Inspection on 27/01/09 for Downing View

This inspection was carried out on 27th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Downing View 28/03/07

Downing View 27/01/06

Downing View 15/10/05

Downing View 14/01/05

Downing View 25/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Downing View 1-3 Loring Road Dunstable Beds LU6 1DZ     The quality rating for this care home is:   two star good 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: Nicky Hone     Date: 0 5 0 2 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.csci.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: Downing View 1-3 Loring Road Dunstable Beds LU6 1DZ 01582604416 01582670226 downingview@bedscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bedfordshire County Council care home 2 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Age: 18 - 65 years Category: Learning Disability Gender: Male & Female No of residents: 2 2 Period of stay: Respite only - up to a maximum of 6 weeks Until reprovision of this service takes place, the premises must be safe, and meet the service users` individual and collective needs. Date of last inspection Brief description of the care home Downing View is a respite service located on the outskirts of Dunstable. The accommodation and grounds are owned and maintained by Aldwyck Housing Association, with Bedfordshire County Council providing the staffing and care support. The long-term plan for this service is re-provision. This is because the building does not meet the National Minimum Standards for Younger Adults (18-65) environmental requirements. It is hoped that the service will remain in the local area. Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home The accommodation comprises of a small flat, which provides respite care for up to 2 adults with learning disabilities at any one time. Stays are limited to a maximum of six weeks. There are two single bedrooms, a shared kitchen, bathroom (with shower facilities only), and living/dining area. The accommodation would not meet the needs of people with a severe physical disability. Community facilities and shops are a short distance from the home, which is also in easy access of local transport routes. There is ample parking to the front and rear of the property, and there is a small enclosed garden. 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: two star good 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: For this inspection we (the Commission for Social Care Inspection) looked at all the information that we have received, or asked for, since the last key inspection of Downing View. This included: - The AQAA (Annual Quality Assurance Assessment). The manager had sent us a completed AQAA in November 2007, and updated it for us a few days after the inspection, as we asked him to do. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live and stay here. The AQAA also gives us some numerical information about the service; Care Homes for Adults (18-65 years) Page 6 of 30 - Surveys which we sent to the home to give to people who live and stay there, their relatives/carers and to staff. We received no replies; - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; and - Information we asked the home to send us following our visit. This inspection of Downing View also included a visit to the home on 27/01/09. We spent time talking to the manager, area manager and the staff on duty. We looked round the home and spent time observing what happened when people arrived from their day services. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. What the care home does well: What has improved since the last inspection? Following our last inspection we made 4 requirements and all of these had been met. Each person now agrees a contract with the home; peoples money is dealt with properly; a representative of the provider visits the home and writes a monthly report; and all the required policies and procedures are in place. In the AQAA the manager summarised some of the improvements made in the past year. These include: support plans are now more service user friendly and more customer focused; staff have received a lot of training; the range of activities has increased; the range of visual aids to assist people to make choices has increased; and the service is starting to focus on independence skills training. Care Homes for Adults (18-65 years) Page 8 of 30 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available about the service for people thinking about staying here, and thorough assessments are carried out so that people know the home can meet their needs. Evidence: Downing View respite service has a Statement of Purpose, and a Service User Guide (SUG). The SUG is available in an easy-read format, with photographs and symbols. The manager also has a version, made up of a few large laminated photographs, to take with him when he meets people wanting to use the service for the first time. This has also been produced in a pocket-sized version, which is adapted to suit each individual persons needs. These documents, and other information which people might like to read, for example the latest CSCI report, are kept in the living room. The home is very thorough in collecting all the information staff will need so that they can support each person properly, and the manager said that no-one is admitted for a stay until all the paperwork is in place. This includes a full assessment of the persons Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: needs, risk assessments, care plan and any guidelines that are needed, for example management of a persons epilepsy. We saw all this in place on the files we looked at. Each person also agrees a contract with the home. This has been designed in an easyread way, with photographs and large print, and each person (or their representative) has signed their contract. Downing View is a very small building, so is not suitable for people with severe physical disabilities. Most of the time there is only one member of staff with the two people staying here, so staff are careful about which two people are staying at the same time, for example, it would be difficult to offer a good service if both people need a lot of personal care, as there would be less time for activities and so on. Some of the people who stay here have asked if they can stay at the same time as a friend, so staff try to accommodate this request. Staff are also using the planning your stay document to plan future stays, and admit two people together who enjoy the same activities. 