Inspection on 02/06/09 for Tarn House

This inspection was carried out on 2nd June 2009.

CQC found this care home to be providing an Adequate 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

Tarn House 30/06/08

Tarn House 30/08/07

Tarn House 26/06/06

Tarn House 24/11/05

Tarn House 23/06/05

Tarn House 05/01/05

Tarn House 13/09/04

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Cuerden Grange Rest Home

Springfield Cottage

Parkside

Park Lodge

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tarn House Mill Lane Walney Barrow in Furness Cumbria LA14 3XX one star adequate service The quality rating for this care home is: 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: Ray Mowat Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Tarn House Mill Lane Walney Barrow in Furness Cumbria LA14 3XX 01229471798 01229470125 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cumbria Care care home 14 Number of places (if applicable): Under 65 Over 65 14 3 0 0 learning disability physical disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD (maximum number of places: 14) Physical disability - Code PD (maximum number of places: 3) The maximum number of service users who can be accommodated is: 14 Date of last inspection A bit about the care home Tarn House is a care home providing personal care and accommodation for fourteen adults with learning and or physical disabilities. The home is owned by Cumbria County Council and managed by Cumbria Care, an independent business unit of the County Council. It is situated in a residential area of Walney Island and is close to local amenities and a local bus route that services the island and the nearby town of Barrow-inFurness. The Home is on two storeys and is divided into four distinct units. These are called Hill View, Sea View, Greenland and Beachwood. Three of the rooms are used for short-term respite care. Each of the units has a lounge and a separate kitchen with dining area. All the bedrooms are single occupancy, some of which are fully accessible for people with physical disabilities. To the rear of the building are two fenced garden areas with seating. To the front of the building are open plan garden areas and a large car park, which is shared with the adjoining day service. The scale of charges for the home varies according to persons assessed needs and are agreed on admission, with additional charges agreed on an individual basis for personal sundry expenses. The home makes relevant information available to residents in an accessible format including the statement of purpose and service user guide. The previous inspection report is displayed in the home and is accessible to people on request. 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 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. During the visit we (The Care Quality Commission) met with people living in the home, visitors and relatives and spent time with the manager and supervisory staff on duty. We also met with care staff individually and talked to them as they went about their duties. The manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA) and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgments in this report. We also examined records relating to the running of the home that are required by legislation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. What the care home does well The home works closely with other agencies at the point of admission to make sure they have all relevant information about a persons personal and health care needs. They have good systems in place that give people the opportunity to test drive the home and make sure it is suitable for them. Comprehensive person centered care plans are being developed with people and their representatives that support people to lead an independent lifestyle and achieve their personal goals. Health action plans make sure health care needs are well documented and appropriate health interventions and appointments are arranged when needs are identified. People are relaxed and comfortable in their home environment and get good support to access the local community to pursue their interests and hobbies. They also value the opportunity to take an annual holiday of their choice with support from staff. People are involved in choosing the decoration and furnishings for their rooms enabling them to personalise their rooms. There are sufficient staff on duty to respond to the individual needs of the people living in the home. Key workers have been identified who work closely with people to make sure they can lead an independent lifestyle of their choice. Consultation is ongoing on both an informal basis and more formally with annual quality surveys being completed to make sure the home is being run in their best interest. What has got better from the last inspection All hot water pipes are now protected to prevent people from burning themselves. There are suitable numbers of staff on duty to meet the needs of the current group of people living in the home. There was evidence staff training has improved with the manager producing a training needs analysis to identify training needs and plan relevant courses. The manager has identified a member of staff to take a lead role in ensuring the care plans of people who use the respite care service are reviewed prior to their next visit and then kept under review to make sure they are up to date and accurate for their next visit. Safeguarding training has taken place to make sure all staff are aware of how to recognise abuse or the potential for abuse and report their concerns. What the care home could do better The statement of purpose and service user guide should be reviewed to make sure all the information is up to date and accurate. Care needs assessments must be kept under review and appropriate action taken if peoples needs change, to make sure the home is suitable and peoples needs can be safely managed in the home. When people who use the respite care service have their care plans reviewed staff should make sure relevant risk assessments have been completed or existing ones are updated. COSHH substances must be securely stored at all times to prevent people from harm. Staff should also receive refresher training in the safe handling of COSHH substances to ensure they understand their responsibilities. All staff must receive fire instructions at appropriate intervals to make sure they know how to respond in an emergency situation. The fire procedures and risk assessment file should be reviewed to make sure all documents are up to date, relevant and in line with fire regulations. