Inspection on 16/01/09 for Mowbray House

This inspection was carried out on 16th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mowbray House 17/01/08

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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: Mowbray House Mowbray House Crook Co Durham DL15 9JG     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: Clifford Renwick     Date: 1 6 0 1 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 33 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 33 Information about the care home Name of care home: Address: Mowbray House Mowbray House Crook Co Durham DL15 9JG 01388768579 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): deborahbishop@youngfoundations.com Young Foundations Ltd Name of registered manager (if applicable) Mrs Deborah Bishop Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The home must only admit service users between the age of 16 - 25 years. Date of last inspection Brief description of the care home Mowbray House is a large detached house situated in a rural area of Durham. The home is registered to provide personal care to five adults with learning disabilities aged between sixteen and twenty five years. Nursing care is not provided. The accommodation is well decorated and maintained. The house is very close to the town centre of Crook. The home has its own transport. The house itself is a very large building, set in its own spacious grounds. Each person has their own bedroom and they share communal areas, which includes a kitchen/dining room and two lounges. One of the bedrooms on the first floor is a staff bedroom for the member of staff on sleepover duty. Care Homes for Adults (18-65 years) Page 4 of 33 care home 5 Over 65 0 0 5 5 Brief description of the care home Mowbray House is part of the residential services provided by Young Foundations Ltd. A Statement of Purpose and service user guide are available at the home for residents who are interested in coming to live at the home. The guides describe the services and facilities provided by the home and how staff are trained to meet service users? care and support needs. CSCI Inspection reports are also available at the home detailing the quality of care provided by the home. Fees payable for living at the home at the time of inspection 3278.26 to 3825.00 weekly. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspections may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. Care Homes for Adults (18-65 years) Page 6 of 33 The last inspection of this service was carried out in June 2008. Before the visit. We looked at. Information we have received since the last visits in June 2008. How the service dealt with any complaints & concerns since the last visit. Any changes to how the service is run. The providers view of how well they care for people in information provided to us in the Annual Quality Assurance Assessment (AQAA) that we sent to them. Looked at information received in surveys that were completed by service users or their representatives. And held discussion with a care manager who has responsibility for a person currently living in the home. he Visit. An unannounced visit was made on the 9th January 2009. During the visit we. Talked with some of the people who live in the home and also staff who were on duty. Held discussion with the deputy manager. Observed staff working practices. Looked at information about the people who live in the home and how well their needs are met. Looked at other records, that must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. We also gathered information from looking at care records to assess how staff supports the service users with their assessed needs. We focused upon looking at care files for 2 service users as a part of the inspection we refer to this as case tracking. And this involves looking at all records of the care for a named individual. It was established during our visit that the people who live in the home prefer to be known as residents therefore this term of reference is used throughout the report. Care Homes for Adults (18-65 years) Page 8 of 33 What the care home does well: What has improved since the last inspection? There has been more consistency in the home with providing training opportunities for staff. There are better systems in place for staff to receive formal supervision and take part in planned staff meetings. Medication records are much improved and each residents has an individual medication pen picture. This enables staff to support the person in person centred way. Redecoration has been carried out in the home and some bedrooms have been fitted with new floor coverings. An activity room has been developed that residents can use and new sofas have been provided in the lounge. Care Homes for Adults (18-65 years) Page 9 of 33 Improvements have been made in maintaining contact with residents and their families and staff have facilitated this contact by providing transport. 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 10 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents needs are assessed prior to being offered a place in the home this ensures that only peoples needs who can be met are admitted. Evidence: Since the last inspection visit once new person has moved into the home. A comprehensive needs assessment had been completed for this person prior to admission and this has continued to be updated by care staff in order that staff are clear and consistent as to how this person is to be supported. The assessment also includes an assessment of risk and enables staff to have strategies put in place to minimise the risks whilst at the same time enabling people to be as independent as possible possible. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans of support are in place to ensure that residents health and social needs are met by staff. And this includes supporting residents to take risks as part of an independent lifestyle. Evidence: Each person has an individual written plan of care that has been developed from the assessment of needs. These care plans set out the actions that staff have to take in order to support people and also to ensure that the care approach is consistent. Discussion with the person in charge at the time of our visit confirmed that the care plans are currently being developed. The care plans use a mixture of written instructions and also pictorial images in order Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: that they are more accessible to the service user. It is good to have the care plans in these different formats however some of the pictorial images/symbols do not always give a good enough description of what they are describing. This was discussed with the deputy manager where discussion focused upon the possible use of photographs particularly for tasks that residents are engaged in as a way of replacing some of the pictorial symbols currently in use. And perhaps this being a way forward to make the care plans more person centred and accessible to the residents. The documentation currently in use overlaps with records that are also used to record health and personal care and a lot of information has been compiled. However when looking at the care plan/support plan some of the information that should be included about the support being offered is held elsewhere within the health file. It is not immediately clear as to what actions staff are taking as a result of this. For other areas of the care plans there some sections that have identified specific tasks for staff to support residents with but the detail at times is not sufficient to demonstrate how this takes place. For example assist x with daily exercise. There is no information recorded as to what this exercise is, when it should happen and with whom. Consequently it makes it difficult to assess the effectiveness of this aspect of the care plan. Another example where more detail needs to be included relates to one persons support needs that deal with continence management. A toileting support plan has been implemented but does not set out what it is that staff are doing to support the person. Therefore it cannot be determined what progress the person is making and what level Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: of support is needed. For some residents staff have identified some particular areas of risks during the night when service users have gone to bed. This involves the potential for one person to enter another persons room uninvited. As a result of this all bedroom doors are fitted with a discrete alarm system that is used during the night and which alerts staff if a resident leaves their room. Though staff have said that the system is effective there is not enough detail within the risk assessment document stating the reasons for the alarm and what the identified risks are. A risk assessment is in place for one person but not for others. And this was discussed with the deputy manager who was offered advice as to what kind of record needs to be in place to support this practice. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported to take part in activities and outings that they enjoy and maintain relationships with relatives and friends. They are also involved in planning menus so that they have a range of meals that reflect their choices whilst at the same time maintaining a healthy diet. Evidence: Staff support residents to take part in activities that they enjoy and these are listed in their individual support plans. During our visit one resident was engaged in using the computer to play games that assist with learning. Activities take place both in and outside of the home and these include going to leisure Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: centres, discos and taking part in one to one activities with staff. There are a variety of games within the home and also the ability to use one of the lounges as a relaxation area where people can if they wish spend time on their own. Holidays are arranged by the home and have included people going on holiday individually with staff or with another resident and staff. There have been 2 separate holidays to Haggerston Castle in Berwickshire and also to Scotland. One service user likes walking and so holidays and outings are arranged around this. Good links are maintained between residents and their families/relatives. One resident spent Christmas with their family and another person spent a day with their family. Most of the residents are from areas outside of this authority and as such families do live some distance away. However staff have ensured that contact has been maintained by use of telephone as well as accompanying residents to visit their families. Observations made confirmed that staff have established a good rapport with residents and interact with people appropriately. The residents have exclusive access to the areas in the home and also the grounds whilst at the same time their safety is maintained. Some residents have chosen to have their bedroom doors locked when not using their rooms. And arrangements are in place with appropriate alarms on doors so that people do not enter other peoples rooms without their permission. Residents meetings are held and minutes of the last meeting held in December 2008 were looked at. This confirmed that the residents are encouraged to be involved as much as possible in how the service is developed. The minutes confirmed that discussion took place about changes to the premises and Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: the fitting of a new kitchen, activities and also use of the garden. Staff are responsible for shopping for foodstuffs, cooking the meals and planning menus with the residents. And from this menus are in place that demonstrate what meals are being provided on a daily basis. The menus are in written format and also use pictorial images though at times these pictorial images do not always accurately reflect the meal that is being offered. There is a pictorial food file that staff are using with residents to choose meals and this is good as the images are photographs and give a good representation of what the meal/dish is. We discussed with the deputy manager about having similar photographs of the meals on the menus as this would potentially offer the residents a better range of information and assist them in making choices. In discussion with staff it was confirmed that they are in the process of developing a food file and this will be used to record residents likes/dislikes. And help with planning of future menus. Staff confirmed that they have managed to build up a good range of information about peoples likes and dislikes with food and this has assisted them in providing food that they enjoy. Staff ensure that snacks and drinks are available in between meals and the residents with staff support are encouraged to make use of the kitchen dependent upon their ability. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents receive support in the way which they prefer and good arrangements are in place to ensure their health needs are met. Evidence: Care records were looked at for three people and this confirmed that personal support is offered to people in a way that they prefer and what is appropriate to meet their needs. The routines within the home are structured to ensure that each person can receive the support in the way that best suits them. Personal support is offered mainly on a one to one basis. And intimate and personal care tasks are carried out in a way that ensures peoples privacy is respected. As stated previously care staff are supporting service users with personal tasks and in discussion with staff they could confirm in detail what level of support they were offering. Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: However this level of detail was not always recorded in the residents individual plan of care. Records are available that confirm residents have access to all NHS services and any specialist health services if required. And a healthcare plan is in place to confirm that peoples health needs are monitored with staff taking appropriate actions if there are any indications that their health needs change. Discussion held with the deputy manager confirmed that further development is being carried out with the health and care plans. None of the residents self administer their own prescribed medicines and this is carried out by staff. All staff have completed training in the safe handling of medicines. Good records are in place to confirm that medicines are administered correctly and medicines are stored appropriately. A yearly staff audit is carried out with staff and this includes a questionnaire to ensure that staff competencies are assessed when dealing with medicines. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place that ensure that any complaints are acted upon. And robust policies and procedures and training for staff ensure that people are protected from the potential of abuse. Evidence: The home have a complaints policy and procedure and a pictorial booklet entitled How to Complain is in place. There has been one complaint made in the last 12 months and this was looked by the commission as part of a random inspection. Most aspects of this complaint were unfounded and for other areas that involved record keeping and where action was required by the company. This was dealt with immediately. Letters of compliments were available from placing authorities that confirmed following three review visits they are satisfied with the service being offered. In discussion with staff they confirmed that they use a variety of techniques to evaluate whether someone using the service is dissatisfied as not everyone would be able to complain using speech as a method of communication. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Staff stated that they would observe for any changes in peoples body language or a change in behaviour as one of the ways of determining if the residents were unhappy with something. Appropriate polices and procedures are in place that deal with the safeguarding of adults. And all staff have received updated training from the company in the last 12 months. This has ensured that staff have been kept up to date with current practice and are also familiar of how people are to be protected from the potential of abuse. Strategies are in place for staff in supporting them to deal with physical and verbal aggression from the residents. Staff adhere to written guidelines and good records are in place to record how any incidents have been dealt with. Staff have also received appropriate trainingin this area of work. Staff ensure that they work to the guidance issued by the Department of Health and this ensures that peoples rights are protected. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a building that is safe and well maintained and this contributes to their well being. Evidence: During this visit we looked at all areas of the home and this included residents bedrooms and all communal areas. Any repairs that were noted in previous inspection reports have been dealt with with the exception of the kitchen. At the time of our visit plans were in place to refurbish the kitchen and replace all units with new units as well as redesigning the layout to make better use of the floor space. A representative from a kitchen company came out to the home during the visit to measure up for new units. Some refurbishment has been carried out to residents bedrooms. Suitable arrangements are in place for the laundering of peoples clothes. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: There were no noticeable defects or safety hazards at the time of our visit and the building is maintained to a good standard. One matter that was discussed with the deputy manager relates to the bedroom doors all of which are fitted with an alarm and which are in place to deal with a risk management issue. There are no written risk assessments in place to confirm why the alarm is used and when and what action staff take if the alarm is sounded. And this was discussed in more detail previously in this report. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent and trained staff in numbers that are appropriate to their needs. And the robust recruitment procedures ensure that only staff who are suitable to work with vulnerable adults are employed. Evidence: Discussion with the deputy manager and examination of the staff duty roster confirmed that sufficient skilled and experienced staff were on duty to meet the needs of residents. Good training opportunities are available for staff with most staff having completed NVQ Level 2 training and with 6 staff currently undergoing NVQ Level 3 training. Staff are also undergoing training that relates to diet and nutrition. Arrangements have also been made for four staff to attend a training course that will enable them to manage an educational programme that can be used with residents. Staff were complimentary about the training that is provided by the company. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: The home also accept social work students on placement as part of their training and at the time of the visit there was 1 student undergoing a practical work placement. In discussion with this person they confirmed that they were satisfied with the placement and had initially been shadowing an experienced member of staff. This had also led to them becoming more involved whereby they had assisted in developing communication aids for one of the people who live in the home. There are currently staff vacancies in the home and one person who is currently working as a sessional worker will take up a full time post in February. As a result of these vacancies there have been occasions when there were 3 staff on duty when there should have been 4 staff. This has been the odd occasion and has not had impact on the service being offered. There is currently a senior residential care officer post available and this is being advertised. Since our last visit three new members of staff have been employed. Examination of their personal files confirmed that all of the necessary documentation had been received as part of the recruitment process. This has ensured that only staff who are suitable to work with vulnerable adults have been employed. Throughout our visit staff morale was good and the atmosphere was pleasant with staff working well with residents and engaging them in activities and events throughout the day. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements in place ensure that residents and staff benefit from a well run home. And the quality of the care provided by the home is kept under regular review which ensures that peoples rights are safeguarded by the homes polices and procedures. Evidence: At the time of our visit the manager was not available due to other commitments within the company whereby they were visiting another establishment. The deputy manager was present throughout our visit and took a full part in the inspection. Both the manager and the deputy manager have a good range of experience in this work and are in receipt of appropriate qualifications. They are ensuring that the home is being run in the best interests of people and Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: working in line with the homes stated aims and objectives. In discussion with the deputy manager it was confirmed that though the residents were not always able to offer a view of the service, steps are being taking to continuously improve the service. Discussions are held with relatives and advice is sought from placing authorities when residents reviews are held. And from this the manager uses information to review and develop the services within the home. Regular staff meetings are held and these are used to share ideas and information with the staff team and also seek their views on the service and identify where developments can be made. Good records systems are in place for the managing of monies held on behalf of service users. Satisfactory records are maintained that confirm staff follow good health and safety practices when working with people. Records of all accident are kept and these include detailed information about the accident and also what actions have been taken. There are also appropriate records kept that confirm staff receive fire instruction training and take part in fire drills. During our visit we also looked at the records that are required to be kept if staff have to restrain a service user. The records that are in use are detailed and include sufficient information to confirm that staff follow the correct procedures and safety guidelines if a restraint technique has to be used. All staff have received appropriate training in this area of work and this ensures that staff are consistent in their approach as well as ensuring that service users are safe and not put at risk. As noted in our the previous inspection visit due to some of the health care needs of the service users, a listening monitor has to be used in 1 persons bedroom to ensure their safety. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: There is a written protocol in place for the use of the monitor and the service users parents have signed confirming their agreement to this. However there is no written risk assessment in place that identifies what the health risks are and the procedure of how the and when the alarm should be used. This was discussed with the deputy manager who was advised of what actions must be taken to address this. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 9 13 A risk assessment document 31/03/2009 must be in place that records in detail why bedroom doors are fitted with an alarm, what the risks are and how staff are to manage this. This will ensure that service users rights are not being overruled. And that staff have consistent strategies in place to deal with perceived risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The individual care plans should continue to be developed so that they set out in detail and are designed in a way that makes them more accessible to service users. Consideration should be given to develop the menus so the that the pictures in use reflect the meal that is being offered. 2 17 Care Homes for Adults (18-65 years) Page 31 of 33 3 42 A risk assessment document should be put in place that demonstrates why a listening device needs to be used in 1 service users room. This should also include details of when it is used by staff and how. So that it demonstrates that dignity and privacy is being maintained whilst ensuring the safety of the individual. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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