Inspection on 20/02/09 for Fryers Walk

This inspection was carried out on 20th February 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

Fryers Walk 23/03/07

Fryers Walk 08/12/05

Fryers Walk 28/06/05

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: Fryers Walk 53 Castle Street Thetford Norfolk IP24 2DL     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: Ruth Hannent     Date: 2 0 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 29 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 29 Information about the care home Name of care home: Address: Fryers Walk 53 Castle Street Thetford Norfolk IP24 2DL 01842821933 01842821934 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Active Care Partnerships (Fryers) Ltd Name of registered manager (if applicable) Mrs Christine Anne Hamilton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Fryers Walk is registered to provide residential care for a maximum of 34 adults with learning disabilities, in a range of self contained units. These include 3 bungalows, 2 cottages and 2 clusters of flats (registered as one establishment). This enables accommodation of people with a range of support needs, from those requiring full physical care and support, to those who are working to achieve independence but need some assistance. Some service users have physical disabilities in addition to learning disabilities. Nursing care is not provided. Some day care is also provided, making use of facilities on and off the premises. 34 Over 65 5 care home 34 Care Homes for Adults (18-65 years) Page 4 of 29 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: This inspection was completed following a site visit carried out on the 20th February. Information used had been collected since the last inspection and included any notifications sent to the Commission, comment/ surveys completed by residents, staff, relatives and health professionals. The Manager had completed the Annual Quality Assurance Assessment and returned the document in time for the report to be written. The visit to the home lasted 6 hours with time spent looking at care plans, reports, personal files, service records, training and induction programmes, activity programmes, menus, personnel files and health and safety documents. Care Homes for Adults (18-65 years) Page 5 of 29 Care Homes for Adults (18-65 years) Page 6 of 29 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.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 7 of 29 Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 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 does have an assessment procedure that will determine if the home is suitable for each individual. Information available for potential residents is suitable and in a format that can be understood with guidance if necessary. Visits are encouraged to the home prior to admission for people to be able to test drive the home and check that the service is suitable. Evidence: The Manager shared a blank format and also a completed assessment for a resident who is already in the home. The Manager gave a clear account of the assessment process from the initial inquiry to the information gathered to make a judgement as to the suitability of this person to live at Fryers Walk. In the entrance to the home there is available all forms of brochures such as the Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: Service Users Guide and Statement Of Purpose. These have been printed in a large format and also have pictures to help people make a judgement of the suitability of the home if they are unable to read. The Manager also talked about the visits to the home so that potential residents can see for themselves what is available and for staff to get to know the person. Care Homes for Adults (18-65 years) Page 11 of 29 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 at Fryers Walk do have their needs documented in a care plan. Decisions by the residents are supported to aid empowerment. Risks are assessed and allowed as part of their independent lifestyles. Evidence: On the day of this visit care plans in one of the bungalows were looked at in depth. The documents showed clear individual details for each person. The dates for reviews were noted to be taking place monthly and annual reviews carried out by professionals involved. The two staff spoken to in this area of the home were very knowledgable regarding the residents they were caring for. They were able to reflect very clearly the individual needs of the residents. They are designated key workers concentrating on just one or two residents when up dating information or communicating with other staff. Although the care plans were very detailed, neat and professional it was not Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: clear how much involvement had been carried out with the person the care plan belongs to. Details were written in a way that says Mr A likes to have his breakfast at --- instead of I like to have my breakfast at ---. Although the information written by staff is comprehensive and care support is broken down well, it would show more empowerment if the care plan had been written as if the person had written it themselves and then signed the document as having ownership of the care plan. The home does use picture formats on other occasions and could use the same system for the care plans. The care plans are written by competent staff and it is evident by talking to residents and seeing the range of support offered that they do make decisions about how they would like to spend their lives. Residents spoken to were very animated in showing and explaining what they were doing and when. The surveys received prior to this visit also gave lots of detail about what and how the staff support them to make decisions. Each