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ray Mowat CQC North West Citygate Gallowgate Newcastle upon Tyne NE1 4PA 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 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 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 . The home is assessing peoples needs prior to admission but need to make sure peoples needs are constantly assessed and changing needs are responded to appropriately, particularly when they effect other people in the home. Evidence: We examined the homes statement of purpose and service user guide. These contained relevant information some of which was produced in an easy read format using pictures and symbols. However it was evident they had not been updated for some time with some of the information now in need of review and updating. All new referrals to the home come from the Adult Social Care team who provide the home with detailed needs assessments. In addition the manager or one of the supervisory team will meet with a person and their family/Representative to make sure they have all the relevant information they require to make a judgment about being able to meet their needs. Visits to the home are also encouraged, which can be for a meal or an overnight stay. This gives the person an insight to life in the home and helps them and the home make an informed decision. There was evidence in the care plan files we examined of the home working closely with other professionals and specialist services to make sure peoples individual needs were being met. The home also provides a respite service, which is another opportunity for a person to try out the home before deciding to move in. Needs assessments were in place for people who only use the respite service from which care plans have been developed. Despite this admission procedure being in place the home has recently struggled to meet the needs of two people who had moved in. Although the placements had worked well initially and a lot of multi disciplinary work had been done to support the people and the staff, the management were slow to react when it was evident the placements Evidence: were breaking down and there were serious safeguarding concerns being raised. The manager stated she was unable to terminate the placement due to senior management directives despite being aware that the staff were not able to meet a persons needs. This put vulnerable people living in the home and staff at risk of assault resulting in them being kept in locked rooms for their own protection. These issues have now been resolved however the manager must ensure all future admissions are fully assessed on an ongoing basis to ensure their safety and the safety and welfare of the other people living in the home. 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 . The home is developing detailed person centered care plans that make sure staff have a good insight and understanding about peoples individual needs and aspirations in their lives. Evidence: The manager has restructured the supervisory team and has allocated a supervisor to take a lead role in monitoring and updating the care plan files of people who use the respite care service. These are being completed prior to a persons next visit to the home to make sure they are up to date and accurate. Currently there is no record of the last review. Two of the respite care plan files we examined did not contain relevant risk assessments to help safeguard a person during their visit, which should now be addressed as part of the planned reviews. All the permanent residents have a person centered style care plan in place that has been agreed with them. This provides a comprehensive record of a persons needs and preferences about how they like to live their lives, which enables staff to provide a very personalised package of care. All the files we examined had been recently reviewed with input from other professionals, ensuring people were experiencing positive outcomes in their lives and achieving their aims. People we spoke to were relaxed and happy in their home. One person described moving in to the home as The best move I have ever made, I love it here. How people make decisions and choices in their lives is well documented and staff are skilled at taking on an enabling role therefore promoting peoples independence both in the home environment and in the local community. This might be deciding what time to get up or go to bed to more significant decisions such as how to spend their leisure time or choosing a holiday. Communication needs are also well documented, Evidence: which is invaluable to staff in helping them to develop relationships with people and gain a better understanding about them. One person with only very limited verbal communication had a communication passport that they kept with them to help them make their needs known, which is good practice. There was a good range of risk assessments in place for people who lived in the home on a permanent basis, which help to safeguard them and the staff supporting them. Hazards and potential hazards were recorded, with control measures put in place to minimise or remove the risk. 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 are now enjoying a fulfilling lifestyle and are happy and settled in their home. Evidence: Designated key workers work closely with each person to develop their person centered care plan, which gives all the staff a good insight to peoples needs and preferences about how they like to live their lives and what and who are important to them. Apart from one person everyone attends some form of day service, which provides them with a good range of educational and vocational experiences. The staff liaise with day service staff and other professionals to make sure people are getting the right support and they are getting the opportunities to achieve their goals and lead an independent lifestyle. The people we met during the inspection talked about the activities and interests they enjoy and how staff support them with both in-house and community based activities. One person said how they like to go shopping each week and has just chosen a holiday to London where they want to see a show. There