Inspection on 13/07/09 for Sunkist

This inspection was carried out on 13th July 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunkist 21/07/08

Sunkist 29/11/06

Sunkist 29/09/05

Sunkist 24/05/05

Sunkist 07/10/04

Sunkist 20/05/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Sunkist 14/16 Winchester Road Worthing West Sussex BN11 4DJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Annie Taggart     Date: 1 3 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.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: Sunkist 14/16 Winchester Road Worthing West Sussex BN11 4DJ 01903218908 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: tony@sunkistgroup.co.uk Sunkist Homes Ltd care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Sunkist is a care home registered to provide accommodation and personal care for up to twenty-six people between the ages of eighteen to sixty who have mental disorders. There is also provision to accommodate up to four people who are over the age of sixty-five years within that number. Sunkist is situated in a residential area of Worthing within easy access of the town centre and its facilities. The premises consist of two large houses that have been linked together internally to form one care home. Private accommodation is provided in twenty-three bedrooms, four of which have been registered for double occupancy. Communal accommodation is provided in a dining room and two lounges, one of which has been designated for smoking, located on the Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 26 Brief description of the care home ground floor. The registered providers are Sunkist Homes Ltd who has identified Mr Belisario Schiavone as the responsible individual to supervise the management of the care home. The Registered Manager is Mr. Anthony Sayers 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: zero star poor 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: In preparation for this visit, we looked at the last inspection report and other information received about the home since the last key inspection including the outcomes from a Safeguarding investigation held by the West Sussex Safeguarding team. An Annual Quality Assurance Assessment was sent to the manager for completion and surveys were sent to service users, staff and professionals involved with the home. The AQAA was returned within the given timescales and contained clear information about the home. Six service user, five staff and four health professionals returned surveys and all made positive comment about the home. The unannounced inspection was carried out at 10am on Monday 13th June and lasted for four and a half hours. Care Homes for Adults (18-65 years) Page 6 of 30 We tracked the assessments, care plans and other documentation such as daily records for four service users and we looked at the system for administering and recording medication. We looked at evidence of activities and community involvement for people, we saw menus and food records and spoke to service users, both in communal areas and in their private bedrooms. Records for the running of the business, including complaints, incidents and accidents, Regulation 26, Providers visits and Regulation 37 reports, maintenance and fire records were seen. The recruitment files for four members of staff were seen and all contained the required documentation. Feedback was given to the Registered Manager, Mr Sayers. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is clear and detailed information available about the services on offer in the home, people have their needs and wishes assessed and contracts of terms and conditions of residency are agreed. Evidence: The homes Statement of Purpose and Service User Guide have recently been reviewed and updated and changes in the homes policy on smoking has been communicated to service users. We saw that people have signed a form agreeing to the changes, to say that they will comply. We looked at the admissions process for one person who has recently come to live in the home and saw that a comprehensive assessment process was carried out and recorded and that the service user and other professionals had been involved. Contracts of terms and conditions of residency are agreed and the four that we looked at had been signed by the service user they related to. Care Homes for Adults (18-65 years) Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are care plans completed in the home, there are potential risks to service users by all areas of their care not being recorded. Evidence: We tracked the care plans for four people and found that three of the plans had very clear and detailed information for the staff team to follow on how people needed and wished to be supported. Care plans detailed personal care preferences, both physical and mental health care needs and social interests. Risk assessment both personal and environmental had been completed and there were also behavioural plans in place where required. For one person we saw that on admission to the home, their assessment recorded that they had a degenerative neurological condition, with no other mental health issues identified. The assessment had then not been translated into a care plan for this persons individual needs, meaning that there was no clear guidance for staff to follow to monitor their condition and there was no evidence of staff training for awareness of Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: this condition. We spoke to the manager Mr Sayers about this and he agreed that this specific part of the persons care plan had been overlooked . Clear and detailed daily records are completed by the staff team and those that we saw were written in respectful language. There was also evidence of regular key worker meetings with service users where they had the opportunity to discuss their future plans. Care Homes for Adults (18-65 years) Page 12 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. There is a programme of activities in place for each