resident has a list of risk assessments that has been carried out and fully recorded (seen in the care plans) when any person may be at risk whilst carrying out their day to day life styles. Care Homes for Adults (18-65 years) Page 13 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do take part in appropriate and very varied activities. Residents are included and and take part in the local community. The home is to be commended in the wide range of leisure facilities that enhances the daily lives of the people who live there. Residents rights are respected and independence is promoted. Evidence: The residents at Fryers Walk have the opportunity to access any varied and suitable outside activities. The home has a mini bus and a people carrier to take anyone to and from their chosen place to visit. The education available outside the home is used, Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: such as life skill sessions, art classes, music sessions, IT skills and arts and crafts. The home then continues with the themes chosen by the residents to include them in their day to day support offered in the day unit in the home. The AQAA tells us of the computer now used to enhance the IT skills learnt and how residents can now keep in touch with families and friends. In the day unit it was noted just how much activity is available for each and everyone. The wipe board at the entrance is full of individual and varied day care programmes that are tailored to each person. The staff member spoken to was able to give a very comprehensive picture of all the various activities. During this visit one man was getting great pleasure out of cleaning the bus, two were writing details to each other, a larger group were doing craft, others were planning shopping. The staff have started to work with residents on their own life story books. The three seen were so detailed that the home needs to be commended on the information that had been gathered to place in these books. Fryers Walk is a variety of different properties that blend into the community with families living across the road from the houses and bungalows. The residents come and go as they wish. On the day of this visit a resident walked up the road with her Social Worker having just been to the Bank to sort out financial concerns. She was then waiting for a taxi to take her to the GPs. Lots of leisure facilities also take place within the home. The staff had recently put on a Snow White pantomime, theatre trips had taken place, horse riding and sailing had been enjoyed. The day unit is full of pictures, evidence of craft and even the painting of murals on the walls. Painting competitions have been entered in Thetford and calenders have been made for the companys calendar competition. Two of the residents talked about the planned holidays. One person is being taken in this country and some are going to Corfu. One resident told us that her boyfriend has also been invited who does not live at Fryers Walk. The AQAA, the comments received from surveys and the comments listened to on the day of this visit give a commendable picture of the variety and effort that goes into ensuring residents have a full life. Family members comments reflect the full life people lead. I would not want my son to live anywhere else and Our daughter has improved so much since moving into Fryers Walk. The residents have meals cooked with them in each house or bungalow. They have a four week menu and choice is offered. The meals are eaten in their own dining facilities. Food is stored in each kitchen area that has been purchased locally. The AQAA tells us that nutrition is monitored for people who require this form of care. Each Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: resident is weighed monthly and records (seen) are held in their files. In the day Unit there is a life skills kitchen that is used to work alongside residents according to ability. Unfortunately the cooker is not working at present at is to be replaced but simple meals can be planned such as sandwiches. Care Homes for Adults (18-65 years) Page 16 of 29 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. Residents are offered support for personal care in the way they prefer to maximise independence. Health care needs are met appropriately. Medication procedures are in place and residents are helped and encouraged to manage their own medication. Evidence: The AQAA tells us that the personal support offered to residents promotes independence, care with dignity and the privacy and respect that they deserve. The care plans, as mentioned earlier in the report, are very detailed and the staff have clear indications of the preferences of the residents. On walking around the complex it was good to see people dressed in clothes that were suitable, their hair styled and coloured if they so wished and jewellery and make up worn. In the unit that houses people with greater need, specialist equipment was noted in the bathroom. Three Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: specialist shower chairs and one shower bed had been purchased to meet the bathing needs of each individual person. The health care needs are supported by local GP practices. Two health professional comment/survey cards had been received at the Commission with comments such as I think Fryers Walk offers an exceptional service, All support is with kindness and dignity and reports are always available and detailed. The care plans have details of visits made to the hospital or GP practice and any other professional who may be involved such as the dietician, continence advisor or psychiatrist. The home promotes self medication if the resident is able to manage their own after the risk has been assessed. The Manager tells us in the AQAA, that support has been taken from