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. People have been involved in putting together their support plans and risk assessments which are clear and detailed, and give staff good guidance on the way each person wants to be supported. Evidence: Each person who stays at Downing View has a detailed support plan in place, covering all aspects of their life. The manager told us that everyone is involved in putting their plan together, and one person wrote hers completely. Written using I, the support plans are written in a very person-centred way. There is a lot of detail in the plans, so the staff team is now working on creating a profile which will give a brief overview of the plan. An alert page has already been introduced and placed at the front of each file so that essential information, for example if the person has any allergies, or has epileptic seizures, is immediately obvious. One of the people staying at the home was happy to show us her file and talk to us Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: about it. The plan was full of information about her, some of which she had written herself. It included her likes and dislikes, what she likes to do, how she likes to be supported and so on. The manager explained that Bedfordshire County Council employs a small group of people who are working to develop person-centred planning across all services and the staff team at Downing View are working with them. The files we looked at contained an easy-read explanation of what a risk assessment is, and why they need to be done. Both people had signed to say they understood this, and one person had written a number of the assessments herself. Risk assessments had been completed for a number of risks each person might encounter, with clear, detailed guidelines on how the person is to be supported so that their independence is maximised but the risks minimised. One person showed us that they have a key to their room, and they had helped to write the risk assessment about this. 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. Staff are working hard to increase peoples skills so they can be more independent, and to make sure people have opportunities for activities so their stay at Downing View is interesting and fun. Evidence: Staff at Downing View have started completing independence assessments. These are based on two areas: peoples skills in the kitchen and their skills doing laundry. The assessments look at what the person wants to do, and what they need to do to achieve their goals. One person staying at the home when we visited completed an assessment of kitchen skills during the inspection. Each person who stays at Downing View for more than one night is offered the opportunity to complete a planning your stay document. Not everyone chooses to do Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: this, but one person, who was staying at the home for 3 weeks, showed us her plan for the first week, and explained that she had filled it in with all the things she would like to do while she is there. People are also encouraged to complete a reviewing your stay document when they leave, to look at whether they were able to stick to the plan, and how much they enjoyed what they did during their time at the home. This is then used to try and make their next stay even better. Menus are planned by people when they arrive, and if they are staying for a few days they might choose to help with the shopping. Everyone has a choice, and very often the two people will choose different meals. On the day we visited both people wanted sausages but one person wanted mash and gravy and the other person chose to have pasta with the sausages. Some of the people who stay at Downing View are able, and willing, to help in the kitchen with the preparation and cooking of the meal. The staff have started a recipe of the month, which is written in an easy-read format, with pictures, and displayed on the kitchen wall. People can choose to try the recipe if they want to: this month it was banana cake. The home has also got a bread-making machine. People have been very proud to take home a loaf of bread to their family which they made while staying at Downing View. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their personal care in the way they prefer, any health needs during their stay are met and staff administer medicines correctly and safely. Evidence: Peoples support plans contain details of the support they need while staying at the home, including with their personal care, and the ways in which they like to be supported. The two people staying at the time of our visit needed minimal support with personal care as they were both quite independent in this. Nevertheless, detailed information was still available so that staff would know this and not offer support where it was not needed. As this is a respite service, peoples main carers retain responsibility for all medical issues. However, the home gathers as much information as possible about peoples health and will seek medical advice if needed during the persons stay. The staff will also support people to attend any medical appointments that fall during their stay, if their carers are not available. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: There is an alert page, now in the front of each persons file, which highlights any medical issues that staff might need to be immediately aware of, such as allergies, and conditions such as epilepsy or diabetes. Inside one of the kitchen cupboards we saw a list of people with any special dietary needs. We discussed this with the manager who agreed that confidentiality would be better preserved if the only information was about the people who were actually staying in the home at the time. Staff assist people with their medication if needed, and each person has a contract in the medication file which they, or their representative, have signed to say they are happy for staff to administer their medicines. Medication is kept in a locked cupboard in the office. The medication file includes an explanation of what all the medicines used in the home are for, and there is an explanation of how each person likes to take their medication. At the time of the inspection only the manager and assistant manager had been trained to administer medicines. If neither of them are on duty, staff from the supported living service will come in to administer medicines. Only one of the people staying at the home takes any medicines: the Medication Administration Record (MAR) chart had been completed properly. 