Inspection on 06/02/09 for Nicholas House

This inspection was carried out on 6th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nicholas House 27/02/07

Nicholas House 07/02/06

Nicholas House 12/09/05

Nicholas House 09/12/04

Nicholas House 09/07/04

Nicholas House 01/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Nicholas House Cairns Close St Albans Hertfordshire AL4 0EY The quality rating for this care home is: 1 Star adequate 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: Julia Bradshaw Date: 0 6 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 36 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Nicholas House Cairns Close St Albans Hertfordshire AL4 0EY 01727839909 01727858742 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): PentaHact Limited trading as Adepta Name of registered manager (if applicable) Georgina Nash Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 care home 7 learning disability Additional conditions: Date of last inspection 2 7 0 2 2 0 0 7 A bit about the care home Nicholas House, provided by PentaHact, is a residential care home for six younger adults with autism, severe learning Care Homes for Adults (18-65 years) Page 4 of 36 disabilities and challenging behaviour. It is situated in a residential area, about two miles away from the town of St Albans. There are ample parking facilities nearby. It has been completely renovated internally to accommodate the assessed needs of the residents. There are six bedrooms. There is a large garden to the back of the building. It has a summerhouse, garden swings and garden furniture. The garden overlooks Highfield Park. The Statement of Purpose, Service User Guide and previous CSCI inspection reports should be available within the Care Homes for Adults (18-65 years) Page 5 of 36 mangers office at Nicholas House. Care Homes for Adults (18-65 years) Page 6 of 36 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: 1 star adequate Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home The focus of the inspections undertaken by the Commission for Social Care Inspection is based upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting three people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. Care Homes for Adults (18-65 years) Page 8 of 36 The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Commission for Social Care Inspection. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection and we looked at the feedback received from questionnaires circulated to people who use the service. The visit took place over one day and was carried out by one Inspector. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. Care Homes for Adults (18-65 years) Page 9 of 36 A selected tour of the building was conducted during which the inspector spoke with people who use the service and the staff on duty. The last Key Inspection was conducted on the 27th February 2007 with an Annual Service Review being conducted on the 9th January 2008. The fee range for the service is from one thousand eight hundred and twenty seven pounds to four thousand and fifty pounds. The fee range is dependant on individual needs. The fee excludes personal items, some personal choices for trips, toiletries and other personal items of choice. Care Homes for Adults (18-65 years) Page 10 of 36 What the care home does well Nicholas House provides a diverse range of services to people across the Autistic spectrum. People living within the service looked relaxed and content with positive interactions of staff observed throughout the inspection. One person spoken to said that they liked the staff because they give me nice food. Generally the service was decorated to an acceptable standard with peoples bedrooms being personalised and reflecting their interests. Care Homes for Adults (18-65 years) Page 11 of 36 The staff team appear both committed and experienced in their work with the people at Nicholas House and carry out their work in a confident and competent manner. The service offers a range of interesting and individualised social and leisure opportunities, as well as daycare placements and holidays. The staff help people to plan the menus, shop and cook. They are able to balance the individual food choices and ensure a healthy balanced diet. What has got better from the last inspection The service now has a registered manager in post. Care Homes for Adults (18-65 years) Page 12 of 36 Several areas of the service have been re-decorated since the last inspection took place and some new gym equipment has been purchased as well as a summerhouse being erected in the grounds of the home. What the care home could do better The service must ensure that all the required mandatory training is being provided to all staff. Care plans must contain all the necessary information to ensure the best possible care is being provided to the people living at Nicholas House. There are two aspects of the environment that require Care Homes for Adults (18-65 years) Page 13 of 36 attention which include, both bathrooms need rerefurbishment and there must be adequate hand washing facilities provided throughout the service. Medication systems need to improve to ensure any mistakes are identified at an early stage to ensure that people using the service are protected. The Statement of Purpose and Service User Guide should be updated to reflect the current service provided and a copy of these documents should be made available within the home. Care Homes for Adults (18-65 years) Page 14 of 36 The complaints procedure must be updated and more detailed and easily accessible to everyone both using or visiting the service. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Julia Bradshaw CSCI CPC1 Capital Park Fulbourn Cambridge CB21 5XE 01223-771300 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 15 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 16 of 36 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 . Information about the service should be kept up to date in order to ensure that prospective users of this service and everyone wishing to enter the home has the necessary information to make an informed choice regarding its suitability. Peoples assessments of need was detailed and complete, ensuring that all parties can be confident that the home can meet all individual needs. Terms and conditions of the home are agreed in writing so that people are clear about the roles and responsibilities of all those within the service. Evidence: A total of three care plans were reviewed and evidence gained regarding the initial assessments that are carried out to access if the service can meet the needs of the person. Information is held regarding the persons history and current needs. An assessment of each persons needs and aspiration are made before the person moves into the home. Competent staff complete these assessments. The service also receives and seeks external specialist support to meet the individuals needs. Whole life reviews occur to support the service users in achieving and reviewing their individual needs, Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: goals and aspirations. The assessment process includes the gathering of information from other professionals. The organisation has its own internal assessment forms. A contract is then drawn between the service provider and the placing Authority. The agreement includes the terms and conditions within the home and the rights of the people who live at Nicholas House. We did not look at the Statement of Purpose and Service User on this occasion as the manager was unavailable and the staff on duty were unable to locate these documents. The manager contacted us later the same week and stated that these documents were due to be updated and a copy of these documents would be forwarded to us, once completed. The manager should ensure that an up to date copy of both these documents are available at all times and that these are able to be located and accessed by the staff on duty, at any time. Care Homes for Adults (18-65 years) Page 18 of 36 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 plans reflect a detailed record of peoples needs, which ensures that people using the service are assessed, reviewed and kept safe from risk. Evidence: Three care plans were inspected in detail and generally were found to provide an good insight into each individuals needs. However individual notes of one care plan had not been kept up to date and some information contained in one care plan for a person with particularly challenging needs had not been dated. The manager and staff are in the process of further developing all care plans into a person centred plan format which can be more easily understood by the people using the service. Everyone living at Nicholas House is supported within the whole life review framework and regular reviews occur to ensure changing needs are continuously assessed and reviewed. However one care plan inspected did not contain the most recent review minutes and action plan from their whole life review. This omission was passed on as part of the inspection feedback. Ranges of risk assessments are completed within the service and actions points recorded. These risk assessments contain all the required information. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Activities and outings enjoyed by people living at Nicholas House determine that people are supported to take risks as part of an independent life style. Risk assessments have been reviewed since the last inspection was carried out. There was adequate evidence to confirm that people had been involved in their care planning with signatures from either the person using the service or their representative. People spoken to on the day of the inspection and comments received by way of surveys carried were all positive about the way that care is received in terms of preserving rights and dignity. People spoken to stated, I like the staff here, they take me out”. The Community learning disabilities team based in St Albans provides specialist health care support. Care Homes for Adults (18-65 years) Page 20 of 36 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 enjoy a variety of daytime activities that promotes choices and encourages personal and social development in order to maintain a balanced and meaningful life. Menus reflect choice and provide a well balanced diet that promotes peoples health and well being. Evidence: People attend the day centre QEQMRC in Bricket Wood and also one person attends Oaklands college for art and cookery. These daytime opportunities provide a variety of activities, suitable to peoples individual needs and aspirations. The initial assessment determines the programme of choice within the day centre. Access to transport is through the on-site minibus. Staff support and encourage people to maintain and develop social, emotional, communication skills. People living at Nicholas House are encouraged and supported to maintain links to the local community. People also enjoy regular trips to the local pubs, day trips to Southend, trips to the zoo, shopping trips Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: into St Albans and pub lunches. People have also enjoyed holidays to the Isle of Wight and Cornwall in the past year. The service also has its own sensory room, which is equipped with a range of both visual and sound equipment. Menus were inspected and offer a range of diverse meals that are representative of the cultural needs and wishes of the people currently living at Nicholas House. The menus benefit from being presented in a picture card format in order for people to make an informed choice about what they would like to eat. Care Homes for Adults (18-65 years) Page 22 of 36 Personal and health care 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 adequate 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 personal care needs carried out effectively and respectfully, ensuring that their wishes and choices are promoted. However the current arrangements for the storage of medication, inaccurate recording and monitoring of medication could put people using the service at risk. Evidence: The medication cupboard is located within the main office of the service. However this arrangement is not acceptable as some medication is required by the manufacturers instructions to be stored at 25 degrees or below to remain clinically effective. The temperature of the medication cupboard has not been recorded and therefore the safety of the medication cannot be evidenced. This means that medication may no longer work or may even be unsafe to use. Medication that had been received into the home has been recorded accurately. All staff have been trained and inducted in the