person living in the home and people have contact with their families and friends. People are offered a variety of fresh, home cooked meals and are supported with move on accommodation. Evidence: From looking at records, observation during the visit and talking to service users we saw that the home supports people with their individual lifestyles choices. People told us that they used their local community, went to visit friends and out to cafes and had contact with their families. Each person has a programme of activities in place that is monitored by their key worker, for some people this includes going to local clubs such as MIND and to day centres. Recently a number of groups have been set up within the home with support from the occupational therapist from another home in the group and this is in order to Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: provide people with further interest and skills. For some people there were few activities recorded and Mr Sayers told us that it was very difficult to motivate and interest some of the people living in the home. During the visit we observed one person lying on a sofa in the lounge for all of the time except for the meal time and another person spent most of the day sitting in a chair near the front door. Some people stayed in their room for most of the time while others went out into the community. We discussed with Mr Sayers how this could be improved and he told us that some people had tried work experience or colleges but that this had not worked out for them but that the home was working very hard to provide activities and to motivate people. From looking at records we saw that the home is supporting some people to move on to more independent living and that care managers and other professionals are involved in the process. We asked a service user how they felt about living in the home and were told, I have been here for six years, its much better than hospital, more comfortable living in the community and you can live a normal life. The home now employs a cook and from looking at records we saw that people are offered a wide choice of fresh, home cooked meals. There are two choices at each meal time and people are involved in menu planning. We saw that people could make themselves drinks at any time and bowls of fresh fruit were available. Comments about the meals included, now we have a chef the food is fantastic, food is really great and we have BBQs in good weather, and the food here is A1. Care Homes for Adults (18-65 years) Page 14 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are Health Action Plans in place, there are risk to service users by all peoples identified health needs not being addressed in a timely manner, by health care recording not being up to date and by errors in medication management. Evidence: In the AQAA we are told that Health Action Plans are in place for all service users and that they are regularly reviewed and updated. From tracking the records for four people we saw that although the plans were in place, they did not provide the required assessed outcomes for all service users. An example of this was that for one service user as there was no care plan in place to address their neurological illness and there was no evidence to show that their condition had been correctly monitored and addressed. During the visit we observed this service user to be unresponsive and very physically frail, lying on their bed. The person had an amount of dried food on their chin and smelled unpleasant and their records showed that for some time they had been refusing medication and personal care. We asked the manager Mr Sayers how this persons needs were being met as there was no care plan in place to address their medical condition and we asked if their changing needs should have been addressed earlier. Mr Sayers told us that he agreed that the person was in crisis and said that a Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: referral had recently been made to their care manager for an admission to a nursing home. We asked Mr Sayers what training had been supplied for the staff team in this persons condition and in how to monitor and address the deterioration of the condition but as there was no care plan in place this could not be evidenced. We saw that their had been input from the mental health team and a care manager but records did not show when the person had last seen a medical doctor. When looking at another persons file we saw that there was a diabetes management plan in place that said that weekly checks should be undertaken. There were gaps in the recording and this was brought to the attention of Mr Sayers. At the last inspection visit personal care was being provided for service users by a domiciliary care worker who came to the home weekly. Following recommendations from a recent safeguarding meeting, the home now employs a support worker to support people with personal care. Most people looked well cared for but there was one person who was very unkempt with dirty clothing on. We asked Mr Sayers about this person and he told us that the person often refused personal care but was moving on to other accommodation. There are systems in place for the administration and recording of medication and recently a new medication room has been put in place that has two large locked medication cabinets. Following the recent safeguarding investigation which included concerns about medication management, the staff team received updated training and a monitoring system has been put in place. From looking at records we saw that there were gaps in signing for one service user and Mr Sayers told us that he had already picked this up and would be dealing with the staff member involved. Medications had been transposed onto Medication Recording Sheets (MAR) by staff members who were not qualified to do so and some had not been signed or dated. Mr Sayers told us that this was an oversight from when there was a qualified nurse on the staff team and that he would address this. There