Inspection on 20/11/08 for Imber House

This inspection was carried out on 20th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Imber House 22/11/07

Imber House 04/05/07

Imber House 23/01/07

Imber House 06/09/06

Imber House 07/02/06

Imber House 05/07/05

Imber House 03/03/05

Imber House 16/08/04

Imber House 15/03/04

Imber House 20/10/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Imber House 412 London Road South Lowestoft Suffolk NR33 0BH 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: John Goodship Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 33 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Imber House 412 London Road South Lowestoft Suffolk NR33 0BH 01502500448 F/P01502500448 pattywebb21@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Patricia Lesley Webb Name of registered manager (if applicable) Mrs Patricia Lesley Webb Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: Date of last inspection 2 2 1 1 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Imber House is a care home for five adults with learning disabilities. The home is situated on a main road in the south of Lowestoft, close to local shops, a bus route and five minutes from the beach. It is a semi-detached building with accommodation on three floors. The people using the service occupy the ground floor and first floor whilst the owner and family have bedroom accommodation on the second floor and their private sitting room on the ground floor. The people living in the home and the family share the kitchen, utility room and dining facilities. Three people have bedrooms on the first floor and two on the ground floor. There is a garden and patio area for general use outside. The fees at the time of this inspection were £495 per week for each current resident. Care Homes for Adults (18-65 years) Page 5 of 33 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 Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home This was a key unannounced inspection. It took place over two days to allow the owner/manager to return from sick leave. It looked in particular at the outcomes for the residents. The manager was present for the second day. We spoke to two residents and two members of staff, and observed the interaction between staff and residents. We looked at two care plans and some maintenance records, and we toured the premises. Care Homes for Adults (18-65 years) Page 7 of 33 We sent out to the home some questionnaires called Have Your Say for residents, staff and relatives. We received five survey forms back from residents. The manager had also completed a selfassessment questionnaire. We have used information and comments from all these sources in this report. What the care home does well Imber House continues to provide a small group of people with a family style environment. The staff team is made up of family members as well as recruited staff and the two people we spoke to showed a good knowledge of residents needs. The surveys from residents told us that they were generally happy with the service provided. Residents comments included: I go out to the pub for a meal. I make a cup of tea. I do sewing and puzzles. Care Homes for Adults (18-65 years) Page 8 of 33 What has got better from the last inspection Four of the five bedrooms have been redecorated. The carpet in the hall and on the stairs has been made safe and was about to be replaced. The fire risk assessment has been updated to reflect the improvements to the fire detection and prevention systems. Some care plans have been written in a way that shows that residents were involved in their development, and are person-centred. Care Homes for Adults (18-65 years) Page 9 of 33 The owner/manager has agreed more realistic fee levels with the placing authorities. This will enable the home to improve its service with proper staffing levels and staff training, and environmental improvements. What the care home could do better The information available for prospective residents and their representatives needs to be updated, and must contain details of the fees, including what they do and do not cover. Risk assessments must specify how hygiene and cross-infection standards are maintained, for example, in communal bathrooms and in the catering function. Care Homes for Adults (18-65 years) Page 10 of 33 There should be an annual business plan to show how the home will progress through the coming year. Records specified in the Regulations must be available at all times for inspection for the protection of residents. The home must have a quality assurance policy for the benefit of residents. There must be a review of how some residents withdraw cash, to protect their privacy and financial safety. Care Homes for Adults (18-65 years) Page 11 of 33 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact John Goodship Commission for Social Care Inspection CPC1 Capital Park Fulbourn Cambridge CB21 5XE 01223 771 300 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 12 of 33 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 13 of 33 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 . Residents can be assured that the home will assess their needs before they come to live in the home. Evidence: We were shown the service users guide. Although this was not in a format that was suitable for some of the residents, the manager explained to us how they were trying to develop a picture based version for one of the residents. The example that we saw was dated June 2007 and had been signed by the resident. The manager told us that she encouraged relatives to go through the documents with the resident to help explain and understand what was in them. The contract we saw quoted fees which were current when the contract with the placing authority was signed. However the Commission is aware that discussions with both placing authorities in 2008 had resulted in increased fees being agreed with them to reflect the needs of the residents. The new fees were 495.00 pounds per week for each resident. We saw the pre-admission assessment and care plan for the most recent