Inspection on 11/12/08 for Tyrwhitt House

This inspection was carried out on 11th December 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tyrwhitt House 11/12/07

Tyrwhitt House 24/09/07

Tyrwhitt House 11/05/06

Tyrwhitt House 06/09/05

Tyrwhitt House 06/05/05

Tyrwhitt House 09/11/04

Tyrwhitt House 27/05/04

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tyrwhitt House Oaklawn Road Leatherhead Surrey KT22 0BX     The quality rating for this care home is:   three star excellent 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: Lisa Johnson     Date: 1 1 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 29 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 29 Information about the care home Name of care home: Address: Tyrwhitt House Oaklawn Road Leatherhead Surrey KT22 0BX 01372841634 01372841601 cmth@combatstress.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Paula Smyth Type of registration: Number of places registered: Ex Services Mental Welfare Society care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: 1. The registered person may provide the following categories of service only: Care home with nursing - (N) 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) 2. The maximum number of service users to be accommodated is 30. Date of last inspection Brief description of the care home Tyrwhitt House is a large detached Victorian property located on the outskirts of Leatherhead Surrey. The service is operated by the registered charity Combat Stress the Ex Services Mental Welfare Society. The home caters for ex-servicemen and women (veterans) with a mental health need, primarily post traumatic stress disorder. The home is set in extensive grounds and has ample car parking. There are 30 single bedrooms, kitchen, servery, dining room, a main lounge, smoking room and an Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 30 Brief description of the care home equipped activities department There are no fees charged directly to the veterans or their families, where the veteran is in receipt of a war pension a charge of 274.00 per day is made to the awarding body. Where a veteran is not in receipt of a war pension the cost of care and treatment is met by charitable income. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This visit was part of a key inspection. The site visit was unannounced and took place over seven hours commencing at 10:00am and finishing at 4:50pm. Mrs. L Johnson Regulation Inspector carried out this visit. The service was represented by Ms.P. Smyth Registered Manager. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment (AQAA). This is a self assessment that focuses on how well outcomes are being met for people using the service. Reference is made to this document throughout this report. During this visit we spoke to six people who use the service to gain their views and we Care Homes for Adults (18-65 years) Page 6 of 29 spoke to three members of staff. We also received feed back surveys from fourteen people who use the service , six were recieved from care workers and nursing staff and surveys were recieved from three health care professionals. During this visit we conducted a full tour of the premises, looked at care plans, risk assessments, medication practices staff personnel and training records and policies and procedures. The inspector would like to thank veterans who use the service, manager and staff for their time, assistance and hospitality during this inspection. 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 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 8 of 29 Care Homes for Adults (18-65 years) Page 9 of 29 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 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people are provided with the information they need to know to know about the service and comprehensive assessments take place prior to admission ensuring that the service can meet their needs. Evidence: The service provides a statement of purpose and service user guide. Information seen clearly describes the aims and objectives and the services that the facility is able to provide.This information is provided to veterans during the initial assessment. A copy is also provided in each bedroom. Prospective people can also access information about the service on the Combat stress website. Information supplied in the AQAA states that the service is planning to commission a new DVD which can be shown to to prospective veterans during the initial assessment visit. Thirteen out of fourteen people surveyed said that they received information about the service before their stay. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: One person said, I was very well informed and another person said, I received a concise welcome pack which explained the purpose of Tyrwhitt house. Pre- admission assessments are conducted prior to anybody being offered a service. this information was seen on peoples files sampled. All veterans who are referred receive a home visit and initial assessment which is carried out by a Regional Welfare Officer, sometimes they are accompanied by a member of the clinical team. Veterans, their families and representatives are provided with the opportunity to visit the service . Care Homes for Adults (18-65 years) Page 12 of 29 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 has a plan of care that the person has been involved in making. People are supported to make decisions and are supported to take risks to enable them to stay independent Evidence: Each veteran has a care plan in place and four were sampled during this visit. Each person has a designated key worker and veterans are fully involved and consulted in planning their care which is agreed with them at the time of admission. All interventions are planned at veterans request or with their consent. The care plan then is updated to reflect any changes. Since our previous visit the service has introduced weekly audits of veterans care documentation. The AQAA has identified that that the service plans to ensure that each person has been offered a copy of their care plan. During discussion with the manager the service is planning to introduce person centred training in person centred approaches will be provided to staff. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: A care worker spoken with said that care plans are brought to their attention, although another care worker surveyed said, The service could improve further by integrating the care assistants in more of the care plans and get them more involved. Veterans receiving the service are encouraged to make decisions supported by staff. The AQAA states that the service has introduced a new approach to planning attendance at groups and scheduling one to one appointments throughout the persons stay and they have increased the number of psycho educational and support groups. The service conducts exit questionnaires and hold fortnightly meetings where people can express their suggestions and views about the service. The service has demonstrated that peoples views about the service are listened to including a a review of the visiting policy, providing a minibus and providing activities and outings suggested by them. Thirteen people surveyed said that they are always or usually make decisions about what they do. A person said, I am more able to understand my disorder and to learn now how to manage it for myself. Since our previous visit the service has reviewed their risk management policies and procedures. A range of risk assessments had been completed and were available in veterans personal files including self medication, self harm, neglect and aggression. On occasions there may be a need to limit individual choices in order to maintain safety but this is discussed with the person and their agreement is sought where possible, this was demonstrated by information seen in veterans care plans. Care Homes for Adults (18-65 years) Page 14 of 29 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. The service supports people to follow personal interests and activities and they are able to participate in the local community. The service is responsive to peoples cultural and diverse needs. People maintain links with their family and friends and are offered a well balanced diet Evidence: During their stay at the service veterans are able to engage in a wide range of clinical, therapeutic, recreational and social activities. There is an activity centre which provides a range of activities including woodwork, photography, computers, gardening, model making and art. During this visit some veterans told us about the art work that they were going to be exhibiting shortly in London. There is a green house in the grounds for people to enjoy and a well stocked Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: library is provided. Information supplied in the AQQA states that at the request of veterans fishing equipment is now available for people to borrow during their stay and links have been established with Aldershot football club. Thirteen out of fourteen veterans surveyed said that they were satisfied with the activities provided by the service, although one person that the service could do with more entertainment in the evenings . A person surveyed said, There is a choice of day trips which are arranged for us and group individual therapies. A programme of social activities and outings was displayed on the notice board. Some people go out shopping and the service has now purchased a wheelchair accessible vehicle and peoples spiritual needs are supported. The AQAA has identified that they plan to review and strengthen their services provided to to female veterans . The service has made links with Surrey Womens Forum and can now access Womens wellbeing Days. The service also works in partnership with a range of external agencies to support each person including the Royal British legion, the Queen Elizabeth Foundation for employment and training and other ex service charities. Information supplied in the AQAA states that the service works in partnership with veterans and their carers and procedures are in place for contact and visiting arrangements. The service also holds a quarterly Just for us group to support veterans partners. During this visit we viewed the services menus and spoke with the chef who told us that menus are based on peoples known preferences and choices are accommodated which were recorded on the menu. During this visit the lunch time meal was well presented. Meals are served at set times but veterans can arrange to eat their meals at alternative times and packed lunches can be ordered if they are away from the centre. There is a kitchen available in the activities centre where veterans can prepare light snacks and drinks. We were informed that snacks and drinks are available twenty four hours a day. There were mixed responses about the meals. Some people were happy with the meals provided but some people said that they would like more variety. Two people also commented there was limited choices for people who are diabetic or vegetarian. It is recommended that the service continuously monitor peoples views and keep the menus under review. Care Homes for Adults (18-65 years) Page 16 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the personal support in the way they prefer and their health needs are met. People are protected by the centres medication policies and practices Evidence: Each person admitted to the service is individually assessed using a wide range of tools and a personal and treatment care plan is is implemented in partnership with them. Key workers construct care plans based on identified needs. Personal care is negotiated with each person and the service responds to requests regarding peoples preferred gender of key worker. Care plans seen during this visit recorded peoples preferred name of address. Health care questionnaire are also conducted . There is multi disciplinary approach to care and veterans using this service have access to a wide range of health care professionals including, occupational therapy and a psychiatric assessment and diagnosis with a psychiatrist or associate specialist in psychiatry which is carried during the initial assessment admission. A wide range of therapies are available including Cognitive Behaviour