Inspection on 18/02/09 for Monro Avenue (54)

This inspection was carried out on 18th February 2009.

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

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

Other inspections for this house

Monro Avenue (54) 12/03/08

Monro Avenue (54) 01/08/06

Monro Avenue (54) 03/01/06

Monro Avenue (54) 31/03/05

Monro Avenue (54) 01/11/04

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Monro Avenue (54) 54 Monro Avenue Crownhill Milton Keynes Bucks MK8 0BL     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: 1 8 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Monro Avenue (54) 54 Monro Avenue Crownhill Milton Keynes Bucks MK8 0BL 01908269116 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): MacIntyre Care Name of registered manager (if applicable) Miss Nicole Jose Croucher Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 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 Date of last inspection Brief description of the care home 54 Monro Avenue is a care home managed by MacIntyre Care and provides personal care and accommodation for six adults with a learning disability. The building is a two storey residential house built in the style of the surrounding properties. The home is situated in a residential area of Milton Keynes and is within walking distance of the local shops, church and local pubs. The home has six single bedrooms on the ground and upper floor and has a secure maintained garden that is accessible to all service users. Access to the upper floor is Care Homes for Adults (18-65 years) Page 4 of 30 care home 6 Over 65 0 6 Brief description of the care home via stairs or a stair lift. The centre of Milton Keynes is close by offering a large shopping centre, cinema, a range of restaurants and recreational activities, cycle tracks and many other attractions. Fees range from £37,292 to £40,390. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Comment cards were distributed to visiting professionals, service users and staff prior to the inspection. Feedback from service users and relatives indicate that they are happy with the service re provided by the home. The inspection consisted of examination of some of the homes required records, observation of practice, discussions with the manager and staff on duty and a tour of the premises. Care Homes for Adults (18-65 years) Page 6 of 30 Feedback on the inspection findings and areas needing improvement was given to the carer who assisted during the inspection. All requirements from the last inspection have been complied with and this inspection has resulted in three good practice recommendations. 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? Systems are in place for when medicines are taken away from the home with service users and there are seperate risk assessments in place for when medicines are away from the home to ensure the health, safety and welfare of those using the service and to ensure that there is no mishandling of medication. Service user plans contain more detail and have been updated to include all the health care needs are fully documented, kept up to date and met appropriately. Recruitment files show a full employment history has been obtained, together with a Care Homes for Adults (18-65 years) Page 8 of 30 satisfactory written explanation of any gaps in employment prior to employing a person to work at the care home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 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: There have not been any new admissions to the service in the past twelve months, according to information supplied prior to the inspection. At the last inspection, documents relating to the most recently admitted service user were examined and found to be in good order with a detailed and comprehensive needs assessment which indicated that the service user had been involved in the process. The home does not take emergency admissions and is not registered to provide intermediate care. People using the service who completed the CSCI surveys indicated that they had been involved in the decision to move into the home and had been given sufficient information about it beforehand. Care Homes for Adults (18-65 years) Page 11 of 30 Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans are in place, which outlines service users needs and ensures that service users needs can be met. The way service users make choices and the management of risks promote continuity of care and service users well being. Evidence: Three care plans were examined during this inspection. The home has introduced new care planning documentation and these have been completed for each person. Each file examined includes a photograph of the person, for easy identification, and a detailed care plan and accompanying risk assessments. It contains essential information about the person, a detailed pen picture, details of people who support the person, intimate care guidelines including preferred gender of staff to give assistance, and an outline of the persons daily routines. The main new areas added to the care planning documentation details how people using the service make decisions and is divided into decisions the person can make for himself or herself, those they need some support with and those they need full support with. There is information in each Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: file of the persons likes and dislikes, how the person communicates, their learning activities, support in managing finances and cultural and faith needs. There is a separate health profile which documents the persons physical and mental health needs have been documented and include information about any other people involved in their care, such as a dietitian and speech therapist. The individuals emotional care needs have been recorded as have behaviours causing concern, with information on how to support people in these areas. All files are detailed and information has been dated and shows evidence of regular review. Reviews of care have involved those using the service using DVD format to present what they have achieved since their last review in a visual format. Not all people using the service