ensure that they record the reason for this. The current practice and lack of adequate recording potentially puts people who use the service at risk. The administration/nonadministration of all medication must be recorded accurately at all times for the health and safety of residents. During the inspection it was also noted that some items of medication were out of date. All items of medication must be within their use by date so that residents are not put at risk. There were also some items of medication not labelled. Again all items of medication must be labelled with the residents names to avoid any mishandling and to ensure residents are not put at risk. No records of disposal for some items of medication were available. The home must keep a record of the disposal of all medication to avoid any mishandling. We also found that some items of medication were being kept above the recommended level of 25 degrees Celsius.The room temperature where items of medication were kept was 27 degrees Celsius at 14:50 hrs. The Commission is concerned that despite medication audits being carried out on a regular basis to check if staff had signed the MAR sheets, those missing signatures/errors were not identified. Due to our concern, the registered manager informed us that an assessment/training would be carried out to ensure each member of staff is competent to handle, record and administer medication properly. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: This service is a care home (nursing) which employs registered nurses. The Nursing and Midwifery Council (NMC) Code of Professional Conduct requires each nurse to be individually accountable for making sure that all medicines are administered correctly. All staff must make an accurate record, immediately after observing a resident taking or refusing their medicines. Care Homes for Adults (18-65 years) Page 19 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. Complaints are generally managed well, which should ensure that residents and relatives concerns are listened to. Evidence: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The home has a complaints procedure that meets the national minimum standards and regulations. It keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The organisation regularly monitors complaints and how they are managed through their quality management and auditing tools. The home understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. Staff receive regular training in vulnerable adults protection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally hygienic and clean, homely and comfortable; this environment therefore facilitates the residents health and emotional well being. Evidence: The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The home is kept clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. There is clear separation of laundry, cooking and bathing facilities. Care Homes for Adults (18-65 years) Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general, the staff team within the home have a range of experience and expertise to support the needs of people within the home. The staff team are well supported in terms of training which in turn assists people living within the home to lead fulfilling lives. The current recruitment practices are robust, and should ensure the safety and well being of people who use the service. There are periods of time when the levels of staffing are not sufficient to meet the assessed needs of people who use the service and could therefore be affecting the well-being of people within the home. Evidence: In general, it appears that the staff teams on the units are stable and experienced; only five members of staff have left the home in the last year. The home does not use agency staff, instead using the existing staff team or bank staff to cover any shortfalls, this is positive for the people who use the service. We examined eight staff files, including two of the most recent employees. There was Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: a clear distinction between the files, on the earlier files some appropriate information had been gathered, however there was no evidence of references having ever been taken up. This issue was discussed with the current manager, who stated that the practice had been just to telephone referees. The current practice is much improved, recent files included completed application forms, two references, copies of identification documents and enhanced Criminal Records Bureau checks (CRBs). In addition, there is also a policy of telephoning referees to confirm the information they have given on the references. We noted that some CRBs had been completed in 2003, this issue was discussed with the manager. We were informed that the home is now in the process of renewing CRBs every three years, currently the home is renewing between thirty and forty on an annual basis. This is seen as good practice. In respect of staff training, it was evident that there has been much improvement in this area since the previous inspection. A staffing matrix has been developed which lists all the care staff and what training has been undertaken. There are mandatory courses which have to be completed on a regular basis, these include training on the Protection of Vulnerable Adults (PoVA), health and safety, fire, manual handling and medication. Staff were able to confirm the levels of training, which they stated exceeded the minimum of five days per year, which is required by the National Minimum Standards. Staff also stated that other courses of interest were available such as Person Centred Planning and a one day course about Parkinsons disease. The homes Annual Quality Assurance Assessment stated that 66 of care staff had completed, or were in the process of completing, the National Vocational Qualification Level 2 or 3. As a result the home continues to meet the target specified in the National Minimum Standards that 50 of care staff should achieve NVQ. Levels of staff supervision were examined and discussed with staff. It appears that in general, staff are being appropriately supported with supervision taking place every six weeks. On one of the units, it appears that supervision maybe occuring less frequently; The manager was asked to look into this issue. The home has started to introduce work performance reviews and personal development plans for each member of staff, this is in the initial stages of development and it is envisaged by the manager that this will occur on a three monthly basis. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: In relation to staffing levels, each unit has a slightly different level dependent upon the number of people who are on the unit. For example, first floor, East has eighteen people who use the service, three care staff and one qualified nurse. A number of staff stated that they felt that there were not enough staff on duty at any given time to give people who use the service the level of care that they would have liked. The example given was that if a carer was unwell, then there is seldom a replacement and the nurse on duty would cover the care. However, this was not raised by people who use the service. We did observe that whilst on one of the units, during the handover period, there was only one member of staff on duty for a half an hour period; this was to provide care to eighteen people. During discussions with staff it was apparent that this was not an unusual situation. This level of staffing is not sufficient to support the assessed needs of people who use the service, and could potentially be putting people at risk. Therefore a requirement has been made that the units at all times must have sufficient staff on duty to support peoples assessed needs. 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 home management generally provides guidance and direction to staff to ensure residents receive consistent quality care. There is a quality monitoring system and this ensures the home is run in a way that is in the best interests of the residents.However the health, safety and welfare of residents and staff are not always being promoted/protected and this potentially places them at risk. Evidence: The registered manager has the required experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. There is a strong ethos of being open and transparent in all areas of running of the home. Effective quality assurance and quality monitoring systems, based on seeking the views of residents, are in place to measure success in meeting the aims, objectives and statement of purpose of the home. The AQAA was received and contained clear, relevant information that was supported by a wide range of evidence. The AQAA lets Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: us know about changes the home has made and where they still need to make improvements. It shows clearly how they are going to do this. Records with regards to health and safety are generally of a good standard however it was noted that one fire door was propped open by a wedge and another fire door was not closing fully.Fire doors must not be wedged open unless held open by a magnetic door holder that responds to the fire warning system. It is recommended that the home carry out a risk assessment on all uncovered hot pipes in the building for the safety of residents. 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 20 13 All items of medication must 29/01/2009 be kept at the recommended temperature level. For the safety of residents. 2 20 13 All items of medication must 29/01/2009 be within their use by date. So that residents are not put at risk. 3 20 13 All items of medication must 29/01/2009 be labelled with the residents names. To avoid any mishandling and to ensure residents are not put at risk. 4 20 13 The home must keep a record of disposal of medication. To avoid any mishandling of medication. 29/01/2009 5 20 13 The administration/nonadministration of all medication must be recorded accurately at all times. 29/01/2009 Care Homes for Adults (18-65 years) Page 28 of 30 For the health and safety of residents. 6 33 18 There must be sufficient staff on duty at all times To meet the assessed needs of people who use the service. 7 42 13 Fire doors must not be wedged open unless held open by a magnetic door holder that responds to the fire warning system. For the safety of staff and residents. 29/01/2009 13/02/2009 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 42 It is recommended that the home carry out a risk assessment on all uncovered hot pipes in the building for the safety of residents. 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. 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