Inspection on 18/12/08 for Renwick

This inspection was carried out on 18th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Renwick 08/01/07

Renwick 01/03/06

Renwick 20/09/05

Renwick 13/10/04

Renwick 23/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Renwick Dragon Lane Manningford Bruce Pewsey Wiltshire SN9 6JE     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: Elaine Barber     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: Renwick Dragon Lane Manningford Bruce Pewsey Wiltshire SN9 6JE 01672563026 Telephone number: Fax number: Email address: Provider web address: Steven@StevenAbbott.wanadoo.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Carol Bottoms Type of registration: Number of places registered: Mrs Jane Abbott,Mr Steven Abbott care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Renwick is a care home registered to care for three people with learning disabilities. It is run by Valued Lives, a private organisation, which operates five care homes for adults with learning disabilities. All are small establishments, intended to offer a normal domestic lifestyle. The main lead for the organisation is taken by one of the registered persons, Mrs Jane Abbott. She is supported by other senior colleagues, including family members. Renwick is in Mannington Bruce, a small village close to the town of Pewsey. Pewsey itself offers a range of amenities. The market towns of Marlborough and Devizes are within 15 minutes drive and Salisbury and Swindon are easily accessible. The organisation provides a number of vehicles for the use of people who live in the homes and they contribute towards the costs. Valued Lives also operates Harlequins, which is a day service used by most people, who live in the homes, for at least part of each week. They pay a small weekly sum towards this. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 Brief description of the care home Valued Lives has recently taken on a farm to provide a wider range of opportunities for day time occupation. The home is a semi-detached cottage. The bathrooms and bedrooms are upstairs. Shared living rooms and the kitchen are on the ground floor. The fees are about 1336 pounds a week but vary according to the needs of people. Information about the home is available in a statement of purpose and service user guide. Copies of inspection reports can be obtained from the home or from our website, www.csci.org.uk. Care Homes for Adults (18-65 years) Page 5 of 31 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 asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing. It gave us information about what has happened during the last year, and about their plans for the future. We sent surveys to the home to give to people who used the service. We received none back. We made one visit to the home on 18th December 2008. We looked at records, policies and procedures and met with two members of staff and the manager. Care Homes for Adults (18-65 years) Page 6 of 31 We spoke to three people who used the service and observed some of the routines of the home. The judgments contained in this report have been made from all the evidence gathered during the inspection, including during the visits. The last time that we inspected this home was on the 8th January 2007. What the care home does well: Each persons needs had been assessed before they moved into the home so that their needs could be met. People had the opportunity to visit the home before they moved in to decide if it was the right place for them. They could meet the people who lived there and the staff and have a meal or stay overnight if they wished. Two people had contracts so that they knew what they had to pay for. Each person had a care plan for staff to follow and to ensure that their needs were met. The care plans contained information about the support each person needed and the manager planned to use them as working documents. People were supported to make choices and decisions. People were supported to take risks as part of an independent lifestyle but some risks need to be reassessed to ensure that people are kept safe. People had a range of interests and activities including, drawing, colouring, arts and crafts, sewing, rug making and skittles. They all attended the day services run by the organisation. They had opportunities to use community facilities including the shops, the pub, the cinema, the library, the church and cafes. On the day of inspection all three people went out to the pub for a Christmas meal. People were supported to keep in contact with family and friends. They all saw their family regularly and saw friends at the day service and a social club. People were involved in the routines of the home, such as cleaning and washing, and they were offered a healthy diet and had a choice of meals. People were supported in ways that they preferred. Peoples emotional and physical health care needs were met. Each person was registered with a local GP and had access to other healthcare professionals such as the optician, dentist and podiatrist. They also saw specialist as needed such as the psychologist and psychiatrist. Staff supported people to take their medication. People were protected by the homes policies and practices about medication. There was a complaints procedure and information about safeguarding adults. Staff knew how to involve outside agencies in investigating allegations of abuse if needed. People were safeguarded by the homes policies and procedures for complaints and protection. People lived in a homely, comfortable and safe environment. The shared areas were painted in neutral colours which gave a spacious feel to the accommodation. People were involved in choosing the decor. Each person had their own room which was individually decorated and furnished. The home appeared clean throughout and was clean and hygienic. People were supported by sufficient staff, who were trained and qualified to meet their needs. All the staff who worked in the home had a National Vocational Qualification at Level 2. Staff received induction training and a range of other training including food hygiene, medication, health and safety, protection of vulnerable adults and basic Makaton so that they could meet peoples needs. Care Homes for Adults (18-65 years) Page 8 of 31 The registered manager was appropriately qualified and experienced to run the home and kept their training up to date. They had started a system for reviewing the quality of care and identified service developments such as buying a farm. There was a range of safety measures to make sure that people were on the whole kept safe. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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. Each persons needs had been assessed so that their needs could be met. People had the opportunity to visit the home to decide if it was the right place for them. Two people had contracts so that they knew what they had to pay for. Evidence: We noted at previous inspections that one of the people who lived in the home moved in in an emergency in 2005 and their needs were assessed at the time. Two people had moved into the home since the last inspection. When we looked at the care records we saw that one person had moved from home and their mother had provided comprehensive assessment information. They also had an assessment by a social worker. The other person had a social work assessment and care plan before they moved into the home. The manager told us that when one person moved from home their mother came to look round the home then the person visited and had a cup of tea with the two people who already lived there. The manager said that they knew the two people already Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: because they went to the day service run by Valued Lives. The person then had an overnight stay before they decided to move in. The manager told us that the other person did not visit before moving in. In agreement with their care managers, staff visited them in their placement to get to know them then they moved in. Their father and sisters visited the following day. When we looked at the files we saw that two people had contracts with the local authority and they had signed their contracts. The third person did not yet have a contract. Care Homes for Adults (18-65 years) Page 12 of 31 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. Each person had a care plan for staff to follow and to ensure that their needs were met. People were supported to make choices and decisions. People were supported to take risks as part of an independent lifestyle but some risks need to be reassessed to ensure that people are kept safe. Evidence: We made a recommendation at the last inspection that care plans should be signed and dated when they are developed and all changes to the care plans should be signed and dated. This had been addressed. We saw that one person had a new care plan with details about the support that they needed and additional support needed for different aspects of care. The plan included the name of the member of staff who developed it and the date it was written. There was also a date for review six months after it was written but this date had not yet been reached. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: The second person had a care plan dated March 2008 and another dated November 2008. There was a date for review six months after this. This person also had additional support guidelines for particular aspects of care which stated that they were due for review in six months. These were not dated but staff had signed a sheet to show that they had read them dated November 2008. They also had behaviour management guidelines. The third person had a care plan dated November 2008 which included the name of the staff member who had written it and a date for review. This person had behaviour management guidelines agreed with the community nurse. The manager told us that this person was on a waiting list for review by the community nurse. The recent care plans were briefer than the previous ones and easier to find the information. The manager told us that they planned to put these smaller care plans into the daily notes with the health notes and to use them as a working tool. They said that the previous care plans would be kept in a separate file and would contribute to reviews. We saw that examples of how people exercised choice and decision making were recorded in their care plans and daily records. They had a choice of activities, TV programmes and food and they chose where to spend their time. The house had been redecorated since the last inspection and one person had chosen the colours. We found that two people had risk assessments for particular behaviours and risk management plans. A third person had no risk assessments yet. The manager told us that there had been risk assessments for more general risks such as those associated with hot water, and hot surfaces, but these had been taken out of the files. These need to be reviewed, as peoples needs change, and used as working documents. Care Homes for Adults (18-65 years) Page 14 of 31 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 had a range of interests and activities and had opportunities to use community facilities. People were supported to keep in contact with family and friends. People were involved in the routines of the home and they were offered a healthy diet and had a choice of meals. Evidence: When we looked at three peoples files we saw that each of them had a weekly plan of activities. During weekdays each person went to the day centre run by the organisation. They also went to the new farm which had recently been bought and stocked by the organisation. The activity plans and the daily records showed that people had opportunities to use Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: community facilities. They went shopping, to the pub, to the cinema, the library, the church and cafes. On the day of inspection all three people went out to the pub for a Christmas meal. Two of the people had had a holiday in the caravan owned by the organisation. We saw that information about peoples interests were recorded in their assessments and care plans. Their interests included bingo, nature walks, skittles, arts and crafts, painting, colouring, music, going to the library, model making and puzzles. The daily records showed that these activities were taking place and they also showed that at home people watched TV, did drawing and colouring and had individual hobbies. When we looked around the living room we saw that each person had their own hobbies including drawing, sewing and rug making. Two people showed us some rugs that they were making and said that they enjoyed rug making. When we talked to people they told us about how they kept in contact with their family and friends. One person had family photos in their room and said that they saw their family regularly. They said that they were visiting their mother at Christmas. They said that they saw their mother at least once a month. They also said that they sometimes went to the pub for a drink with two men who lived in another house run by the