are risk assessments in place for people who self medicate and there is training given for service users, recorded over time. From looking at records we saw that on 4/5/09 a total of nineteen tablets including anti-convulsive medication had been found in the wash bag of one service user who was self medicating. Action was taken regarding liaising with the service user to allow the staff team to administer their medication and a Safeguarding referral had been made to the West Sussex safeguarding team. During the visit we saw one person being visited by the care manager and another Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: person was being visited by members the Mental Health Forensic Team. Mr Sayers told us that as a result of the recent safeguarding investigation there had been benefits to service users by their being more input from other professionals and people having more regular reviews. Care Homes for Adults (18-65 years) Page 17 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. Although there are processes in place to record and investigate complaints and to protect people from risk of abuse or harm, there are potential risks to outcomes for service users by these processes not being followed and complaints not being recorded and investigated. Evidence: There is a complaints procedure in place, a copy of which forms part of the service user guide and is also displayed in the hall of the home. From looking at records we saw that there was evidence that complaints and concerns are usually recorded and acted upon. When tracking the records of one service user we saw that for one person there were ABC charts ( behaviour recording charts) in place and several staff entries in these were concerning complaints from service users about the behaviour of this service user, who it was recorded had been abusive to service users and staff and had been seen eating out of the kitchen bin. Although these issues had been recorded in the charts as behaviours and concerns the form did then not go on to say what action had been taken as a consequence to these entries, nor were the complaints then recorded as complaints and investigated. We spoke to Mr Sayers and discussed the entries and he said as he had just come back from annual leave he had not seen them but would investigate and take appropriate action. From looking at records we saw that the staff team had attended training in safeguarding people from risk of abuse or harm and the four staff that we spoke to Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: were aware of their responsibilities and would report any suspected abuse straight away. There have been three safeguarding alerts leading to one investigation by the West Sussex Safeguarding team. This has now been closed with recommendations for improvement agreed with the home Care Homes for Adults (18-65 years) Page 19 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. Although communal areas of the home are comfortable and homely, service users private bedrooms need to be updated and refurbished and kept to an acceptable level of cleanliness. Evidence: From observation during the day and from looking at maintenance records we saw that there is a programme of updating and redecorating the environment in place. Communal areas such as the lounges have been redecorated and have comfortable and homely furniture with a large screen television and lots of videos around, there is a conservatory type dining room and a rear garden that has been attractively set out with tables, umbrellas, a water feature and two BBQs. We saw the bedrooms of ten people who were willing for us to see their rooms and some were well decorated and attractively furnished. In one room there was a very strong smell of urine in the ensuite toilet, in another room the carpet was stained and in need of cleaning and another room was in a state of disarray and was very unclean with belongings all over the floor and surfaces, the carpet was covered in food and rubbish and the room had an unpleasant smell. In another room, which also was in need of redecoration the person had their bed stripped and we saw that the mattress Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: was stained and that the bedding was old, dirty and stained. We identified these rooms to the manager Mr Sayer and he told us that although people were offered help with cleaning their rooms, some people did not accept this, he also said that the people in two of the rooms were soon to be moving on to other accommodation. Mr Sayers told us in the AQAA and at the visit that there had been an agreement with the Directors of the company that two rooms would be redecorated each month until the whole house was completed and that he would make these rooms a priority. During the visit we saw staff members supporting some people to clean and tidy their rooms and they were encouraging people to sort out some of their belongings. The staff team had gloves and aprons to use and there were antiseptic hand gels in bathrooms and communal toilets. Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are being supported by a caring and committed staff team, there are robust recruitment processes in place and the staff team are provided with induction and training. Staff competence could be improved by further training being provided in the specific identified conditions of service users. Evidence: In the AQAA we are told that there are sufficient staff to meet the needs of the people currently living in the home and that the staff team had the required skills and experience to safely support people. We are also told that over 50 of the staff team hold the NVQ award at level 2 or above. During the visit we saw that the four support workers on duty were kind and caring in their dealings with service users and that there was a good rapport between them. Comments from service users included, the staff here are always cheerful and encouraging and its alright living here, we are well looked after and only have to shout