Inspection on 19/11/08 for Marlow

This inspection was carried out on 19th November 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Marlow 8 Nursery Lane Worthing West Sussex BN11 3HS     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: Lesley Webb     Date: 1 9 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. 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 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: Marlow 8 Nursery Lane Worthing West Sussex BN11 3HS 02392632542 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rebecca Karen Ward care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 14. 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: Learning disability (LD) Physical disability (PD). Date of last inspection Brief description of the care home The home has been purpose built on the site of a demolished local authority care home in the town centre of Worthing. There is car parking at the front and patio garden to the rear of the house. Accommodation includes a fully fitted kitchen, a large lounge, dining room, laundry and staff office. Each bedroom is large and airy with fully accessible shower en-suite facilities. All have full ceiling tracking systems from bed to toilet. Furniture includes a wardrobe, chest drawers and bedside cabinets with lockable drawers. Toilets and bathrooms are wheelchair accessible. The decoration throughout communal areas is neutral, bright and airy with good natural light and is domestic in appearance. Fees charged for living at the home range from one thousand three Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 14 14 Brief description of the care home hundred and ninty nine pounds to three thousand one hundred and thirty six pounds a week. It should be noted that any fee information included in this report applied at the time of inspection and that people may wish to obtain more up to date information from the care home. Care Homes for Adults (18-65 years) Page 5 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: One inspector undertook this site visit over one day, with the home being given no prior notice that we would be visiting. During the site visit time was spent talking to staff, the Registered Manager/Proprietor and day to day manager and where possible residents. We also examined records and observed care practices before giving feedback about the inspection. The people who live at this home have a variety of needs. This was taken into consideration when we case tracked two individuals care provided by the home. For example the people chosen were male and female and have differing communication and care needs. Care Homes for Adults (18-65 years) Page 6 of 29 The home completed its Annual Quality Assurance Assessment (AQAA) and sent this to us prior to our site visit. The contents of this were examined and tested for accuracy when we visited the home and also used when forming judgments on standards of service provided and outcomes for residents. 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 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. Assessment processes ensure potential new residents needs are identified by the home before placements are offered. People considering moving into this home can undertake a range of visits to help decide if it is suitable for them. Evidence: The homes Annual Quality Assurance Assessment (AQAA) was sent to us prior to our visit. With regard to assessment processes it states that once a referral is received a copy of the social services assessment is obtained, visits are undertaken to prospective residents in their own homes and a pre admission assessment completed. It is then from this the decision is made as to whether the home can meet the individuals needs and a placement offered. During our visit to the home we examined admissions documentation for the two newest people to move into the home and talked to members of the management team, finding the information in the AQAA to accurately reflect admission practices within the home. For example both residents files contained evidence of pre-admission Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: assessments having been completed and contained copies of the placing authorities assessments and care plans. Having this information helps staff working at the home understand the support individuals require. We also spoke to a relative of a resident. They informed us transition to the home went well and included visits to the home for a meal and overnight stays. 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. Care planning and risk management systems ensure residents needs are met. Where possible residents are supported to make decisions about their lives. Evidence: We examined the care records of two residents, observed practices and spoke to staff and management, finding evidence that the care people receive is based on their individual needs. For example files sampled contained comprehensive care plans for a range of needs including communication, health and relationships. Life Stories are also completed. These give an insight into peoples backgrounds, likes and dislikes and strengths, giving staff information so that they can provide support in a person centred way. Each resident is allocated a key worker. All staff that were spoken to demonstrated a good understanding of this role and the needs of people they support. For example one person explained, help organise her shopping, toiletries, quality time, physio at home. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: she likes trying on make up and is conscious of her body image, so when shopping let have choice by pointing and touching, she smiles when she has chosen items. The people who live at this home have a range of needs that have the potential to impact on them being involved in decision making. Observations during our visit confirm that residents are encouraged to make decisions about their day to day lives. For example staff were observed giving choices at meal times, in activities and what clothing people wished to wear. The day to day manager informed us some residents use objects of reference to communicate, another Makaton (a form of sign language) with three staff having received training in this and another resident a communication passport that has been devised with input from the Speech and Language Department. Risk assessments were seen to be in place for a number of personal risk areas for individuals. Examples being use of wheelchair, swimming, falls, hot drinks, seizure and choking. We saw that the care plans and risk assessments for one resident have been cross referenced, promoting an holistic approach to care management. This system was not in place for another resident. We discussed this with the Registered Manager/Proprietor and day to day manager, with them agreeing to ensure this is implemented for everyone. 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. Social, educational, cultural and recreational activities meet individuals expectations. Residents are supported to maintain contact with their families as per their needs and wishes. Meal times are relaxed and enjoyable events. Evidence: The homes Annual Quality Assurance Assessment (AAA) sent to us prior to our visit gives detailed information about how residents are supported to lead fulfilling lives. For example it states There is an extremely active activity programme in place at Marlow. It is personalised for individuals and a new one written every week to allow for flexibility where required. Service users are supported to be active and visible in their community. Examples of activities which service users have been involved in over the last 3 months include: Swimming, day services, College courses, Bowling, shopping, pub and restaurant visits. Staff access local services with service users and then Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: collate the information for service users who can then make an informed choice. Most service users will attend the local college for at least one day a week to do a course specific to their interests and abilities. Service users are well known in their community and are greeted by neighbours and staff in shops, cafes and pubs which they visit regularly. Whilst mainstream activities are promoted, some service users like to attend disability groups. Location of activities is no barrier as transport is available in the form of 2 wheelchair adapted vehicles. Most service users have families who are active in their lives. Contact is encouraged, and there is an open door policy whereby visitors are welcomed at all times. We examined the records of two residents, observed practices and talked to staff and management and found the information contained in the homes AQAA to accurately reflect practices within the home. For example some residents were observed being supported to go out in the community using the homes transport, another resident was at a day placement and other residents were seen participating in a music therapy session. A resident who uses a wheelchair was observed moving around the home including the kitchen and was not seen to be restricted access in any part of the home. Staff were observed encouraging this resident to participate in the preparation of lunch, supporting the resident with regard to daily living skills. During our visit to the home we spoke to a relative who expressed their satisfaction with the home. They stated, there are no rules on visiting, can go whatever time suitable, always welcomed, offered cup of tea, given a choice of rooms for privacy, treated well. Lunch was indirectly observed. Staff were seen offering encouragement and support in a discreet and respectful way. Staff sat with residents and the atmosphere appeared relaxed, with lots of chatter and laughter heard. Care Homes for Adults (18-65 years) Page 15 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. The principles of dignity and privacy are put into practice. The health and personal care that residents receive is based on their individual needs. Some medication practices are not safe and have the potential to place residents at risk. Evidence: Efforts are made to promote the dignity and independence of residents. For example a member of staff was observed assisting a resident to use a walking frame, offering encouragement and support. The Registered Manager/Proprietor informed us the home is currently in discussions with the continence service to provide alternative aids for another resident as the home feels these will promote the residents independence further. We found evidence that residents are supported with the health needs. For example both of the residents files we examined contained care plans for the management of specific health needs and evidence of external professionals involvement. The day to day manager informed us that a resident with high support needs for the Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: management of epilepsy receives an enhanced nursing service from the community team, that includes supporting staff employed at the home by compiling guidelines and providing training for the administration of medication. When examining the the systems for storing and recording medication we found one resident did not have a supply of as and when required medication for four days, with the medication administration record stating waiting delivery. The day to day manager informed us that they had run out of this medication. The same resident is prescribed an as and when required medication for the management of epilepsy. The day to day manager could not produce a record detailing when this medication entered the home or how much of this medication is currently stocked. We informed the day to day manager that a record of all medication entering the home must be maintained and systems for monitoring medication stock must improve in order that sufficient prescribed medication is in the home to meet residents needs safely. Records evidence three medication errors in July 2008 for a resident that we case tracked. Two when they were not administered all of their medication and one when they were administered another residents medication. Records confirm that on two occasions the home sought medical advice because of these errors. The Registered