Therapy, EMDR, Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: one to one counselling, educational approaches, art and creative therapies, peer support and relaxation. Since our previous visit the service has introduced multiprofessional case conferences and reviews. Information seen in four care plans sampled during this visit demonstrated that treatment plans had been implemented in consultation with people. Care notes sampled provided clear and comprehensive records of the care and support provided. A number of positive comments were received from people about the care and support that they receive by the service including, My personal experience has been exceptional the staff are very understanding and very caring about my needs; Excellent place, very nice, caring staff ,experts in this very specialist field ; The staff are extremely caring and helpfuland the staff treat me with respect and kindness. During this visit the service medication policies and practices were examined. Most veterans staying at the unit maintain and self administer their medication which is encouraged to maintain their Independence. Detailed risk assessments are are carried out at the time of admission. Each person has lockable facilities in their bedroom for safe storage. Veterans bring their medication in with them which is checked by two members of staff and signed on the medication administration record. The medication administration record was examined for one person who requires their medication to be administered ,this was seen to be in order. Medication including controlled medication was appropriately stored and recorded. Information seen demonstrated that robust systems have been implemented to regularly audit medication practices to maintain good practice and highlight any errors . Care Homes for Adults (18-65 years) Page 18 of 29 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 using the service are informed about the process or raising complaints and they are safeguarded from abuse Evidence: The service has a complaints procedure in place, which is included in the service user guide and this was seen on display on the notice board. Information supplied in the AQAA states that staff are encouraged to respond to observations, suggestions and concerns at the earliest opportunity and veterans using the service are supported as required in making complaints. A suggestions box is also available. Since the last key inspection the service has received thirteen complaints. Detailed records were maintained by the manager and information seen demonstrated that these complaints have been investigated and the outcomes documented within the agreed timescale. All complaints received are analysed and staff are provided information and feedback. Since our previous inspection no complaints have been received by the Commission. Twelve out of fourtenn veterans surveyed said that they were aware of the complaints procedure and would know who to talk to if they had a concern. A person using the service said, I did make a complaint once and action was taken and the complaint was resolved. Another person said, on the notice board there is an explanation of the Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: various stages of the complaints procedure A veteran surveyed said, Its a bit unclear who is the right person to make a complaint to. Two veterans spoken with during this visit also stated this and suggested that a flow chart would be beneficial with the procedure to make it clearer. Another person surveyed that some of their previous comments were not acted upon and some of nurses are not always approachable. The service has local safeguarding vulnerable adults from abuse procedures in place, which make reference to the local authority procedures which have been obtained. . Staff receive safeguarding vulnerable adults from abuse training which was confirmed by staff training records and from members of staff spoken with. Two members of staff spoken with during this visit were clear about their responsibilities should they witness or be made aware of any incident where the safety of people is compromised. Since our previous visit one safeguarding matter was appropriately reported by the following the local authority policies and procedures. Care Homes for Adults (18-65 years) Page 20 of 29 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 using the service are provided with a safe, comfortable and clean environment to stay in Evidence: Since our previous visit there have been significant improvements made to the environment. A redecoration programme has been carried out and new carpets have been laid throughout the treatment centre. New furniture has been purchased for the TV lounge, which now provides a comfortable area for people to use. Redecoration has taken place in the dining room and two shower rooms have been refurbished. There is a designated smoking area which has been relocated. The service also provides a well stocked library. There are large, accessible gardens which contains a green house and an activities centre. The facility is accessible to people who may use wheelchairs and electric scooters and accessible bathrooms and showers are provided. The service provides single bedrooms which have washing facilities. We were informed that veterans are able to bring in any preferred possessions during their stay. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Bedrooms were clean and comfortable, although the manager has identified in the AQAA that these would benefit from more homely touches. Two people told us during this visit that the current bed mattresses dont meet their needs and would benefit from further equipment, this was brought to the attention of the manager who said that they would follow this up. Information supplied in the AQAA states that over eight hundred and fifty veterans visit the service which has meant that the establishment within the treatment centre has increased and the physical enviroment and space is not sufficient. Proposals have been agreed for further development of the site which will allow for expansion to include new living rooms, games rooms, expansion of therapy and treatment space and an extension to the activities centre. During this visit the home was cleaned to a good standard and was hygienic. Infection control procedures are available and cleaning schedules are in place,which are closely monitored. Since our previous visit the service has been visited by the enviromental health office which was satisfactory. Staff training records sampled during this visit confirmed that staff receive infection control training. Surveys received from people using the service state that the home is always clean and fresh. One person said, They are always cleaning and another person said, The home is cleaned to a very high standard and all the staff make a contribution to this a team effort. Care Homes for Adults (18-65 years) Page 22 of 29 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 are supported by appropriate numbers, trained and competent staff who are supervised. People are protected by the services recruitment policy and practices. Evidence: People are supported by both qualified mental health nurses and care staff. The duty rota reflected that during the day veterans are supported by two to three qualified staff and four to five care staff. At night time there is a qualified nurse and two carers. The service is also supported by catering, ancillary, administrative and maintenance staff. Since our previous visit a number of new staff have been employed to improve the skill mix. Since our previous visit the service has demonstrated that staff training and development has been strengthened. Staff are supported to attend both internal and external training and the service has developed a new education and training plan. Staff spoken with during this visit told us about the training that they had recieved. Two staff surveyed said that they would benefit from further training related to specialist areas of care. There are eleven care workers employed by the service and we were informed that Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: three members of care staff hold National Vocational Qualifications, four staff are currently completing the qualification and a further four members of staff are commencing the course in the new year. New staff receive induction following the Skills for Care Induction standards. Two members of staff spoken with confirmed that they received induction and completed a probationary period. Training is also provided to staff on mental health issues including anxiety management, Post traumatic stress disorder, anger management and depression. A person using the service said, Staff are intelligent, qualified and individual support is provided twenty four hours a day. A health care professional surveyed said, If care staff do not have the right skills and experience to meet an identified need, appropriate referral or staff training is obtained. During ths visit one person said that a member of staff is difficult to find during the handover period Significant improvement has been made with the staff recruitment practices carried out by the service. Four members of staff personal files were sampled which included fully completed application forms and two written references. Information seen on the files demonstrated that enhanced criminal record bureau (CRB) and protection of vulnerable adult (POVA) checks are conducted prior to any body commencing employment. Staff are also provided with the General Social Care Code of conduct (GSCC) Systems have been implemented for staff to receive regular formal supervision to include all care staff and nurses receive clinical supervision. Information supplied in the AQAA states that the manager intends to introduce a more robust system of staff appraisal and to develop personal development plans for each member of staff Care Homes for Adults (18-65 years) Page 24 of 29 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 service is run by an experienced registered manager and is run in the best interests of people using it. The environment is safe for people because health and safety practices are carried out Evidence: Since the previous inspection there has been a change of registered manager. The current registered manager is a qualified nurse and has past managerial experience at a senior level of working in mental health services. Staff spoken with said that they felt supported by the management structure. The manager was observed to have an open approach and ensures that they are accessible to veterans and staff. A person using the service said that the manager is providing fantastic leadership. The Registered manager has provided comprehensive information in the AQAA about the improvements that have taken place and of the future planned developments. A member of staff surveyed, said, Its a joy to work here and there have been some changes over the last few months I think are all for the better. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The service has a structure of staff meetings in place which was confirmed by staff spoken with. These include clinical staff meetings, professional nursing meetings, clinical governence meetings Veterans are supported to share their views and provide feedback at fortnightly meetings and the minutes from these meetings were displayed on the notice board. Exit satisfaction questionnaires are conducted and the results are analysed. Monthly quality monthly quality monitoring visits are conducted , which were viewed during this visit, which were detailed and comprehensive. The service has also developed and introduced a range of other audits based on clinical governance frameworks. The service has robust systems in place to ensure veterans health and safety. Information seen during this visit demonstrated that environment risk assessments are conducted, water temperatures are regularly monitored and recorded and that servicing and maintenance of all facilities and equipment is up to date . Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 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 17 It is recommended that a continuous review takes place of the meals provided. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - 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!