organisation. Two other people said that they were also going to stay with their family over Christmas. One person said that they saw their family at least once a month. They said that they saw their friends at the day service and at a social club that they went to. The daily records showed when people had had contact with their family and friends. One person went to visit their sisters. The manager told us that people were involved in the routines of the home, such as the cleaning, washing and cooking, according to their abilities. One persons records showed that they were not able to cook a full meal but they could prepare drinks and snacks. One person told us that they had been vacuuming and had done their washing. The manager said that this person liked to be involved in all the routines of the home while another person needed more encouragement to take part. We saw that there was a varied menu. The manager said that people chose the meals using menu cards. Healthy eating was promoted. A record was made on the menu of which person had chosen each meal. People were involved in buying the ingredients and meal preparation with staff support and according to their abilities. Care Homes for Adults (18-65 years) Page 16 of 31 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. People were supported in ways that they preferred. Peoples emotional and physical health care needs were met. People were protected by the homes policies and practices about medication. Evidence: We looked at three personal files. We saw that the way that each person liked to be supported was recorded in their plan. One person had a record of their preferred daily routine. We saw that peoples health care needs were identified in their assessments and care plans. One persons relative was managing all their health care needs. We saw in the other two peoples files that all their appointments with healthcare professionals were recorded. Both were registered with a GP and they saw a range of other healthcare professionals including a psychiatrist, optician, dentist, podiatrist, psychologist, community nurse and chiropodist. One person had a health action plan. The person, who had lived there longest, had had an annual health check. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: There was a record of the medication that each person took. Each person had a list of homely remedies agree by the GP. One person had as required medication and they had a protocol for administering this developed by the community nurse. Medication was stored in a locked cupboard. this did not comply with the current regulations for storing controlled drugs. However, there were no controlled drugs. There were medication administration records and we saw that staff completed these each time they administered medication to people. There were also records of orders of medication and stock control. Care Homes for Adults (18-65 years) Page 18 of 31 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. People were protected by the policies and procedures for complaints and safeguarding. Evidence: There was information available regarding complaints. The procedure was last updated in September 2004. A version with words and pictures was available within the Service User Guide. Contact details for the CSCI were included. No complaints had been received since the last inspection. The aim was to minimise any likelihood of this, by having strong recording systems that made all staff accountable for the actions during each particular shift period. There was a wide range of information about safeguarding adults. This included details about the multi-agency safeguarding procedures within Wiltshire. The training records showed that staff had received training about protection from abuse. Two people who lived in the home had behaviour management plans and there was a restraint policy. This had been drawn up by all the staff with the involvement of the community nurse. Physical interventions were described and there were guidelines about which holds may be used and in what circumstances. Staff had received appropriate training about the holds that could be used. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Staff assisted people to manage their money and appropriate records were kept. These records were audited. Care Homes for Adults (18-65 years) Page 20 of 31 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 lived in a homely, comfortable and safe environment. The home was clean and hygienic. Evidence: Renwick is a semi detached cottage in the village of Manningford Bruce and is in keeping with neighbouring other properties. It is a quiet rural location. The nearest town is Pewsey, which is approximately 3 miles away. The property is rented by Valued Lives. There was a living room and an adjoining sitting room, a small kitchen and a large hallway downstairs. Upstairs there were two bedrooms, a staff sleeping in room and a bathroom with a shower. Since the last inspection all the shared areas had been repainted. One of the people who lived in the house had been involved in choosing colours. The lighter colours gave a spacious feel to the rooms. One persons bedroom had been redecorated when they moved in. A second person told us that they had chosen the pictures in the dining room and the manager told us that another person had chosen the pictures in one of the living rooms. There were new sofas in the living room. We noticed that some of the drawers in the kitchen were Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: broken. The manager said that the owner was in discussion with the landlord about replacing the units. We made a recommendation at the last inspection that the heating should be reviewed because the accommodation felt cold. The house was heated by storage radiators. The registered person had provided and installed a new electric fire in the main living room. There was an oil filled radiator in the other living room and two small electric heaters in the kitchen. The house felt warm on the day of our visit. There was a domestic washing machine in the kitchen. The manager said that staff supported one person with doing their washing. The house looked clean throughout on the day of our visit. Care Homes for Adults (18-65 years) Page 22 of 31 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 were supported by an effective staff team, who were appropriately trained, competent and qualified to meet their needs. Evidence: The provider told us in the AQAA that all the staff who worked in the home had a National Vocational Qualification (NVQ) at Level 2. The manager confirmed