Manager/Proprietor confirmed we had not been notified of these events in line with Regulation 37 of the Care Home Regulations. This instructs that we must be notified of any adverse event affecting a resident where medical advice is sought. We were informed notifications would be completed in the event of any future incidents. The day to day manager stated that all staff receive medication training as part of their induction and that this includes shadowing experienced staff. The supplying pharmacist has not provided medication training. We discussed CSCI guidance with regards to competency assessments for staff. The day to day manager stated she would obtain the CSCI guidance and implement this. Care Homes for Adults (18-65 years) Page 17 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. Staff have a good understanding of supporting residents to raise concerns and of safeguarding. Procedures are in place that offer safeguards to residents. Evidence: The homes Annual Quality Assurance Assessment (AQAA) sent to us prior to the inspection states The written complaints procedure is available to all service users, families and others who visit the home. Complaints are fully investigated and all involved parties informed of the outcome. There are whistle blowing and adult protection policies at Marlow. All staff are made aware of them and sign to confirm they have been understood. At induction, staff receive training on the different types of abuse ranging from sexual and financial to more innocuous types such as bullying and neglect. Adult Protection and identifying signs of abuse training is given to all staff and updated annually. Evidence gained at our visit to the home indicates this information to be correct. For example all staff that we spoke to demonstrated understanding of supporting people to raise concerns. As one person explained, you get to know certain looks on face, body language, some know makaton, one residents puts his thumb up and uses facial gestures, others you know they may be unhappy by how they are sitting, holding themselves and expressions. We have to find out why unhappy, ask questions in ways they can understand using yes or no as longer words can confuse, sometimes its a Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: process of elimination. A relative we spoke to during our visit informed us they would feel happy to raise any concerns, should they arise, stating, staff are very good. Policies and procedures are in place for the protection of vulnerable adults. These include a Whistle blowing policy that we saw displayed in the office. Seven of the fourteen staff currently employed at the home have received Adult Abuse training. We asked staff how they ensure people they support are protected from harm. All were able to explain what they would do. For example one stated, first if I saw anything I would go straight to manager, make sure resident is safe. Report colleagues, have no choice, residents come first. We sampled the financial records and personal monies of two residents and found both to be in good order and up to date. We did note that the records for both people detail personal monies used to purchase meals taken outside of the home. We discussed this practice with the Registered Manager/Proprietor, asking if this is reflected in residents contracts as meals usually form part of the basic fee agreed with funding authorities. We were informed meals are provided by the home unless a resident is out in the community participating in an activity. The Registered Manager/Proprietor could not confirm if this was included in the contracts of residency and agreed to look into this further to ensure no one is financially disadvantaged. Some people who live at this home have behavioural needs and receive support from staff in order that these do not place other residents at risk. Staff that were spoken to demonstrated good understanding of behaviours, triggers and affects. Care plans for one resident with behavioural needs were seen to be in place. This gives information to staff so they give support in a consistent and safe way. Care Homes for Adults (18-65 years) Page 19 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. The physical design and layout of the home enables residents to live in a safe, wellmaintained and comfortable environment that encourages independence. Evidence: The home has been purpose built on the site of a demolished local authority care home in the town centre of Worthing. There is car parking at the front and a patio garden to the rear of the house. Accommodation includes a fully fitted kitchen, a large lounge, dining room, laundry and staff office. Each bedroom is large and airy with fully accessible shower en-suite facilities. All have full ceiling tracking systems from bed to toilet. Furniture includes a wardrobe, chest drawers and bedside cabinets with lockable drawers. Toilets and bathrooms are wheelchair accessible. The decoration throughout communal areas is neutral, bright and airy with good natural light and is domestic in appearance. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: Signage and labeling throughout the home is discreet and has been assessed a meeting fire safety regulations. The home has appropriately placed smoke detectors and emergency lighting. Hand washing instructions were seen to be sited throughout the home. These promote good infection control. The home was seen to be clean and no odours detected. Eight of the fourteen staff currently employed at the home have received infection control training. Care Homes for Adults (18-65 years) Page 21 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. Staff in the home are trained, skilled and in sufficient numbers to support residents living there. In the main recruitment practices safeguard residents. Evidence: Staff observed during our visit appear to have built positive relationships with the residents in their care. For example they were seen to be patient and attentive. Staff spoken to were knowledgeable about the residents needs and appeared interested in their work. There are currently seven people living at the home. The day to day manager