resident. It identified the key areas of personal, social and health needs. These had been used to develop the care plan. Care Homes for Adults (18-65 years) Page 14 of 33 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 can expect their needs to be monitored and reviewed to keep the support they need up-to-date. Evidence: We examined two care plans, one for the newest resident, and one for a person who had lived in the home for some years. Both plans had been written in a person-centred style, using clear statements about the persons needs and how they wished to be supported. One had been reviewed in the last twelve months. The other had not been reviewed yet. Both plans held risk assessments appropriate to the resident, such as toileting, showering, travelling in cars, going out on their own. The daily records which we saw were comprehensive in their descriptions of what each resident did each day. They gave a full picture of the resident covering their meals, activities, personal care, day centres and appointments with health staff. Residents told us that they were usually able to choose what they wished to do. Two said that they were not always able to do this at weekends. One person told us that they would like to go out more often, although they described things they did such as Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: going out to the pub for a meal. The AQAA told us that residents were encouraged to help with the shopping, with choosing what they wanted to eat and helping to prepare and clear away afterwards. One resident told us: I make a cup of tea. I do sewing and puzzles. The AQAA told us that two residents received direct payments which were used to give them one-to-one support on some days of each week. This increased the choices available to those residents, and gave them alternative activities to the day centre. Care Homes for Adults (18-65 years) Page 16 of 33 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 . Residents can expect to be able to make choices about their lifestyle and take part in activities within the community. Evidence: Residents all attended some form of organised day centre or college course on some days during the week. One resident had a part-time job with a local company. One person had a dedicated one-to-one support worker on three days a week. Another had a dedicated person five days a week. The AQAA told us that the home was making more use of public transport, and using more community facilities, such as a drop-in centre for coffee, chat and meeting new people. The AQAA also told us that the manager was trying to fund more one-to-one hours so that residents could access the community as individuals instead of as a group. Staff told us that one resident had been on holiday to the West Country, and two residents had gone with staff to Ipswich for a few days, staying in a caravan belonging Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: to the manager. The other two residents had not yet been on holiday. The manager told us she was hoping to arrange to rent a cottage so that all residents could go away for a holiday. This had proved popular in the past. Relatives had told us on previous inspections that they were satisfied with the care provided by the home. The AQAA told us that the home was trying to encourage more family participation. The AQAA told us that questionnaires would be sent out annually to families and services in the future. The home kept a good record of all meals taken by each resident. We saw fresh vegetables in the store. Staff told us that a varied diet was offered taking into account those on special diets.The care plan for one resident identified the need to encourage them to eat healthily. The staff showed us the food recording system which Environmental Health officers require to be kept. This is called Safer Food, Better Business. There were no entries in the file so there was no way of finding out if residents were properly protected. Care Homes for Adults (18-65 years) Page 18 of 33 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 can expect their personal and healthcare needs to be met. Evidence: Care plans held the health needs for each resident. These covered physical needs and, for one resident, behavioural needs. There was evidence of visits to the GP, dentist, optician, and visits from the chiropodist. Dental hygiene and foot care were issues covered in the care plans. Staff told us that one resident could sometimes become aggressive. Staff explained to us how they contained and calmed this state by removing them from the situation causing their agitation. The home had arranged an appointment with the hospital consultant to review their medication and seek advice on how better to support this person. One resident had a pacemaker fitted and needed to visit the specialist clinic for regular check-ups. Most of the residents were able to look after their own personal care needs with guidance, support and encouragement from staff. They followed their own routines, for example, when they chose to go to bed and which clothes they wore. We examined the medication records. Staff told us that none of the residents administered their own medication. There were no gaps in the signatures confirming Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: the administration of medication. The reason for any administration of PRN (as required) medication was explained on the record. This was good practice. Staff on duty told us that they had been trained, one by the pharmacy supplier and one by DVD and test papers by an external training provider. We were shown the training records of this training. One member of staff had said that they did not need to observe one resident taking their tablets as they always did. The manager accepted this was unsafe practice and would emphasis the correct procedure to all staff. The manager explained to us how the staff had supported the residents when another resident had died. Support had also been given by the day centre for two residents who had lost family members. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect to be listened to and their views acted upon. Residents cannot be assured that the financial procedures of the home fully protect them. Evidence: The home had a complaints procedure which the AQAA told us would be re-written in a format that residents would understand. However residents told us in the survey that they knew who to speak to if they were not happy. Not all of them knew how to make a complaint. Although the AQAA told us that residents meetings were held, the manager told us that these were not formally recorded. Staff always discussed matters with residents usually at mealtimes when all were present. The home had received no complaints since the previous inspection. Staff explained how residents withdrew cash from their accounts for daily living expenses. One resident had all their monies supplied by relatives. Another resident used the treasury function of the placing authority, to whom the home sent all invoices. Three people were supported to withdraw cash from the bank weekly using a debit card at a cashpoint. The cards and their PIN numbers were held by staff. Only the manager and one other staff member knew the details of the PIN numbers. The manager explained to us the difficulties of trying to support the residents to use the bank or the post office for the withdrawal of cash. We were shown the receipt books recording all withdrawals, with the signature of resident. However the current system Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: did not fully protect residents. Staff confirmed that they had done a training session on the protection of vulnerable adults, and had received certificates upon successful completion. We saw the training certificates for these sessions, and noted that others were planned in the next six months. The AQAA told us that two residents had advocates. One was a long term friend who also helped to drive the homes minibus. The other residents advocate was a support worker at their day centre. We noted that both advocates had CRB certificates. Care Homes for Adults (18-65 years) Page 22 of 33 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 . Residents can expect to live in a home that is homely and comfortable, and is satisfactorily maintained. They cannot expect to be fully protected from crossinfection. Evidence: Imber House is home to the five residents, and is also the family home of the owner. The manager, in the AQAA, described it thus: We have a small family environment. Four of the five bedrooms had been redecorated and refurbished in the last year. The fifth would be done in 2009. Two residents had paid for their new furniture with the agreement of their relative. This was recorded. It was understood that the furniture belonged to these residents and would go with them if they moved to alternative accommodation. Following the previous inspection, action had been taken to make the hall and stair carpets safe. The manager told us that new carpets were due to be laid in the hall, stairs and landing two days after our second visit. We saw that the unused stairlift had been removed. Wall tiles were still missing in the first floor bathroom. We saw that there were bars of soap, face cloths and towels in the room. We would expect to see liquid soap Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: dispensers for communal hand wash basins, with residents bringing their own towels and soap into the room for bathing and showering. The home must risk assess this room against best practice in hygiene and cross-infection procedures. The toilet next to the bathroom had no toilet roll, and no paper towels. The manager told us that one particular resident would remove these items as soon as they were put up. We discussed the alternatives which could be used and the manager agreed to explore these. In the homes improvement plan, which was required of the owner after the last inspection, the owner said they would send the Commission a new maintenance and decoration plan. This has not been received. The manager agreed to do this now that she was fully recovered and the homes financial planning was more secure. Care Homes for Adults (18-65 years) Page 24 of 33 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 can expect to be supported by a caring team. They cannot be assured that staff have the communication skills to meet their needs. Evidence: In the owners response to the improvement plan, it stated that when the higher levels of funding were paid, additional staff would be employed. The staff on duty told us about the numbers of staff on each shift. Changes had been made because of the funding of one to one support for two residents, and to support the needs of the newest resident. Two staff covered getting up and breakfasts. One person was on duty during the day. most of the residents went out during the week either to day centres or with their one to one carer. One person sleeping in covered from 9pm to 7am, with two staff on from 4pm to 8pm. At weekends there were two staff on all day. One resident was funded for a one to one worker for five days a week, another resident for three days a week. We inspected two staff files for recently appointed staff. These contained recruitment documentation, training records and supervision records. The manager had developed a training plan for the first six months of 2009 following our first visit. The topics covered moving and handling, medication, food hygiene, nutrition, first aid, challenging behaviour, health and safety, and death and dying. We also saw the Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: supervision schedule for this period including annual appraisals. We observed that there was a friendly interaction between the residents and staff. Residents had told us in their survey that staff always treated them well, and listened and acted on what they said. The manager told us that she was hoping to train staff to use signing language, such as makaton. One resident could use makaton and was helping staff to learn it. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect to live in a comfortable home, with their health and safety protected. Evidence: The manager had suffered a period of ill-health towards the end of 2008 and had only just been declared fit when we visited the second time. Although she had not been medically fit for the whole range of duties, she had returned to the home where she lived, so had not believed she needed to inform the Commission of her absence. She told us that she had used some of the recuperation time to review and update some of the paperwork regarding training, health and safety, and supervision. We saw the results of this, which have been described above. She also told us that staffing arrangements now left her more time for her management role, and for planning for residents care. Our first visit coincided with her hospital admission. This meant that staff were not able to access certain records, such as staff files, or give us full information about aspects of the care. It is a regulation that records must be available at all times, but Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: we decided that in the circumstances it would be reasonable for us to return for a second day to view all records. Nevertheless it is the managers responsibility to ensure that a designated person is left in charge during any absence of the manager, who can access the records at all times. The financial viability of the home had been of concern to the Commission at the previous inspection. Following discussions between the homes owner and the two placing authorities, new fee levels had been agreed, with some back dating to reflect when certain residents were admitted. We were told that one authority had started the new payments in April 2008, but the other had delayed them until September 2008. The AQAA told us that extra funding would lead to more staff being employed, staff training would be updated, leaving management more time to ensure paperwork was done and kept up-to-date. The ill-health of the manager had delayed progress on some of these issues, but we saw that action was now being taken. The manager described to us the plans to improve and maintain the home and the service. The AQAA told us that there was a quality assurance programme. This had not been implemented. We were shown the procedures which the manager intended to use. Again progress on completing this had been delayed. We discussed how the manager could assure herself of the quality of the homes care. She agreed to write a brief quality assurance policy, including what was already in place. She intended to issue questionnaires to all those who came into contact with the residents, including day centres and health professionals. Following major improvements to the fire prevention and protection systems in the home, the fire risk assessment had been updated. It had been revised in November 2007 and reviewed in August 2008. The record of fire drills showed that they were undertaken monthly. Emergency lighting and fire fighting equipment was regularly maintained by contractors. We examined the record of accidents and incidents. There were only two in the current book, both in September 2008 and both concerning the same resident sliding to the floor while at day centre. Staff on duty were not aware of the reason for this and there was no information in the care plan to help us. The manager told us that the next project was to completely renew the kitchen units, equipment and flooring. there were gaps in the flooring and chips in the work surfaces. The Safer Food, Better Business file recommended by the local Environmental Health department was unused. On our first visit, there was no evidence that temperatures of the fridge and the freezer were checked daily. On our next visit, these record sheets were attached to the front of both these appliances starting from 2nd January 2009, and showed that both were operating at safe temperatures. We noted that items in the fridge were properly covered and dated. The manager told us that a replacement fridge was on order. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 5 The service users guide must contain details of the total fee payable for the services provided and the arrangements for the payment of such a fee. 30/01/2009 To enable prospective service users and their representatives to make an informed choice about where to live. 2 23 20 14/02/2009 The use of debit cards and PIN numbers for residents to withdraw cash must be reviewed. This will ensure that residents are protected from the risk of financial abuse. 3 30 12 The toilet on the first floor must have hygienic arrangements for holding toilet rolls, and for hand 13/02/2009 Care Homes for Adults (18-65 years) Page 30 of 33 washing. Residents health must be protected from the risk of cross infection. 4 30 12 The health of residents must 13/02/2009 be protected by assessing the risks of using the communal bathroom on the first floor. The home must maintain cross-infection procedures for the benefit of residents. 5 41 17 The records specified in the 15/01/2009 Regulations must be available for inspection at all times in the care home. To ensure that residents rights and best interests are safeguarded. 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 2 20 30 Staff should be able to verify that residents have taken the medication prescribed for them. A annual maintenance and improvement plan should be drawn up for the premises to ensure the home remains clean, safe and homely. Staff should be trained in the communication needs of residents to enable their views and wishes to be known. A quality assurance policy and procedure should be developed, including those topics already in place and any others relevant to ensuring the quality of care. An annual business plan should be drawn up to cover Page 31 of 33 3 4 32 39 5 43 Care Homes for Adults (18-65 years) financial plans, staffing plans,environmental plans and quality monitoring. Care Homes for Adults (18-65 years) Page 32 of 33 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. 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