was evidence that people are using the local amenities on a regular basis such as the local shops, post office, the local pub and church, which gives them the opportunity to feel part of the local community. Social activities and individual leisure interests are well documented within the care plan enabling staff to support individuals or small groups with similar interests to lead a lifestyle of their choosing as the following comments reflect. I like living here its better now I like going to social club twice a week for a dance and to meet my friends. I like going to the pub. We like to sit in the garden and sometimes have meals out there. Evidence: Family and friends are made welcome and there are frequent visitors to the home. Care plans record peoples family contacts and other relationships that are important to them, which enables staff to support them to maintain contact with the significant people in their lives. There was a relaxed atmosphere in the home as people were getting ready for the day at their own pace and following their preferred routine. Staff provided unobtrusive support taking on an enabling role by prompting and encouraging independence. The four distinct units in the home operate independently of each other with regard to meals and mealtimes, with arrangements planned around the needs and preferences of the individuals in each unit. The menus we examined reflected a varied choice of food giving people a healthy and balanced diet. Fresh fruit and snacks were available to people in addition to the regular meals, with staff having a good knowledge of peoples likes and dislikes. 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 . Personal and health care needs are well documented and staff support people to access relevant services when needs are identified. Evidence: The person centered care plans as described earlier include a comprehensive record of the personal support people require in their lives, helping staff to provide a very personalised service and a good continuity of care. This includes detailed pen pictures, records about peoples daily routines and also what support networks and relationships they have. It was evident staff have developed a good relationship with the people they support and have a good insight to individual personalities and peoples preferred routines. In addition to the person centered care plan, health action plans have been completed for each person, which records all their health care needs in detail. This includes a record of all medication information, health professionals and services they use and a record of all routine or one off appointments and check ups. The support that people require to access services is also recorded to ensure peoples independence is promoted. Care plans contain detailed strategies developed with input from the relevant professionals, to help staff to provide appropriate levels of support and make sure peoples specialist needs can be met. We examined the contents of the medication cabinet and spot checked some of the stock held against the medication record sheets. The majority of the medication held in the home is managed through a monitored dosage system. All other medication was in clearly labeled packaging from the pharmacist. The stocks held were accurate and there was evidence of the manager and supervisory staff completing their own regular stock checks, which is good practice. We also examined the contents of the controlled drugs storage facility and register and found these to be in good order. PRN (as and when required) medication protocols have been developed and agreed to Evidence: guide staff in how and when to administer specific medication to meet the needs of the individual. 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 feel confident about raising a concern or complaint and that it will be taken seriously. People now feel safe and relaxed in their home. Evidence: Since the last inspection visit there have been three complaints from people who use the service. These related to complaints about the negative impact on their lives caused by another person exhibiting challenging behaviour resulting in them being locked in rooms for their own safety. As previously described this situation was dealt with under safeguarding protocols and has now been resolved. The complaints were formally recorded and responded to by the senior managers of the organisation a record of which is held on file in the complaints record. The homes procedures are working effectively with people able to raise concerns, which are taken seriously and responded to in a timely manner. Safeguarding training is now taking place as required with six staff completing training since the last inspection. The services policies and procedures are up to date and in line with current good practice and legislation. Based on our discussions with staff they have a good understanding about identifying and reporting concerns or actual abuse. 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 . Some aspects of the environment are in need of attention as they are not decorated to an appropriate domestic standard. Evidence: Despite being raised with the manager previously some rooms still have grey insulating foam, held on with industrial black tape, protecting water pipes in various rooms in the home. Although this protects people it looks unsightly and is totally inappropriate for a small domestic situation. In addition metal radiator guards are in place throughout the home and strip lighting, which might be practical but are more suited to an institution and do not give a homely feel. The manager must now address these issues making sure all areas of the home are suitably maintained and meet peoples needs in a comfortable and homely way being decorated to an appropriate domestic standard, as stated in their own statement of purpose and service user guide. People have been able to decorate their own rooms to their personal taste and with their own belongings such as photographs, furniture and fittings of their choice. Some of the rooms have the original built in cupboards, which although dated are functional. People we met were pleased to show us their rooms and were rightly proud of them, as one person said I like to look after my room and keep it nice. One room we examined needed the carpet replacing, however the person whose room it was informed us this was planned and they would be choosing the carpet. The gardens to the rear of the home have been improved with accessible patios and seating areas where people can relax and socialise or have a meal. There are dedicated domestic staff who make sure the home is clean and hygienic throughout, with people who live in the home also being involved in some household cleaning and domestic tasks. There are suitable aids and adaptations around the home that promote peoples independence with bathrooms and toilets being accessible and fitted with suitable equipment. Evidence: Two fire doors we examined although they opened were stiff and in need of some attention to make sure they will work effectively in an emergency. This was pointed out to the manager who contacted the maintenance department immediately. 