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. People can be confident that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. Evidence: A pictorial complaints procedure has been developed which is easy to understand for the people who stay here. It is displayed on a board in the entrance hall. The home keeps a record of any complaints. There had only been one since our last inspection. A relative had complained that the person had been given a food she was allergic to, and was not wearing a coat when she went to school. This complaint led to the support plan files being re-arranged so that the alert page is now at the front, and to the lists of peoples food allergies/likes/dislikes being in the kitchen cupboards. The home does not deal with peoples finances at all, other than keep a small amount of cash in the office safe if people or their relatives want that to happen. Some activities are planned in advance so that people know how much money they will need to bring with them. Records and receipts are kept to show what the money has been spent on. We checked the money held for the person staying for a few weeks at the home: the records and cash were correct. All the staff who work at Downing View have been trained in safeguarding vulnerable adults (SOVA). The procedure for staff to follow, and telephone numbers for them to Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: contact the right people if they suspect any abuse is happening, are clearly on display in the office. No SOVA referrals have been made. 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. Downing View is not ideal for its purpose and needs decorating so that the building offers a more comfortable place for people to stay. Evidence: Downing View respite service is a small home attached to a larger building which used to be a residential care home but is now supported living. The home has its own front door, although the entrance is not very attractive. The hallway is quite narrow, goes past the kitchen and leads to the lounge/dining room. The two bedrooms, bathroom, and office are through the lounge. Bedrooms do not have washbasins or ensuite facilities. Although very small, staff have tried to make the best use of the space available and it feels homely and welcoming. There are a lot of photographs around the home, especially in the living room. Each person has agreed that their pictures can be put on the walls, and staff said most people are really pleased to see a picture of themselves on the walls when they arrive at Downing View. On the day we visited, the home was clean and tidy, but is in need of re-decorating. We were told that this is planned and will happen shortly. The bath has been removed, Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: to make a walk-in shower room which is more suitable for the people who stay at the home. There is an agreement with the supported living house next door that people can use one of the bathrooms there if they prefer to have a bath. There is only one toilet, which staff said can cause difficulties if someone is enjoying a nice long shower and someone else needs the toilet. Without a wash basin in the bedroom, people are not even able to clean their teeth if someone else is in the toilet. This is also the only toilet for the staff. There is a washing machine and tumble drier in a cupboard in the hall. The cupboard has been fire-proofed to meet the fire safety officers requirements, and, although not ideal, means the washing machine is not in the kitchen. 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. The people who live here benefit from staff that are recruited well, and who have sufficient training, supervision and support so that they can do their jobs properly. Evidence: Usually, there is only one member of staff on duty for the two people staying, with a manager on call. However, the manager said that he requests additional staff if profiling assesses that extra staff are needed for the people staying at the time, or for the activities they have planned to do. Extra staff are on duty on Mondays when new people come for a tea visit. There are three permanent staff, and there are now three agency staff who cover any vacant shifts. These agency staff have worked at Downing View for some time, have received the training needed for the job, and are skilled at what they do. Induction of all staff, including new agency staff, takes a considerable amount of time, because the staff will be working on their own. A lot of the induction is around safeguarding, and includes the manager presenting staff with a scenario, staff giving a written response, and then a discussion taking place. Every three months the issues are reviewed at staff meetings. The manager has written a questionnaire which is given to staff a couple of months after their induction is complete, to make sure they have absorbed Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: and remembered everything they need to know. The results of this are then used, if necessary, to improve the induction. The manager feels that others do not recognise the level of responsibility the staff have, because they work alone, and their salaries do not reflect this either. We looked at the information kept in the home about staff. The information was all up to date and very well organised. There is a pro-forma in place for each staff member, including agency staff. Each has a photograph of the staff member, and the ones for the homes own staff show that all the information required by the regulations is on their personnel file, held centrally at County Hall. These had been verified by a senior manager. We spent a morning in June 2008 checking a random selection of files of staff who work across the County Councils registered services. Generally all the required information was available on the files we looked at. Some staff have been employed for many years, and started long before the current requirements were in place. The Council has worked hard to get as much information as possible, and has ensured, for example, that Criminal Record Bureau (CRB) checks have been done, and are renewed every three years. Records showed that all three permanent staff have received all the necessary training. They each have a visual staff training record so that the people who stay at the home know that