informed us that the home deploys four staff on each early and late shift and two staff during the night. In addition to this the day to day manager undertakes all her hours supernumerary to those of care. We examined the recruitment records of the two newest people to start working at the home and found them generally to be in good order and to contain the required information to protect residents. This information included two references, forms of identification and Protection of Vulnerable Adults (POVA) clearances. One of the references on file for one member of staff was dated after they commenced work at Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: the home. We discussed this with the Registered Manager/Proprietor who confirmed this person had commenced work without a full enhanced Criminal Records Bureau (CRB) disclosure having been obtained (a POVA first was in place and the person did not undertake any lone working). We explained that Department of Health guidance should be followed when undertaking this practice, including obtaining two written references and completing of a risk assessment. The Registered Manager/Proprietor agreed this would be followed in future. Records confirm all staff working at the home have received an induction. The day to day manager informed us that this includes shadowing other staff, reading policies and procedures and information about people living at the home. Information supplied to us by the home prior to our visit states seven of the fourteen staff employed at the home hold a National Vocational Qualification (NVQ). At our visit to the home the day to day manager informed us the majority of staff have also undertaken training specific to the needs of people living at the home. In addition to this records confirm all staff have received training in epilepsy, three in Makaton and four in eating and drinking. Training that staff have received helps them understand the needs of people living at the home. Care Homes for Adults (18-65 years) Page 23 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. In the main management of the home meets residents needs safely. Quality monitoring processes include obtaining the views of people and allow the home to measure if it is meeting its aims and objectives. Health and safety is well managed, ensuring residents live in a safe environment. Evidence: The home has a day to day manager. This person is not the Registered Manager. At our visit the day to day manager informed us she has completed an application to become the Registered Manager and will be shortly submitting this. The day to day manager informed us she holds the Registered Managers Award and plans to commence the NVQ level four in Health and Social Care after Christmas. When asked what her main roles and responsibilities are as day to day manager, she stated, to make sure service running in a way that benefits residents. We were informed the day to day manager has fourteen years experience in care and also a background in finance. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Evidence is sited throughout this report that indicates management of the home is meeting residents needs. The one area that must improve is that of medication. This was discussed with the Registered Manager/Proprietor and the day to day manager. They agreed that any necessary improvements would be undertaken to ensure risks to residents are minimised. We were informed by the day to day manager that quality monitoring processes include the reviewing of care packages, residents meetings, and management audits. The Registered Manager/Proprietor informed us she carries out bi-monthly quality assurance inspections to the home and that when visiting talks to staff and visitors in order to obtain their views on the service provided. The Registered Manager/Proprietor informed us she intends to record these conversations and any actions needed as a result. In addition to this the Registered Manager/Proprietor visits the home five days per week. As mentioned throughout this report the Registered Manager/Proprietor supplied a detailed and informative Annual Quality Assurance Assessment (AQAA) that was in the main, accurate and reflective of practices within the home. Copies of certificates have been seen as part of the homes initial registration application. These include those for domestic electrical installations, emergency lighting, servicing of the fire detection alarm system and gas appliances. Risk assessments relating to equipment and safe home management are in place and updated. One resident has currently been assessed as needing bed rails. A risk assessment is in place for this. This does not include information regarding the need for checks to this equipment to ensure they are safe. During our visit the Registered Manager/Proprietor obtained the Health and Safety Executives guidance regarding bed rails and informed us she would ensure this is implemented immediately. Records confirm the majority of staff have received training in health and safety, manual handling, first aid and food hygiene. All staff have received training in fire. Training in these areas promotes the health and safety of residents. Care Homes for Adults (18-65 years) Page 25 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 26 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 1 20 13 In line with Regulation 13 19/12/2008 (2) a record of all medication entering the home and stock stored must be maintained. This must happen to ensure there is sufficient stock of medication in order that it can be administered as directed by the prescriber and to ensure systems for monitoring medication stocks are safe. 2 20 37 In line with Regulation 37 the home must notify CSCI of any adverse event to a resident where medical attention is sought. This must happen in order that monitoring systems offer safeguards to residents. 19/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards Care Homes for Adults (18-65 years) Page 27 of 29 and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 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. 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