and they (the staff team ) help you. We looked at the recruitment records for four members of staff and all had the required documentation in place including a current Criminal Bureau Check (CRB) and two references. For one new member of staff recently recruited there was a POVA First Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: in place and the person was in the home, being inducted but not working with service users. The staff on duty confirmed that they were well supported and that regular supervision was carried out, all records were not in place as the deputy manager was on leave and her supervision file was not in the home. Training records showed that the staff team receive an induction in line with the Common Induction Standards, they attend mandatory training such as first aid and moving and handling and we saw that other training such as Dementia Care, Communication, Challenging Behaviour in Mental Health and Equality and Diversity awareness are attended. As identified in other parts of this report we could not evidence that training had been provided in the specific needs of one service user. Care Homes for Adults (18-65 years) Page 23 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. Although there is an experienced and committed manager in place, to ensure the safe welfare of service users at all times, the manager needs to put into place systems that ensure that they are able to meet the identified and changing needs of all of the service users in the home Evidence: The Registered Manager of the home is a qualified social worker and has a number of years experience working with people with mental health care needs. Mr Sayers told us that he and the deputy manager are currently undertaking the National Management Award at a local college as the company they were undertaking the Registered Managers Award with, had gone out of business. The staff team on duty were very complimentary about Mr Sayers, describing him as very supportive and accessible and one person said, obviously working with people with mental health care needs there are good days and bad days but we have good support from the manager, handover periods and staff meetings. Regulation 26, Registered Providers visits are carried out by a Director of the Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: company and outcomes recorded and we saw that service users have the opportunity to feed back on the service being provided at key worker meetings and house meetings. We saw that a quality assurance process had been carried out by surveys being sent to service users, families and other people involved with the home. Outcomes had been collated and were used to inform a future development plan for the home. We looked at the system for the management of service users monies and saw that clear records were in place and receipts gained for expenditure. Service users also signed to say when they had received money and in the two accounts that we checked the records corresponded to the monies held. Records show that regular maintenance is carried out in the home and we are told that recommendations from a recent Environmental Health Agency check have been carried out. Records show that the staff team receive regular fire training and there is a fire risk assessment in place. At the last inspection visit, it was identified that many of the people living in the home smoke heavily in their bedrooms and we asked the manager how the staff team were being protected from passive smoking. At this visit we saw that smoking room signs had been added to the doors of people who smoke. In addition, changes have been made to service user contracts and signed by people to say they would ensure that their rooms were smoke free for an agreed period of time before staff members spent time in them. We looked at records of incidents and accidents and saw that these were being were being dealt with appropriately As detailed in other parts of this report, to ensure that peoples identified needs are met and that people are kept safe at all times, improvements are needed to care planning, to supporting people with their health care needs and to medication management. Care Homes for Adults (18-65 years) Page 25 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 26 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 6 15 The Registered Manager 30/08/2009 must ensure that all areas of peoples needs identified in the assessment process are detailed in the care plans. This is to ensure that the staff team have the information they need to ensure that peoples individual needs are being met. 2 19 12 The registered manager 30/08/2009 must ensure that care plans, monitoring systems and staff training are put in place to address the individual and assessed health care needs of service users. This is to ensure that the health care needs of all service users are assessed and recognised and that there are procedures in place to address them at an early stage. Care Homes for Adults (18-65 years) Page 27 of 30 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 3 20 13 The registered manager must ensure that their are safe systems for the recording and monitoring of medication in the home This is to ensure that service users are not put at risk by not having their medication at the correct intervals and that records are correct. 30/08/2009 4 22 22 The Registered manager must ensure that all complaints made by service users are recorded and acted upon. This is to ensure that service users complaints are addressed, investigated and responded to within 28 days. 30/08/2009 5 30 23 Service users private bedrooms must be kept at an acceptable level of cleanliness and repair. This is to ensure that the health and safety of people is assured and that infection control issues are addressed. 30/08/2009 Care Homes for Adults (18-65 years) Page 28 of 30 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: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC 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!