staff have had the right training to be able to support them properly. One person who plans to come and stay at the home will need specialised administration of some medication. The manager said training for this is being arranged with the community nurse from the learning disability team who will train the staff before the person comes to stay at Downing View. 80 of the staff who work at Downing View (including agency staff) have been awarded a National Vocational Qualification (NVQ) in care. All staff, including the regular agency staff, receive supervision, annual reviews take place and all staff have been given a copy of the updated staff handbook. Staff meetings are held monthly and minutes kept. At the last meeting, staff did an exercise around values. The staff member we spoke with confirmed everything the manager said, for example about supervision, induction, training, staff meetings and so on. She said she felt well-supported and had received enough training (either with Downing View or the agency) so that she could do her job well. 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. This home is managed very well indeed, so that the people who stay here have the best possible experience, based on what they want to do. Evidence: The manager, Mark Edmunds, only works part time (18.5 hours a week) in managing the respite service. The other half of his full time job is as an assistant manager in the supported living service. There is an assistant manager for the respite service, but she only has 8 hours a week administration time: her other hours are worked as shifts on the support rota, when she is the only support worker for the 2 people staying, so has no time for management tasks. The manager explained that because there are only 2 people staying at any one time, this is looked on as a small service which needs far less management time. However, there are currently 38 people receiving a service, so there is a lot of work to do in planning the stays and making sure each person has all the necessary paperwork in place and up to date, as well as doing the 101 other jobs which fall to the manager. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: We spoke with the member of staff on duty, who was from an agency but had been working at Downing View for nearly a year, nearly full-time. She said the managers are very supportive, and she clearly admired the way the manager is always coming up with new ideas, and is very thorough. We were amazed that the manager, assistant manager and the small staff team have achieved so much in the time they have available. The manager is very enthusiastic about what has been achieved already, and how much more can be done to improve the service for the people who stay at Downing View. One fairly new idea in place is a monthly planner. On this the manager lists who is coming to stay for the month, which staff are keyworkers for those people, and what needs doing in the files and so on. Staff then write briefly on the planner, which is on the board in the office (so is visible and not forgotten), what they have done. This is monitored at staffs supervision. The staff member we spoke with said the monthly planner has been really helpful. A number of the things we have talked about in this report, such as the planning and reviewing your stay documents, monthly planner, support plans discussed and written with people who stay here, all form part of the homes quality assurance system. People who stay are asked for their views on how the service they get could be improved, and the staff team works out how any possible improvements can be made. In May 2008 the home sent questionnaires to all the people who use the service, and their relatives. From the responses they received, the home made 4 promises, which are displayed on the notice board in the living room: laundry, fresh fruit, transport, and friends staying together. The manager said they have kept all 4 promises. The manager also contacts each family every 6 months and offers to visit them at home to discuss what has gone well for their relative and what could be improved. Quality assurance is built into the business plan for the home, which the manager explained dovetails into the development plan. We looked at some more of the records the home is required to keep. A representative of the provider carries out a visit to the service every month and writes a report. The visit, and the resulting report, are very thorough, and highlight any areas in which the service can improve. The home notifies CSCI of any incidents that affect the well-being of the people staying at the home (although there has only been one notification needed in 3 years, and none since our last inspection). The home has a comprehensive fire risk assessment. We looked at records of tests of the fire alarm system and the emergency lighting. Tests are recorded in a log book, produced by the fire service, which makes it clear that tests of the fire alarm must be done weekly, and tests of the emergency lighting monthly. Unfortunately these had Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: been missed. Only 17 tests of the fire alarm had been done in the 52 weeks of 2008, with several big gaps, including no test between 06/05/08 and 08/07/08. There were no tests of the emergency lights recorded in the log book, which was first used on 28/08/06. We do understand that the two systems are linked to the systems in the supported living part of the building, however, the regulations require a care home to carry out the tests and keep the record. The fire alarm had been tested on the day we visited, so We made a requirement that the manager had to test the emergency lights within 24 hours. We wrote to the provider asking them to tell us how they were going to improve on this issue. Their letter was sent back to us in time, and was very clear about how the improvements would be made, and sustained. We have confidence this will happen. Care Homes for Adults (18-65 years) Page 27 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 28 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 1 42 23 Carry out tests of the fire 13/03/2009 alarm and emergency lighting systems regularly as required. A test of the emergency lighting must be done within 24 hours (that is, by 28/01/09). So that the systems work well if there is a fire, and people are kept safe. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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