Inspection on 24/10/08 for Kent House

This inspection was carried out on 24th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kent House 16/10/06

Kent House 15/02/06

Kent House 31/08/05

Kent House 17/02/05

Kent House 04/10/04

Kent House 20/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kent House Kent House 1 Haslerig Close Aylesbury Bucks HP21 9PH     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: Barbara Mulligan     Date: 2 4 1 0 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. the things that people have said are important to them: They reflect 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 31 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 31 Information about the care home Name of care home: Address: Kent House 1 Haslerig Close Kent House Aylesbury Bucks HP21 9PH 01296330101 01296394580 kh@birt.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Disabilities Trust care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - PD Date of last inspection Brief description of the care home Kent House is a specialist care home for adults with acquired brain injury. It is registered to provide rehabilitation and long-term care for twenty-two people from various parts of the country. The Brain Injury Rehabilitation Trust, which is a charitable organisation, owns the home which is located in Aylesbury close to shops, pubs the post office and other amenities. The building is purpose built and was first registered in 1994. The accomodation comprises of bedsits, four bungalows adjacent to the home for those service users who have greater degrees of independent living skills and one self contained flat. There are seating arrangements around the garden areas where service users who smoke like to gather. The current weekly charges are £1402.00. Additional charges are made for hairdressing, toiletries, newspapers and magazines. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 22 Care Homes for Adults (18-65 years) Page 5 of 31 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 unannounced key inspection was conducted over the course of a day and covered the key National Minimum Standards for younger adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. Surveys were sent out to people who use the service before the inspection and fourteen were received by the Commission. The inspection officer was Barbara Mulligan. The registered manager is Christine Wood. The inspection consisted of discussion with the registered manager and other staff, opportunities to meet with some service users, examination of some of the homes required records, observation of practice and a tour of the premises. A key theme of Care Homes for Adults (18-65 years) Page 6 of 31 the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? Risk assessments are fully completed and kept under review. The management of incontinence is assessed by the district nurse and managed by the homes staff. Tippex correction fluid and scribbled over entries in care plans has now ceased. The homes recruitment practices have been improved upon and strengthened. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 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 31 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. People who use the service have their needs thoroughly assessed prior to admission ensuring that staff are prepared for admission, and given opportunity to visit the home beforehand to ensure it meets their needs. Evidence: The registered manager said that she handles the initial referral and at this point she will try to gain as much information about the referral as she can. There is a psychologist who is based at the home five days a week and they undertake the initial assessment. There is an admission procedure dated 19/11/2007 and the assessment tool is detailed and comprehensive.This covers the activities for daily living which includes such areas as maintaining a safe environment, communication, breathing, eating and drinking, elimination, personal cleansing and dressing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying. The inspector examined four completed needs assessments, including those new to the service. These are fully completed to a high standard and involves visits to potential service users at home or hospital, meetings with family and detailed Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: consultation with the placing authority. An assessment is also completed of the service users capacity. All assessments seen are signed and dated by the person completing the assessment. Care Homes for Adults (18-65 years) Page 12 of 31 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 health and personal care needs of people using the service are well met, with personal care delivered in a way that promotes respect and dignity, ensuring that peoples health and wellbeing is promoted and protected. Evidence: The care of four people living in the home was case tracked and their care plans were examined. These are very detailed and informative and reflect the changing needs of the individual. Care needs are identified with a very detailed action plan setting out guidelines detailing how staff will meet those needs. Each file looked at contains a lot of detailed information. There are rehabilitation plans in place which cover personal, domestic and community activities of daily living to enable the individual to be as independent as possible within a supported environment. Each service user agrees and signs the rehabilitation plan. Following the previous inspection a requirement was issued for residents identified with continence problems to be assessed to support staffs good practice. Evidence of continence assessments and guidelines on how to Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: support the individual with incontinence was observed in two files looked at and this requirement has been assessed as complied with. There are Occupational Therapy guidelines and vocational placement guidelines in place and these are informative and detailed. Following the previous inspection a requirement was issued for tippex correction fluid and scribbled over entries in care plans to cease. It is pleasing to see that this has been complied with. Daily notes are detailed and each entry is given a number which correlates to the different sections of the care plan. There are clinical psychology notes, speech and language therapy notes and vocational placement notes notes. These all give a detailed over