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 staffing situation in the home has improved with there now being a regular staff team who are receiving appropriate training and support to meet the needs of the people currently living in the home. Evidence: The staffing situation in the home has improved with no relief staff being used on a regular basis as previous. The only vacant hours are a 16 hour night staff post, which is being covered by permanent staff working additional hours, which gives a good continuity of care to people. Staff morale was good with staff confirming that the atmosphere in the home was more relaxed now and that they get good support and regular supervision. Staff are issued with suitable job descriptions and complete an appropriate induction training programme. The manager has completed a training needs analysis for all the staff to identify their training and development needs. A programme of training has been planned from this identifying the numbers of staff who require specialist training or refresher courses in the coming year. This information is shared with the organisations central training department who make sure suitable courses are provided. If the training plan is implemented as planned this will ensure all staff have the relevant skills and knowledge for their roles. We examined staff files and found these to be in order, with relevant checks and references recorded and records of formal supervision meetings between staff and one of the management or supervisory team. 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 . People have a lot of autonomy in the running of the home, however some aspects of health and safety must be improved to make sure people are safe at all times. Evidence: The manager is still working toward her registered managers award. She is suitably experienced working for many years in Learning Disability services and more recently in a management role. There is a mutual respect with the supervisory and care staff who she works closely with to ensure the home is operating in the best interests of the people living there. As mentioned previously due to senior management directives she felt she was not in a position to make a decision about the inappropriate placement of two people in the home, whose behaviour was having negative impact on the other people in the home. These issues were eventually resolved after an unacceptable period of uncertainty when people were living in fear of assault and having to be locked in rooms for their own safety. Regular consultation is taking place with people on both a 1-1 basis with key workers and other staff and in small groups but also on a more formal basis using quality assurance questionnaires. The results from the consultation are collated and used to develop targets for the homes annual business plan. The routine maintenance and servicing of equipment and services is taking place as required as well as staff completing weekly and monthly safety checklists to maintain a safe environment. However there were some health and safety concerns noted during the visit resulting in an immediate requirement being issued to the manager. COSHH substances (which are substances that can be hazardous to health) were stored in two different kitchen cupboards upstairs, neither of which were locked. This is poor practice and has been noted on previous inspections. The manager must ensure all staff are aware of their responsibilities in relation to the handling and storage of COSHH Evidence: substances and regularly check that good practice guidelines are being followed. We examined the fire log and found that all regular maintenance and checks are being completed as required. However the last fire instruction to take place with staff was in February 09. The manager must ensure all staff receive regular fire instructions in line with Fire Service guidelines at least six monthly for day staff and three monthly for night staff. We also examined the homes fire risk assessment and procedures. The fire risk assessment and procedures are in need of review to make sure they are in line with current guidelines and all out of date procedures and related information should be removed from the file as this can cause confusion. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 42 13 The manager must ensure all 13/06/2009 staff are aware of their responsibilities in relation to the safe handling and storage of COSHH substances and regularly check that good practice guidelines are being followed. COSHH substances have been left in unlocked cupboards and were accessible to vulnerable people putting them at risk. 2 42 13 The manager must ensure all 05/08/2009 staff receive regular fire instructions in line with Fire Service guidelines at least six monthly for day staff and three monthly for night staff. All staff must be kept up to date with relevant fire instructions to make sure they have a good understanding of fire precautions, equipment and escape routes. 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 1 The statement of purpose and service user guide should be reviewed and updated to make sure all the information is up to date and accurate. Risk assessments should be completed as part of the planned review of respite care service users files. The fire risk assessment and fire procedures should be reviewed to make sure they are in line with current good practice guidelines and only current procedures are held in the file. 2 3 9 42 Helpline: Telephone: 03000 616161 or Textphone : or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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