this. The rota showed that there were two staff on duty during the day and evening and one staff member sleeping in at night. On the day of our visit we met two members of staff. They took the people to their day service and then out for a Christmas meal. There had been no new staff recruited since the last inspection. At our last inspection we found that the staff had a range of training including health and safety, food hygiene, first aid, medication, including special methods of administration, and abuse awareness. There were also courses about epilepsy, challenging behaviour, person centred planning, physical intervention, autism, and dementia in people with Downs Syndrome. Refresher training was held for health and safety, food hygiene, first aid and administration of medicines by special methods. When we looked at the training records we saw that since our last inspection staff had Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: received training in basic Makaton, safeguarding vulnerable adults, administration of medication, including by special methods, and basic food hygiene. Care Homes for Adults (18-65 years) Page 24 of 31 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 registered manager is suitably experienced, so that service users benefit from a well run home. Further work is needed to the quality assurance system to ensure that peoples views underpin all self-monitoring, review and development by the home. Peoples health, safety and welfare were generally promoted and protected by the health and safety measures. Evidence: The registered person was Mrs Jane Abbott. She had lengthy experience of working with people with learning disabilities, and had owned and operated her own services for many years. Mrs Carol Bottoms was registered manager for Renwick. She was working towards the registered managers award (RMA) and kept her training up to date. She told us that she was having trouble completing the RMA because she was having problems with the assessor who kept changing. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: We made a requirement at the last inspection; the registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care at the care home. The registered person shall supply to the commission a report in respect of any review conducted by him and make a copy of the report available to service users. We advised that in order to comply with this requirement the registered person must supply to the Commission a copy of the report about the quality assurance survey and make a copy of the report available to service users. This had been partly complied with. During our visit to another home we saw a format for reviewing the quality of care and a strategic plan for 2007 to 2009. We saw that a questionnaire had been developed for people who use the service. The registered person had identified service developments and had developed a farm to provide day time activities for people. However, she needed to complete the audit of peoples views and the review process to obtain feedback from people and to ensure that any future service developments are based on peoples views. The manager told us that she had sent questionnaires to the relatives of each person who lived in the home. She said that one had been returned and had contained very positive feedback. The manager said that she was going to ask the new secretary employed by the organisation to go through the questionnaires with the people to obtain their views and also to ask their relatives to go through the questionnaires with them. The registered person completed an Annual Quality Assurance Assessment (AQAA), which provided us with information about the service. We found that this provided much information about the overall service developments, for example the new farm. However, it was identical to the AQAAs for the other homes in the organisation and did not tell us anything about particular outcomes for people in this home. There was a health and safety policy to comply with the relevant regulations. There were monthly health and safety checks and records were kept. The manager told us that there used to be health and safety risk assessments but these had been taken out of peoples care notes and they were focusing on more individual risks. We saw individual risk assessments in peoples files. These did not always focus on health and safety issues for example the risk of scalding from hot water or burns from hot surfaces. One persons needs were changing which might make them more at risk from exposure to these. There were arrangements for the training of staff in moving and handling, fire safety, first aid and food hygiene. Hot water temperature regulators had been fitted to the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: taps. Water temperatures were taken and recorded monthly. There were Control of Substances Hazardous to Health (COSHH) assessments, equipment was regularly serviced and portable appliances were tested annually. There was a very detailed fire risk assessment covering all areas of the home and records of fire safety checks. Care Homes for Adults (18-65 years) Page 27 of 31 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 31 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 39 24 The registered person shall 31/03/2009 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care at the care home. The system shall provide for consultation with service users and their representatives. So that any service developments are based on peoples views. 2 42 13 The registered person must reassess the risks from hot water, hot surfaces and windows and other general risks. 15/02/2009 To make sure that people are kept safe as their needs change. Care Homes for Adults (18-65 years) Page 29 of 31 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 9 The risk assessments should be reviewed as needs change and used as working documents to ensure that people are kept safe. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody)(Amendment) Regulations 2007 should be installed so that any controlled drugs that are prescribed can be stored safely. The Annual Quality Assurance Assessment sumitted to the Commission should contain information about the specific outcomes for people in this home as well as overall service developments. The registered person should consult the guidance on the Health and Safety Executive website about risk assessment and control measures. 2 20 3 39 4 42 Care Homes for Adults (18-65 years) Page 30 of 31 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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