are able to communicate verbally and the home is proactive in implementing systems to enhance communications with service users. Each service users care plan contains a communication profile, and some information in the care plans are set out with pictures and photographs. Service users are given opportunities to make decisions about their lives, with assistance as needed. This includes help to make decisions regarding their choice of activity, daily routines, menu planning and preferred daily routines. Pictures and photos are used to assist the service users when making a choice. There is a pictorial complaints guide on a notice board in the home, a pictorial staff rota, with photographs of staff and a pictorial menu of the days meals. The complaints procedure has been put onto an audio cassette for one person using this service who is registered blind. The key worker for this person is presently putting the service users care plan onto audio cassette and plans to look at other areas where an audio cassette can be used for this individual. Within each service users plan of care are detailed risk assessments detailing any risks and how these are to be minimised whilst retaining each users independence.Examples of risk assessments seen include personal care, medical and health support needs, relationships and emotional support, finance, learning opportunities, domestic/life skills, leisure, transport, home safety and challenging behaviour. Missing person procedures were in place in the event of anyone being absent from the home without notice and for staff to refer to, if need be. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. People who use the service are supported to develop the menus that promotes independence and choice. Evidence: From the information supplied by the manager, all the individuals living at the home take part in activities of their choice, and are able to use the local community facilities. Service users are involved in a number of activities which includes attending day care services and also have a day off in the week to undertake personal activities with the homes staff, such as personal shopping. On the day of the inspection a regular weekly hydrotherapy session had been cancelled and staff took the two individuals out for other activities and lunch. Day care services will also visit the home to undertake Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: activities with individuals. Some service users attend sensory sessions and staff facilitate some in-house activities. People using this service are supported to pursue their leisure interests with activities such as trips to the cinema, meals out and swimming. The home has its own transport and people who use the service can access taxis, buses and other forms of public transport if they wish. There are no restrictions about family and friends visiting and this is detailed in the service users guide and confirmed through comments made from the surveys. Some service users go home for visits with support from staff as required and service users are supported to remember family birthdays and special occasions. People who use the service are able to receive visitors in the privacy of their own rooms, and are able to choose whom they see and do not see. From observations on the day of the inspection visit, staff members were seen to treat the people living in the home with respect and were encouraged to be as independent as their needs allow. Meals are planned on a weekly basis with the people who live in the home and reflect their individual choices. Pictures are used to help people with menu planning. A record of what is eaten daily by individuals is maintained.The menu is varied and service users are able to have an alternative choice if required. Service users are provided with appropriate eating aids and staff provide assistance to individuals with their meals in a respectful way.The registered manager said that individuals are weighed regularly and the inspector saw these recorded for each person. Care plans demonstrate that service users nutritional needs are assessed and regularly reviewed. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical, emotional and health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. Evidence: Some of the service users in the home are very dependent on staff who attempt, through body language and other forms of non verbal communication to determine when service users would like to go to bed, bath, have their meals and take part in other activities. This is recorded in individual care plans. This extends to supporting service users to choose the clothes they wish to wear, hairstyles, make up and general appearance. The care plans set out in detail the service users preferred routines, their likes and dislikes and partnerships with families, friends and relevant professionals outside of the home. Essential information needed by staff to be able to provide personal and health care support was included in care plans. Staff support people using the service to see their local GP and other community healthcare services when needed, both within the home and in the local community. In each file there is an intimate care policy that details how personal care is to be Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: delivered to each person in a way they prefer. There is also a health screening file that contains information about the service users medicines, visiting the doctor and how I like to be supported, visiting the nurse, chiropodist, opticians and the dentist. Evidence was seen in the files of hearing tests, visits to the psychologist, physiotherapist, occupational therapist, and dietician. Service users have the necessary disability equipment they require to enable them to maintain their independence and robust risk assessments are in place detailing how the care is to be delivered in a safe manner whilst maintaining and promoting the users independence. At the previous inspection it was noted that three files examined did not contain evidence that monthly weights were being undertaken regularly. All files looked at during this inspection contained monthly recordings of peoples weights. At the previous inspection