administering medication. There is currently no controlled medication held in the medication cupboards, however there is a robust procedure in place for the administration of these medications, if required. The current medication policy and procedure seen on the day of this inspection was Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: dated August 2007 and should be updated to ensure the policy reflects any recent changes to the services medication systems or procedures to ensure the health and welfare of the people living at Nicholas House is maintained at all times. There was a reconciliation carried out on prn ( as required) paracetamol for one service user and this proved to be inaccurate with a discrepancy of six paracetamol missing. This was raised immediately with the person in charge and the inspector asked for this to rectified as a matter of urgency. All non blister pack medication should have a date of opening recorded. Two bottles of medication did not have this recorded. Health records are maintained within the main care plan and reflect the needs of the individual, including any specialist support people may receive and any visiting health professionals , dentists , opticians or chiropodists. However one care plan stated that there had been a concern raised regarding obesity but the weight chart contained several gaps and was incomplete. This is an essential part of the monitoring process and this omission could also place this service users health and welfare at risk. All personal care support is well maintained ensuring individual needs, choices and preferences are met at all times. Care Homes for Adults (18-65 years) Page 24 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current system for managing complaints is incomplete and therefore does not ensure an accurate pathway for people to complain, which could compromise the opportunity for people living within this service, to express their views and opinions. Evidence: The service uses the organisations complaints procedure. However on the day of this inspection there was no evidence of a formal complaints system in place or evidence to confirm how issues that are raised are managed and resolved. The staff on duty were able to supply a grumbles book for us to look at but this does not comply with the required standard of managing complaints effectively. A pictorial version of the complaints procedure was seen in the office but nowhere else in the building. A detailed procedure is in place to ensure that people using the service are protected from abuse and harm. Staff receive suitable and adequate safeguarding training. Staff employed within the home are all subject to enhanced Criminal Records Bureau disclosure. Care Homes for Adults (18-65 years) Page 25 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the environment provides a comfortable place in which to live but inadequate infection control systems and poorly maintained bathing areas currently compromise peoples health and safety and well being Evidence: Several areas of the service have been re-decorated since the last inspection took place. All communal areas of the service are nicely decorated with new furniture in the main lounge and several bedrooms have been re-decorated and new laminate flooring has been fitted. The service has acquired a summerhouse for the garden and some new fitness equipment has been purchased since the last inspection took place. However there are two main areas of concern relating to the environment which include inadequate hand washing facilities and the poor state of repair of both bathrooms. None of the toilets inspected had soap or hand drying facilities and the paintwork and decoration was shoddy with a variety of cracks and peeling paintwork.This is unacceptable and should be given urgent attention in order to ensure that people have access to hand washing facilities that are of an acceptable standard and do not compromise peoples health and safety. The health and safety checks were inspected and were all up to date, including the fire checks. The most recent fire drill was carried out on the 29/09/08. A risk assessment Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: was in place dated the 4/11/08 and the emergency lights were last checked on the 5/2/09. Bedrooms appears clean, bright and have been created to reflect peoples individual interests and provide a private space in which people can relax and enjoy some personal time. There are adequate communal areas and the service also benefits from having a well equipped snoozelem. The home also has a large back garden with a variety of outdoor equipment, including a new summerhouse and bar-b-q area for people to enjoy in the warmer months. Care Homes for Adults (18-65 years) Page 27 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inadequate training records cannot ensure that people using this service are being supported by suitably trained staff and therefore placing people at possible risk. Evidence: The manager was not on site during this inspection and therefore the shift leader conducted this inspection in their absence, however we did speak to the manager several times on the telephone during the course of this inspection to clarify some issues. The rotas were checked and confirmed that the service provides adequate staffing throughout both the day and nighttime. On the day of this inspection there was initially one person on shift, one person who was out with a service user, and a further three staff members arrived for the evening shift during the latter part of this inspection. This service also provides two members of staff who offer additional support to one service user throughout the day and nightime. Training records were inspected but there was insufficient evidence to confirm that all staff had completed the necessary mandatory training required (fire training , moving and handling and food hygiene. Staff have also been provided with Mental Capacity Act training, Safeguarding training and advanced Autism training. The manager is currently doing their NVQ level 4 in management. First aid training and infection control training has not been provided within the required timescales. The recruitment Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: records of this service were unable to be inspected due to the manager being off site during this inspection. However the recent Annual Quality Assurance Assessment completed by the manager stated All staff have to complete a thorough recruitment process which involves them completing an interview, written test, attending an individual service assessment where they spend some time in the home with the individuals that live there. If the candidates are successful at all the above them they are offered a job and then have to complete a CRB and medical. The service currently has 4.5 whole time staff vacancies and vacant posts are either covered with permanent staff or regular bank staff, which is imperative in providing a consistent approach to people living with Autism. Staff spoken to confirmed they receive regular supervision and staff meetings are held on a regular basis. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of this service is prevented from being fully effective due to systems and policies not being fully adhered to and hence placing the people using this service at possible risk. Evidence: The manager was not present at this inspection and therefore some documentation was unable to be inspected i.e Staff recruitment and selection records. Also staff had some difficulty in locating some of the documentation required within the main office. The service has an open house policy with regard to service users entering the main office area. Whilst this makes a very informal and welcoming place for people to use , it could also compromise the issue of confidentiality, with all documentation relating to people living at Nicholas House being held within this one main office. The medication cupboard is also held within this very busy office, which is not the ideal environment for dispensing medication in a safe and quiet atmosphere . There must be up to date Regulation 26 visit reports available for inspection. On the day of this inspection the latest report on the file was the 27/05/08. The manager ensures that supervisions and staff meetings are held regularly and staff confirmed that they feel supported and Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: respected by the manager. However the manager must ensure that all mandatory training is kept up to date as there was insufficient evidence to confirm staff had received first aid or infection control training within the required timescales. The manager has confirmed through the recently completed Annual Quality Assurance Assessment that people are safeguarded from harm by the homes recruitment procedures, safeguarding training and the complaints procedure. Generally people living within the service are provided with information that can easily be understood although this could be further developed throughout the service. The home currentlly provides pictorial menus and has introduced of an objects box which helps people choose their daily and social activities. The service should endeavour to provide pictorial service user questionnaire to ensure that people have the opportunity to be more involved in the running of the service. The service manages peoples personal monies effectively and appropriately. A random check of two peoples monies was found to be accurate and reconciled with the individual ledger. All records relating to health and safety standards are maintained and carried out effectively by designated senior members of staff. Quality assurance systems should be both formalised and further developed before the next inspection takes place, to include both service user feedback and also to incorporate the views of outside professionals and families and carers. There should be an up to date copy of both the Statement of Purpose and Service User Guide available within the service at all times. On the day of this inspection neither of these documents could be located by the staff on duty. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 30/03/2009 There must be a robust system in place to ensure that all medication is monitored and reconciled on a regular basis to eliminate errors and to maintain the health and safety of service users To ensure people are protected by there medication procedures in place 2 20 13 The temperature of the 31/03/2009 medication cupboard must be regularly recorded and systems in place to ensure that medication procedures and practices are carried out effectively and safely. To ensure the health and safety of everyone living within this service Care Homes for Adults (18-65 years) Page 33 of 36 3 22 22 There must be an effective and detailed system in place to ensure people using this service have their views listened to and any issues they may have are acted upon 30/04/2009 To ensure people are listened to and anyone having issues about this service have a method of complaining. 4 27 16 Both bathrooms require complete refurbishment due to being poorly maintained with cracked paintwork and these areas are both uninviting and cold. 31/12/2009 New bathrooms are required in order to provide a comfortable and safe place in which people can wash and bathe. 5 30 23 Infection control standards 30/04/2009 are inadequate with no hand washing facilities in any part of the the building. These bathrooms must be brought up to an acceptable standard before the next inspection takes place. The inadequate hand washing facilities compromise infection control standards and place people at risk of infection 6 35 18 Staff training records were 30/05/2009 incomplete and there was insufficient evidence to confirm that all staff had received first aid training and Page 34 of 36 Care Homes for Adults (18-65 years) infection control training within the required timescales Inadequate training compromises the health and welfare of people using this service 7 42 24 Systems in place to protect 30/03/2009 and safeguard people living within Nicholas House must be strictly adhered to at all times.The health and welfare of people is currently placed at risk due to poor infection control standards, errors in the recording of medication and inadequate staff training To ensure people using this service are provided with the best possible care and standards are not compromised that may adversely affect people using this service. 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 Care Homes for Adults (18-65 years) Page 35 of 36 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. 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