view of how the individual is progressing. The inspector asked how people using the service are involved in the day-to-day running of the home. The registered manager said that there are residents meetings held on a monthly basis and there is also a service users committee who meet monthly to discuss any issues about the home. Minutes are kept of both these meetings and these show that issues raised are managed appropriately and how staff support residents to make decisions. Each person meets with their primary support worker monthly and the service users have the opportunity to decline these meetings if they wish. Again notes are kept of these meeting and held in individual files. The inspector had the opportunity to talk to an advocate from Aylesbury Vale Advocates and is also an IMCA. He visits the home regularly and is advocate to nine individuals. He said that this is the best run home I visit and the staff are consistent in their approach with behavior management. There are numerous service users who manage their money and the registered manager is appointee to five individuals. The advocate completes regular checks of these five peoples financial records. If anyone requires support with money management a financial management programme is implemented. Following the previous inspection a requirement was issued for risk assessments to be fully completed and kept under review. During this visit the inspector examined the risk assessment documentation for the four service users as part of the case tracking. Examples of risk assessment seen include using transport, substance abuse, self harm, absconding, bathing independently, compliance to medicines and smoking. These were all fully completed, signed and dated and reflective of regular reviews. One response received from a person who uses the service said, sometimes staff are doing other things when I want them to be with me, and two staff resonses indicated that, staff can be short at times due to sickness and sometimes when people are on holiday we have to find bank staff to cover but most of the time we have full cover. Care Homes for Adults (18-65 years) Page 14 of 31 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. People who use the service have a varied and active lifestyle, which reflects their interests, and are supported to maintain family links and friendships inside and outside the home. Menus are developed by people who use the service with support from care staff that promotes independence and choice. Evidence: As part of rehabilitation the home actively seeks vocational placements for people using the service. At the time of the visit there were numerous service users undertaking these placements at the local hospital and others include gardening, working in the library and with the WRVS. One person is in part time paid employment. Many of the people using this service attend the local college to undertake literacy and numeracy training, cooking skills and IT and flower arranging. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Staff encourage and support residents to take part in their preferred social and leisure pursuits in the local community. Whenever possible residents are encouraged to use public facilities as part of their rehabilitation and social reintegration programme as well as for social and leisure purposes. Residents make use of community facilities with adequate staff support to access these resources. These include trips to the local shops,bowling,cinema, meals and the hairdresser. The home has its own transport and service users are also encouraged to use public transport. The home employs a programme co-ordinator who organises activities for people using the service. He said that these are arranged and provided around peoples cognitive and behavioral goals. These are rotated twice weekly or when requested by service users. Activities provided in-house include a drama group, current affairs, a baking group, breakfast group twice a week facilitated by the occupational therapist, pet therapy and a reminiscent group. The home has recently employed an assistant programme co-ordinator and are just waiting for her employment checks to be completed. At the time of this inspection the home was able to meet the potentially diverse needs of its residents. Care staff seen interacting with service users do so with respect and in a manner that is appropriate to the individual. In terms of equality the home has male and female residents and staff, a varying age range and people with different degrees of disability, people with different religious believes and service users and staff of different ethnic origins. There are no restrictions about family and friends visiting and people who use the service are supported to maintain family relationships. Service users choose whom they wish to see and can see visitors in private if they wish. From observations on the day of the inspection visit, staff members were seen to treat the people living in the home with respect and patience. One individual was becoming anxious and distressed and staff responded to him in a respectful and appropriate manner. People who use the service have a key to either their bedsit or bungalow and have the freedom to be alone or in the communal areas. Preferred term of address are used for service users and this is recorded in the care plans. Mealtime was not observed during this inspection. However the inspector was informed that staff ask service users what their preference is for the following days meal.There is a three weekly rotating menu and there is a choice of meal available. Several individuals who live in the bungalows are able to cook their own meals and this is encouraged. The Occupational Therapist holds a breakfast club twice a week where service users are supported to make breakfast. Staff sit with service users at meal times to provide support and assistance. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The home will offer drinks and snacks throughout the day in accordance with needs of each individual. Nutritional screening is evident in all care plans. Care Homes for Adults (18-65 years) Page 17 of 31 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. Personal and healthcare support for people who use the service is good and the systems for the administration of medication are generally well managed, protecting service users and ensuring their personal and healthcare needs are appropriately met. Evidence: Information regarding personal care is recorded in the individual care plans. Service users are supported to choose when they like to go to bed, have a bath, have their meals and take part in other activities. Care plans set out in detail the service users preferred routines, likes and dislikes and partnerships with families and friends. Staff ensure that personal care is flexible, consistent and responsive to the changing needs of service users. This is well documented in care plans. Depending on service users individual needs the clinical and staff team provide residents with physical rehabilitation, long term care and support, behavioral rehabilitation, neuropsychological and behavior management treatments. Each individual has a primary support worker and a weekly or daily programme depending on his or her needs and abilities. Time is designated to the service user and their primary support worker for meetings to discuss any issues relating to their care. These are well Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: documented in service user files. Residents are made aware that they can have the services of an advocate if they wish to. There is good evidence of health care screening in care plans. All service users are registered with the same GP practice and the GP visits the home on a regular basis. Staff provide support service users needing to attend outpatient and other appointments. There is evidence that eye screening is being undertaken and a domiciliary service visits the home or service users can visit a local opticians. Dental services are accessed via the local health centre. Protocols were in place for individual residents relating to seizure management and diabetes. These are detailed and provide specific guidelines for staff to follow. At the time of the visit there were two service users choosing to administer their own medicines. The home uses a monitored dosage system. These are kept in two lockable medication trolleys, one for morning medicines and one for afternoon medicines. The medication administration record (MAR) sheets were examined and there were no gaps noted. The inspector asked to look at training records regarding the safe administration of medicines. Training is carried out in-house by the registered manager. The supplying pharmacist has also undertaken medication training. The organisation need to ensure that the training staff receive is accredited and this is strongly recommended. Medication administration record charts which had hand written entires on them were signed by the nurse writing them and checked by a second person and this is recognised as good practice. Medicines are stored securely for the protection of people who use the service. It was noted that some medicines prescribed to be given only when required had no guidelines in place for staff to follow and this is strongly recommended. Care Homes for Adults (18-65 years) Page 19 of 31 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. Procedures for managing complaints and adult protection are in place but some minor revision is needed to ensure people have accurate information to hand. Evidence: The organisation has a complaints procedure and this was available on the notice board in the main communal area of the home. The complaints procedure is in the Service Users Guide and individual service user has a copy of this in their bedroom. The inspector examined the complaints log and there were two complaints recorded. One was from a service user and one was from a neighbour. Both of these have been responded to within timescales and are well recorded. The Commission for Social Care Inspection has not received any complaints about this service since the previous inspection. The inspector examined the organisations Protection of Vulnerable Adults Policy dated December 2005. This contains out of date guidance, after gathering relevant information the service manager/director will decide whether or not to authorise an inspection. This conflicts with the local authority Safeguarding policy and needs to be updated. Staff were unable to find the local authority safeguarding policy. This means that at the time of the inspection there was no correct or up to date guidance for staff to follow. The registered manager asked a staff member to contact the local authority on Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: the day of the inspection to request a new copy of the policy. It is a requirement of the report that the organistions policy is reviewed to include up to date guidance. Staff training records were disorganised and held in one of either three places. This made it difficult to assess if all staff had received training in safeguarding vulnerable adults.However, training was held in the home on 08/02/08, 12/06/08 and 07/08/08. The inspector requests confirmation that all staff have received training in Safeguarding Vulnerable Adults. Care Homes for Adults (18-65 years) Page 21 of 31 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. A clean, comfortable and homely environment has been created for people who use the service, ensuring that they have appropriate surroundings in which to live. Evidence: Kent House is a specialist care home for adults with acquired brain injury. It is registered to provide rehabilitation and long-term care for twenty-two service users from various parts of the country. The Brain Injury Rehabilitation Trust, which is a charitable organisation, owns the home. The home is located in Aylesbury close to shops, pubs the post office and other amenities. The home consists of bedsits, bungalows and a flat all contained within a supported environment. The home has a garden area, which is wheelchair accessible and there are areas where people can go to smoke. The inspector undertook a tour of the premises to look at all communal areas of the service. The internal decoration of the home is in good repair, and there are personal touches around the home such as plants, books and pictures. The registered manager pointed out that there are no small quiet lounges in the home for service users to meet friends and/or family or just for some peace and quiet. Plans are being made for some refurbishment to take place in the near future and the registered manager said that this will provide two new small lounge areas. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: There are accessible toilets available for service users throughout the home. The homes laundry is managed within the home, in a designated laundry room. One comment recieved said that what the home does best is, Provide a good home for all the service users who live there. Care Homes for Adults (18-65 years) Page 23 of 31 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. While the range of staff training and development offered via the Brain Injury Rehabilitation Trust is good, the training records held in the home are disorganised and must be able to demonstrate that all care staff have received the training they need. Recruitment procedures are robust and ensure suitable staff are recruited to care for and support service users with a Learning Disability. Evidence: The home continues to support staff on NVQ training and according to the information recorded in the AQAA, there are ten care staff who have completed NVQ level 2 training or above and a further fifteen are working to wards this. Four staff files were viewed at this inspection, including those new to the service. They all had completed application forms and interview records. Two references had been sought and Criminal Records Bureau (CRB) checks had been undertaken. There was evidence that staff had undertaken an induction programme. All had photographic evidence of identity. Following the previous inspection a requirement was issued for the weaknesses identified in the homes recruitment procedure to be addressed. It is pleasing to see that this has been complied with. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: There is a corporate induction programme in place that will ensure new care workers are familiarised with the organisation and their roles and responsibilities. This is a very detailed and comprehensive document. The registered manager said that newly employed staff will work with her for two days. Then they are issued with their induction booklet. This is the Disabilities Trust Training booklet and covers the common induction standards. Staff are expected to complete this within six months of employment. Training records are disorganised and kept in one of three places. This makes it difficult to assess if all have staff had the training they need. The inspector requests that confirmation is sent to the Commission that all staff have received the training they need. This will be a requirement of the report. Care Homes for Adults (18-65 years) Page 25 of 31 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. There are systems within the home that are used to ensure that service users health, safety and welfare are protected and promoted and the home is run in the best interests of people who live there. However records for mandatory training must be kept in order and up to date. Evidence: The service has a registered manager who is a registered general nurse and has completed the registered managers award in care and management. She has fifteen years experience in management of clients with acquired brain injury. Her post comes with a job description outlining duties and responsibilities. The registered manager reports to an external line manager who carries out monitoring visits on behalf of the provider. Examples of further training in the past twelve months include, Human Resources training, mental capacity training, leadership and management training and care planning. The home has an annual development plan in place, which is reviewed annually. Once Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: a year the organisation sends out questionnaires to residents, relatives and referrers to find out if they are satisfied with the service delivery. The results of this are summarised in a graph in The Brain Rehabilitation Trust newsletter. The home uses the Commission on Accreditation of Rehabilitation Facilities (CARF)standards which organisations use as guidelines in developing and offering their programs or services to consumers. CARF uses the standards to determine how well an organisation is serving its consumers and how it can improve. The home achieved CARF accreditation in June 2007 and have also achieved Investors in People Award. There is a folder containing compliments and thank you letters, mainly from the relatives of service users. A range of health and safety checks are in place at the service and carried out on a daily, weekly or monthly basis. Fire safety records show that the fire risk assessment s fully completed and is up date. There is also a fire risk assessment for each person using the service. Weekly fire checks are carried out and recorded. Fire training was carried out in t he home on 02/11/07; 01/07/08; 06/03/08 and 01/07/08. The fire risk assessment is dated 14/08/07. This must be reviewed and updated on an annual basis and will be a requirement of the report. There is written evidence of water and fridge and freezer temperatures. There are service certificates available for PAT testing dated 03/08/08; electrical installation 03/11/08 and gas 22/10/08. Training records are disorganised and are kept in one of three possible places. This makes it difficult to assesses and a requirement has been issued under training and development for the home to provide evidence that care staff have received the training they need. Care Homes for Adults (18-65 years) Page 27 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 The registered person is required to ensure that the organisations safeguarding policy is reviewed to include up to date guidance for staff to follow. To ensure staff are working to current information to safeguard service users from abuse. 30/12/2008 2 35 18 The registered person is 30/11/2008 required to ensure that confirmation is sent to the Commission that all care staff have received the training they need, this must include all mandatory training. To ensure that staff are trained and competent to do their job. 3 42 23 The registered person is required to ensure that the fire risk assessment is reviewed and updated annually. 30/11/2008 Care Homes for Adults (18-65 years) Page 29 of 31 To ensure the risks to service users and staff in the event of a fire are minimised. 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 20 It is strongly recommended that training in the safe administration of medicines is accredited training. It is strongly recommended that where a medicine is prescribed as only as required that specific guidelines are in place to direct staff when and why these medicines should be given. Care Homes for Adults (18-65 years) Page 30 of 31 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). 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