it was identified that the number of medicines held within the home did not tally with that documented. Two were missing and these were with the service user who was away from the home for the day, although there was no documentation in place to evidence this. A requirement was issued for systems to be put in place to ensure accurate record keeping and risk assessments when medicines are away from the home to ensure the health, safety and welfare of those using the service and to ensure that there is no mishandling of medications. The registered manager has implemented a record of medicines leaving the home and being returned to the home and there are risk assessments in place for medicines being taken with service users when they leave the home and it is pleasing to see that this requirement has been complied with. Medication practices were examined during this visit to the home. Medication was stored safely and medication administration records (MAR) were in good order with staff signatures alongside prescribed dose times. There were several handwritten entries on the MAR charts and it is strongly recommended as good practice that when it is necessary to handwrite on a medication administration record chart in the home, the member of staff writing the chart signs and dates the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. One staff member has been nominated as the in-house medicines rep and she undertakes a monthly audit which includes looking at stock control, storage, administering and disposal records, staff awareness and competence and maladministration. This is recognised as good practice. There are guidelines in place for the administration of as required medicines, which were available in the medication administration records and individual care plans. Records of medicines disposed of were in good order. Training records for staff expected to administer medicines were examined and it was noted that they have completed training within the last three years. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: The organisation has also introduced two medication workbooks. Newly employed staff are expected to complete the first book as part of the first stage of the induction process in the first six weeks and the second book is completed as part two of the induction process. Thereafter staff are expected to complete this on an annual basis. It is the responsibility of the organisation to ensure that all medication training completed by care staff is accredited. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for managing complaints and adult protection are in place ensuring people who use the service are listened to, kept safe and protected from abuse. Evidence: The organisation are presently revising and updating the complaints procedure. The Annual Quality Assurance Assessment (AQAA) document indicates that the home has received one complaint, however during the inspection the registered manager said they have not received any complaints and this was a mistake on the AQAA. Some of the service users in the home are very dependent on staff who attempt, through body language and other forms of non verbal communication to determine whether service users are happy or if they may have concerns about the service. There is a pictorial complaints procedure in the main hallway of the home using photographs and pictures. For one service user who is registered blind the home has recorded the complaints procedure onto an audio tape. This is recognised as good practice. In addition to this each individual completes a Listen to me books with their key worker every month. This also gives the service user an opportunity to indicate if they have any concerns or complaints. The Commission for Social Care Inspection has not received any complaints in respect of this service. The Annual Quality Assurance document indicates that there have been three safeguarding of vulnerable adults referrals in the last twelve months all of which were Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: dealt with under the local inter agency safeguarding policy and procedures. The organisation has its own safe guarding vulnerable adults procedures and also have an up to date copy of the Milton Keynes multi agency policy and procedures for the protection of vulnerable adults. Staff training records demonstrate that care staff, with the exception of one trainee, have completed Safeguarding training. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within this home is very good, providing service users with an attractive and homely place to live. Evidence: The building is a two storey residential house built in the style of the surrounding properties. The home is situated in a residential area of Milton Keynes and is within walking distance of the local shops, church and local pubs. The house is clean, well decorated and homely. Thought has been given to the needs of service users throughout the home. For example, there is sensory equipment in rooms for people with a sensory impairment, there are many photographs of service users which are recognised by people using the service. A seating area has been provided and made comfortable in the main hallway of the home where several service users prefer to sit. The garden has been made accessible to people using the service. A pathway has been painted bright colours which is easy for people to see and use. A seating area has been provided and there are many garden ornaments around the home. Each bedroom has been personalised to meet the needs of the person and to reflect Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: their likes and preferences. These are very well presented and again contain specialist equipment such as sensory equipment. The kitchen is accessible to service users if they wish to assist with meal preparation. The home provides adequate toilets, shower and bathing areas which are spacious and contain grab rails, assisted baths and other aids. The laundry facilities for the home are sited so that soiled washing does not come into contact with the kitchen. Hand washing facilities are sited in the laundry. Policies and procedures were observed by the inspector for the control of infection, which includes the safe handling and disposal of clinical waste. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are looked after by appropriate numbers and skill mix of staff, who are trained to carry out their duties. Robust recruitment policy and practices in place to support and protect the residents. Evidence: The staff who were met during the inspection were knowledgeable and presented as good advocates for service users. The rotas show adequate numbers of staff are working in the home at any time to meet the needs of the people living in the home. At the time of the inspection, the home did not need to use agency staff to help cover the rota. The Annual Quality Assurance Assessment document shows that four of the twelve permanent care staff have completed a National Vocational Qualification level 2 or above and a further one is presently working towards this qualification. During the previous inspection it was identified that the application form does not ask for a full employment history therefore a requirement was made to address this. It is noted that the organisation has a formal agreement with the Commission for it to hold centrally some specific staff recruitment documentation and maintain a signed checklist within the home. Four of these checklists were examined during this inspection. There is a section on this list for the registered manager to sign if a full Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: employment history has been obtained. This was verified by the registered manager in all cases. Each file shows that all necessary clearances have been received. It was further noted that two staff CRB disclosures were dated 2003 and 2004 and as a matter of good practice it is recommended that CRB disclosures dated 2003 and 2004 are repeated. All newly recruited members of staff receive a structured induction training including shadowing more experienced carers until both parties feel confident and comfortable. Staff are provided with mandatory training in core subject areas which is updated accordingly, and undertake ongoing development in order that they are appropriately trained and equipped with the skills to meet the varying personal care needs of the service users, thereby protecting the service users health, well being and safety. The training records show that staff are up to date with mandatory training. Feedback from staff was positive and they felt that the training was good and they were supported by the manager who provides them with regular formal supervision. There are regular staff meetings held and minutes are kept of these which the inspector observed. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with systems in place to ensure the health and safety of services users and staff is maintained. Evidence: The registered manager has been in post since 1999 and is currently undertaking her National Vocational Qualification Level 4 in Care, after which it is anticipated that she will undertake the Registered Managers Award to enhance her skills and knowledge. The Annual Quality Assurance Assessment (AQAA) sent out prior to the inspection was returned within the requested timescale and was well completed. The AQAA informed us of changes they have made and what areas need to be improved upon and details how this is to be achieved. The data section was accurately and fully completed. Examples of further training undertaken by the registered manager include safe guarding vulnerable adults, risk assessing, positive approaches, the mental capacity act and absence management training. The registered manager reports to an external line manager who carries out her supervision and also undertakes monitoring visits on behalf of the provider. These were examined by the inspector and follow a detailed Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: format and show that speaking with staff and service users is a regular feature of the visits, plus good practices such as examining a sample of service users money and staff training records. Service satisfaction questionnaires have recently been sent out to relatives and representatives of people using the service, GPs and care managers. The results from this have been collated to show the outcome of the exercise and an action plan has been formulated for improvement. The home has it own newsletter called the Monro Mag and this is sent out to relatives and other people involved in the home. The inspector read one letter from a relative who complimented the newsletter and said the Monro Mag has kept us up to date with events and thanked the staff for all their hard work. The organisation carries out an annual audit referred to as the Big Respect Audit and this took place in May 2007. Each person using the service is able to complete a listen to me book with their key worker and this gives them the opportunity to provide feed back about the service. A range of health and safety checks are in place at the service, carried out on a daily, weekly or monthly basis. Portable electrical appliances had been checked on 24/11/2008, electrical hardwiring was checked on 16/07/2004 and the gas service certificate was dated 08/02/2008. There are service certificates for fire equipment and emergency lighting. There are records of weekly fire alarm testing and staff training is up to date for all care staff working in the home. The fire risk assessment is dated 27/02/07 and should be updated updated annually. This is strongly recommended. Fire drills are carried out with the full involvement of the service users and these are recorded in the homes fire safety records. There is evidence of water temperature recording, work placement risk assessments and accident and incident reports. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 It is strongly recommended that when it is necessary to handwrite on a medication administration record chart in the home, the member of staff writing the chart signs and dates the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. It is recommended that all CRB checks dated 2003 and 2004 are repeated. It is strongly recommended that the fire risk assessment is reviewed and updated. 2 3 34 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!