Boots, to enable someone who has deteriorating sight, a method that will help them to continue to take their own medication. Each separate house, bungalow and flats have the facility to lock away their own medication. In the units where people need staff to administer the medication a locked cupboard is in each area with blister pack medication locked inside. The staff were noted wearing bibs that state do not disturb while medication is being administered. The medication is audited and staff are trained and competent before being allowed to administer medication. (Training matrix seen). Care Homes for Adults (18-65 years) Page 18 of 29 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. Residents will be listened to and any concerns will be acted upon. Residents are protected from abuse, neglect and harm. Evidence: The AQAA tells us that 5 complaints were recorded since the last inspection and that they were all managed within the timescales stated in the policies and procedures. All the comments from residents and staff told us that they feel able and do talk to the management about any concerns that they have. One relative commented This home is so much better than the last and I would have no problem in contacting the Manager if I am unhappy about anything. Another said I feel confident I would be contacted if any concerns arose. The home has a procedure for complaints that is in all the information offered to residents about the home and in a format that can be understood. The home did have to manage a difficult situation since the last inspection which did involve the Adult Protection Team. The notification about the situation was sent to the Commission and after the APU team had looked in more detail it was not necessary to pursue the case. The home acted in the appropriate manner and dealt with the issue correctly, notifying the Commission of the outcome. The home does have a whistle blowing policy and one comment from staff said they Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: would always report on any concerns they may have that may be considered abusive. The home does train the staff in the Protection Of Adult Abuse and this was noted on the training matrix. Care Homes for Adults (18-65 years) Page 20 of 29 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. Residents do live in a homely, comfortable and safe environment. Residents own bedrooms suit their needs and lifestyles. All areas of the home are clean and hygienic to ensure good infection control procedures are in place Evidence: The premises of Fryers Walk are a mixture of houses, bungalows and flats that are shared by people, who according to need and ability share with people who can live and work together. Each accommodation seen included the day unit and offices, two flats, two bungalows a larger bungalow and a house. The buildings are in good condition and suitably furnished. Some front doors are about to be replaced as they have become rotten in parts. Each house/bungalow/flat is a small family style residence and placed within the community on the edge of Thetford town. Every one is large, light and airy with plenty of space to move around. The residents can easily access the town and do often go into the centre. There is a record of servicing in each area with dates seen for Gas, Chlorination and Equipment testing. All maintenance Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: books seen are kept up to date. All the areas walked around appeared risk free and fire records looked at were all up to date with the last weekly record showing 19/02/09. The gardens are neat and tidy with various items of garden furniture ready to be use in the better weather. It was noted that the access to the garden could not be achieved by anyone who had any form of mobility problems due to each back garden door having a step down and no hand rails. To allow residents access and freedom of movement outside it would be more suitable for ramps and handrails to be available leading into the back gardens of each property. Each individual accommodation seen was furnished appropriately with each bedroom looking homely and personalised. One resident spoken to showed her budgie and was able to say she was happy in her home. Another two who live in a house together talked happily about their home and how they loved were they lived. The residents comments received ( thirteen in total) mentioned the home they like to live in. One person said I do not think I could find a nicer home. This is my home. In all areas seen the home was very clean and tidy. The staff work with the residents to manage the home they live in with clear cleaning schedules. During this visit one resident was being assisted with loading the washing machine and other laundry areas seen were very clean and tidy with each house having their own laundry facility. Care Homes for Adults (18-65 years) Page 22 of 29 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. Residents are supported by competent and qualified staff. There are suitable numbers and an effective staff team to meet the needs of residents when required. Residents are protected by the homes recruitment procedures. Staff do need to have regular supervision sessions to ensure they have the correct support to carry out their jobs. Evidence: The home has a designated training staff member who works with the staff on the NVQ programme. The staff team are encouraged to complete their NVQ qualifications and staff names of who have already achieved this was seen. Staff members spoken to talked of their training, with one who had already achieved the qualification and one who was working towards it. The Manager tells us in the AQAA that the home is proactive in securing NVQ training to ensure compliance to meet regulation requirements. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: On the day of this visit a number of residents were in different areas of the various houses with quite a number in the day unit. There are designated staff working just on daily activities with a variety of activities happening during this visit. In each area it was noted that enough staff were available to be able to sit with residents and help with these, from assisting with craft to helping a resident with daily living skills. All residents seen were motivated and smiling with lots of banter and laughter taking place. The Manager had completed the AQAA showing the number of hours allocated weekly to the home which appeared suitable. During the day three personnel files were inspected. The Manager gave a full account of the procedure for recruiting but noted, in one file, was the missing identification documentation to prove the identity of the staff member. The files are supposed to be audited but this paperwork had not been missed. The staff member it related to was contacted and ID forms were copied while we were still in the building. It would be recommended that all the personnel files are audited again to ensure nothing is missing from any staff file. All the CRBs and POVA First were in place. The training officer had files available for each staff member with copies of certificates for all training completed. There was also seen a training matrix to show what training is planned for which month. The staff spoken to and comments received from staff prior to this inspection tell us of the support and training being appropriate and suitable for the kind of knowledge required for Fryers Walk. The comments received from 11 staff all state that the support offered from management is always available but one to one supervisions are not as often as would be liked. The Manager also stated that some of the supervisions were not taking place regularly and a pattern needs to be established. Care Homes for Adults (18-65 years) Page 24 of 29 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. Residents do benefit from a well run home. The ethos, leadership and management approach benefits the residents. The home needs to have a comprehensive quality measuring system in place to review, improve and develop the service. The health and safety of residents and staff is promoted and protected Evidence: The Manager at Fryers Walk has been registered for a few years. She has completed the AQAA in detail and was able to carry out the inspection visit competently. She has achieved her Registered Managers Award and is working with the Deputy Manager to achieve his along with the NVQ 4. The home has a comprehensive folder containing all the homes policies and Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: procedures which the Manager reported are followed by the staff team. The staff team spoken to and comment/surveys received gave very positive remarks about the Manager. The Managers door is always open, the Manager is always available to talk and I was helped with my role by the Team Leader and Manager. The interaction noted on the walk around with both staff and residents showed a good relationship and easy approach with the Manager was the ethos portrayed in this home. The home and the Company who own Fryers Walk carry out regular audits each month, looking at different areas of the service. The results of these are available. The audits involving residents, staff, stakeholders and families have not been carried out recently and no collated results were available. As the home does have some form of audit system it is recommended that a fuller monitoring system of quality is carried out to assist in the development programme for the home. The training officer ensures that all staff are competent in the areas of health and safety by ensuring the induction programme includes all subjects. The training in each area is carried out as soon as possible after recruitment and is linked in with the Skills For Care induction. The water temperatures are held at the correct 43 degrees with records seen. Three different taps were tested by hand and the water was felt to be at a suitable temperature. The home has just acquired a new manual that has all the safety data sheets for all the chemicals held within the home. The staff have not had access to this new manual as yet but it was seen during this visit and appears very comprehensive and complies with COSHH regulations. A record of accidents was seen and nothing major had needed notification to the Commission. Dates of servicing that had taken place were noted. Portable Appliance Testing 20/01/09, Fire Equipment 01/06/08, Gas safety record 26/01/09, Loler testing 18/02/09, Chlorination certificate 13/10/08, Environmental Services 06/01/09. Date stamps also confirmed as correct were noted on electrical devises and fire extinguishers Care Homes for Adults (18-65 years) Page 26 of 29 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 29 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 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 6 It is recommended that the care plans are worded to show how the person has made the decisions and more I need rather than They need. It is recommended that ramps and handrails be considered for the garden access to allow freedom of movement in and out of the garden. It is recommended that an audit on all personnel files takes place to ensure all relevant paperwork is in place. It is recommended that one to one supervision is consistent and happens at least 6 times a year. It is recommended that a full quality monitoring procedure is carried out to aid the development and improvement of the service. 2 24 3 4 5 34 36 39 Care Homes for Adults (18-65 years) Page 28 of 29 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!