Inspection on 05/03/09 for Northdown Residential Home

This inspection was carried out on 5th March 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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: Northdown Residential Home Canterbury Road Molash Canterbury Kent CT4 8EX     The quality rating for this care home is:   one star adequate 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: Kim Rogers     Date: 0 5 0 3 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: Northdown Residential Home Canterbury Road Molash Canterbury Kent CT4 8EX 01233740882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Lifestyles (FL) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 15 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 15 Northdown is set in its own extensive gardens and situated in a rural location near to the villages of Molash and Chilham. The City of Canterbury and town of Ashford are both approximately 5 miles away. The home has access to its own transport, facilitating trips into the wider community. There is an infrequent public bus service operating nearby. Northdown is registered to provide accommodation for a maximum of 14 people who have learning disabilities. At the time of the inspection there were 8 people using the service. The accommodation is divided into a main house, on two floors, with 12 registered bedrooms and a detached building containing 2 semi-independent flats close to the main house. A considerable amount of communal space is provided, including a relaxation room, teaching kitchen, smoking area, two large lounges and art and craft Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home area. There are sufficient toilet and bathing facilities throughout the home and the cottage for easy use. Staff have their own dedicated sleep in and office area. The current fees for the service at the time of the visit range from about 1011.74 to 2280.83 pounds per week. Information on the Homes services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. For more information about the fees and services please contact the provider. Since the last inspection of 1.12.08 there is a new Provider. 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: one star adequate 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 was a key inspection of the service and included an unannounced site visit by one inspector. The site visit was carried out over about four hours. All of the key minimum standards were assessed. The previous key inspection was carried out on 1 and 2 December 2008. At the last inspection we found that two previously made requirements had not been met. These two requirements related to care planning and risk assessments. We sent them a warning letter and served a statutory enforcement notice. We found that they have made improvements and addressed the requirements of the statutory enforcement notice and other requirements made last time. Care Homes for Adults (18-65 years) Page 6 of 30 We spoke to service users, staff and the manager. The manager is new in post since the last inspection. The manager has been at the home for about one month and said she is the temporary manager. We sampled records, made observations and had a look around the home. The manager is referred to in the report as the manager even though they are not registered with us. This means that they have not passed the fit person process. We sent surveys to service users and staff. We received all of the surveys back, five from staff and five from service users. All of the surveys were positive about the service provided. We looked at the Annual Quality Assurance Assessment or AQAA that the manager completed. This gives information about what the home does well and how they intend to improve. We looked at other information we have received about the home including any concerns, complaints and notifications about incidents and accidents. Since the last inspection there have been further concerns raised to us about the home. There has been a safeguarding alert and investigation, which found that a service user suffered physical abuse by a member of staff in the form of an inappropriate restraint. The manager and area manager have taken steps to make sure that this does not happen again. What the care home does well: What has improved since the last inspection? There is a new provider at the home. The new area manager and new manager have been working to make sure the previous requirements are met and that outcomes for people who use the service are improved. They have made sure that everyone now has a service user plan or support plan developed with them by the Provider. Peoples current needs and goals have been identified and recorded using a person centred assessment tool. Individual plans are being developed with people so staff know what support people want. The requirements made at the last inspection have been met. This means that peoples personal care needs are now recorded. Peoples health needs are now recorded and supported. Guidelines to show staff how to support problem behaviours have been either produced or updated. Shortfalls in staff training have been identified and training either held or planned to meet these shortfalls. The way that potential risks are assessed and managed has been improved protecting and enabling service users. Individual guidelines to show staff how people prefer to communicate are being developed. The monitoring of the service has improved. The new area manager is spending time at the home supporting the staff and new manager and is monitoring practice. This protects service users. The smoking room has been decorated with new flooring and better extraction fitted. One person said that Northdown is now a calmer place to live. Staff are now involved in reviews if service users wish them to be. Staff have been given more responsibility meaning that they are more involved in the running of the home. Care Homes for Adults (18-65 years) Page 8 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information about the home, which helps people know more about the service. Assessments are completed or obtained before someone moves in to ensure the home can meet their needs. Evidence: We found that no one has moved into the home since the last inspection and there are currently no plans for anyone to move in. Because of this we could not test the assessment process. However new baseline assessments have been completed with each person using new paperwork. This means that peoples needs and personal goals have been assessed and recorded. We found that there is some information about the home that includes colour photographs. This makes it meaningful and gives prospective service users information about the service provided. A recent company audit identified the Statement of Purpose and Service user guide need updating. The manager said she will do this so that the information is up to date. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: We found that each person has a contract detailing the terms and conditions of their stay at Northdown. 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. People know their needs and goals will be recorded and supported. Potential risks are identified and steps taken to reduce risks. Communication support has improved. Evidence: We found that each person has a service user plan or support plan, which has person centred information. This has been developed from individual person centred assessments that people have been involved in completing. Support plans include information about the persons life history and background which gives staff a more detailed picture of who the person is and the life they have had. We found that a persons needs and personal goals have been identified and recorded. There are plans to include detailed plans of support so staff know what to do and by when to support the achievement of goals. People who use the service said they have been involved in developing the new plans Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: with their key workers. This is an improvement since the last inspection and meets the requirements of the statutory enforcement notice. We found that a new risk assessment tool has been introduced. This shows the likelihood and severity of possible risks. We found that potential risks have been identified and assessed individually. This makes it clearer to staff on what to do to reduce potential risks to people without restricting them. This is an improvement since the last inspection and meets the requirements of the statutory enforcement notice. We found that regular reviews of plans have been introduced in that key workers complete monthly reports. More formal reviews are carried out on a six monthly basis and reviews held with care managers and significant others on a yearly basis. This means that any changing needs can be identified and acted on so people get the right support. We found that work has been done to improve information about how people prefer to communicate. We saw clear communication guidelines for one person showing clearly how they communicate and how to communicate with them. This means that staff should have the information they need to enable them to support choices and decision making. We found that there are plans to improve the environment so it supports communication. For example there are plans to have a board showing who is on duty. This means that people can find out for themselves rather than having to rely on staff telling them. 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 have the opportunity to take part in a range of activities. Relationships and hobbies are supported. The food is good and people are involved in planning and preparing meals. More support is needed so people have the opportunity to develop existing skills and learn new skills. Evidence: We found that people are supported to access the community and have the opportunity to take part in a range of activities. One person said they enjoy watching live football matches at the local pub. Some people use the train or two company vehicles. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Service users said they enjoy attending college and one person has a job. There is an activities room that can be used for activities like art and craft. We found no plans in place to support skills development like cooking, budgeting, life skills. This means that people may not increase and develop their independent skills. However, the new support plans have only recently been introduced. Plans to increase existing skills and learn new ones can be added in time. Get togethers are held with other company homes. This means that people have the opportunity to make friends. We found that relationships are supported with details of family and friends recorded. People said they keep in touch with their families by phone and letter. We found that visits to friends and family are supported by the home. We found that the kitchen is accessible to people and saw people making their own drinks. We found that the meal choices of the day are displayed on a notice board in the dining room. Coloured pictures are used to make it meaningful to people. Some people make their own breakfast and drinks. The kitchen is spacious and clean with a smaller attached training kitchen. The dining room is spacious and light and we found that people are given the time they need when eating so they are not rushed. We found that peoples nutrition is monitored so staff can act if there are any significant changes. We found that there is more detail in plans about peoples needs regarding eating and drinking. 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. Peoples personal and health care needs are recorded and supported. Medication practice is safe. Evidence: We found improvements in the recording and monitoring of peoples health and personal care needs. This meets requirements made at the last inspection. We found that peoples personal care needs are now recorded in individual plans. This means that staff should know how people prefer to be supported. One person said that staff give them the support they need with personal care. We found that health needs are now recorded in individual plans. The action that staff need to take is also recorded. This means that staff know what to do to support people to remain well and healthy. We found that health needs are monitored so staff can act if there are any changes. We found that each person has been involved in completing a health action plan. This gives people some responsibility, involvement and control over their own health. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: We found that referrals to health professionals for support have been made to ensure people have the right support. We found that records of health appointments are kept including visits to GP, chiropody, opticians and dentists. We found that people have support to attend appointments. We looked at medication records at the recent inspection. Since the last inspection some staff have had medication training. New medication cabinets have been purchased with the plan to support people to have more control of their medication with the right support. They plan to offer people the opportunity of storing their medication safely in their rooms. One person said they would like to do this but would prefer it if staff kept the keys for safety reasons. Care Homes for Adults (18-65 years) Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is not meaningful to everyone so not everyone knows how to use it. Some improvements have been made to protect people from harm and abuse. Staff must have the skills to support people with problem behaviours. Evidence: We found that there is a complaints procedure but this may not be meaningful to everyone. This means that not everyone can use it. People did say that they would speak to staff if they had a problem. The home has had no complaints since the last inspection. Some concerns were raised to the Commission in January 2009. This included concerns about care planning, staff working long shifts and the way people are charged for transport. These concerns were shared with other agencies and looked into at this inspection and at a contract compliance audit in January. We found that the Provider is addressing these issues. We found that staff have training in how to safeguard vulnerable adults. However training in supporting people with problem behaviours is limited. Some people have problem behaviours that challenge the service. Staff were at times struggling to support people due to the lack of training and support. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: There has been one safeguarding alert made to the local adult protection team since the last inspection. The adult protection team at social services and the police carried out an investigation. They found that a service user suffered physical abuse in the form of an inappropriate restraint by staff but that mitigation should be considered in that there were no behaviour support guidelines, lack of staff induction and training and lack of a care plan and risk assessments. This places service users and staff at risk of harm. The number of incidents of challenging behaviour has reduced since the last inspection. This is due in part to one person moving out of the home and another person having their medication reviewed. One person said the home has been a calmer place to live since the last inspection. The operations manager said that training is being arranged so staff have some skills in supporting people with problem behaviour. The operations manager has reviewed support plans to ensure there are guidelines in place for staff to follow to support problem behaviours. At present no one has a functional assessment, functional analysis or positive behaviour support plan. This means that staff are not sure why people present the behaviours they do and how to support people in a positive proactive way. A referral has been made to the psychologist at the local community team to help support one persons behaviours. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, safe and well maintained. Evidence: We found that communal areas are spacious with different areas that people can use. This means that people can choose a more quiet area if they wish. However private space is limited to bedrooms. Visiting professionals have reported the do not always have a private place to meet with and talk to service users. We found that some of the communal areas are stark. Framed individual and group photographs will make it feel more homely for people. The manager said she plans to address this so the home feels more homely. The gardens are large and well maintained. Service users said they sit outside for meals in the warmer weather. The garden can be accessed from the dining room freely so people can get fresh air when they want to. One person said they are planning to grow vegetables. The home is generally clean during the visit. The laundry room is kept locked so access is restricted unless people have staff with them. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: There is a number pad fitted to the inside of the front door so only staff can open it from the inside. This is used to restrict access to the front of the property to keep people safe on the nearby road. There have been incidents when service users have run into the road. Any restriction should be made in service users best interests, be the least restrictive option and be kept under review. There is a separate smoking room for service users to use. This room has been decorated and new flooring fitted since the last inspection. The extraction has been improved as recommended at the last inspection. The manager said that there are plans to redecorate other parts of the house. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet peoples needs. Outcomes for people will be improved if staff have in depth training relating to peoples needs like person centred planning and positive behaviour support. Evidence: We found that recruitment checks are carried out before people start working at the home protecting service users. However we found that the content of references is not always considered which lead to an incident detrimental to a service user. Information in references must be taken into account so staff have the support they need and service users are protected. Staff have job descriptions and contracts of employment. At the last inspection we found some shortfalls in mandatory training. Training relating to service users needs like supporting challenging behaviours and person centred planning is limited. This means that staff may struggle to meet service users needs and people may not get the consistent support they need. The operations manager said that some mandatory courses like food safety, first aid and health and safety have been held and more are planned. A one day course about person centred planning has been held and training in supporting challenging Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: behaviours is planned. Staff will need in depth training in these subjects to fully grasp, understand and implement person centred support. We found that staff induction has been reviewed and is adequate. The manager said the home is fully staffed and they have not used agency staff for a while. The operations manager said they plan to recruit some bank staff to cover staff holidays and sick leave. We found previously that staff supervision is not in line with the Minimum Standard, that is at least six one to one meetings a year. This means that staff do not have the opportunity to meet with a line manager and talk about work and personal issues and get the coaching, mentoring and support they need. This is especially important in a service supporting people with problem behaviours, as it can be a stressful environment. The manager said she has met with some of the staff on a one to one basis and plans to meet with everyone to give them the support they need. A staff meeting was held on the day of the visit. We found that some staff work long shifts, that is 07.15 to 21.30 then a sleep in shift followed by 07.15 to 21.30 shifts. This means staff are at the home for up to thirty eight and a half hours. Due to service users needs we recommended at the last inspection that the length of shifts be reviewed to ensure staff do not get tired and stressed. Care Homes for Adults (18-65 years) Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been adequately managed for some time. The health and safety of service users and staff is not fully protected. The monitoring of the service has improved. Evidence: The management of the home has been inconsistent over the past few months. There has been no registered manager for some time. There is currently a temporary manager who has been in post for one month. The manager has support from the operations manager who has been in post for two months. The previous inconsistent and ineffective management of the service has meant that outcomes for people have not improved. There is a new registered Provider. We found that the Provider has committed resources to improve outcomes for people. For example the operations manager has been at the home supporting the temporary manager to improve care plans and risk assessments. Parts of the environment have been improved. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: There have been improvements in a short space of time, that is, in the last three months since the last inspection. They have addressed the requirements of the statutory enforcement notice and met the previous requirements. The challenge now is to maintain the improvement and to ensure that staff have the skills and support they need to fully implement and embed the improvements. This will take a change of culture which needs careful and planned management. The operations manager spoke of their plans to manage this by way of one to one meetings, staff meetings and training. We found that the monitoring of the service has improved. The operations manager visits the home each month and checks records, talks to service users and staff and makes a report. The manager has given staff responsibility for various tasks like health and safety. This gives staff a role and means they are part of the running of the service. An audit by the company has been carried out and an action plan for improvement produced. The Provider has sent us an action plan of improvement and has sent in updates to this. We found that surveys are used to seek peoples views about the service but there is little evidence that service users views underpin any changes or improvements. Some people have been saying for years that they are not happy living at Northdown but there have been no real plans for change until recently. There are now regular service user meetings so people get the opportunity to air their views. The AQAA shows that health and safety checks of equipment and premises are carried out. However we found a lack of checks of fire equipment including the alarm, emergency lighting, break glass points and fire doors. This places service users at risk. We found that the instructions displayed in the hallway about what to do in the event of a fire are in small text so may not be meaningful to service users. This means that service users and visitors may not know what to do in the event of a fire. The manager said she has realised this and plans to address it straight away. We found at the last inspection that not all staff have been trained in health and safety including first aid, infection control and fire awareness. This means they may not have the skills they need to keep service users safe. Some staff have attended training recently and more training is planned to address the shortfalls. This means that requirement of the last inspection has been met. Care Homes for Adults (18-65 years) Page 26 of 30 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 1 37 9 There must be a permanent 31/07/2009 suitably qualified and experienced manager in post who is registered with us. So that people know the manager is a fit person to manage the 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 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!