Care Home: 16 Vista Road

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What the care home does well This home had a calm and friendly atmosphere, and was light, bright and airy. The lounge and dining rooms were decorated and furnished to a good standard. Staff on duty were knowledgeable about service users care needs and the staff team worked together well. Care plans are informative and helpstaff to understand the level of assistance service users want and need. The staff team encourages service users to enjoy a variety of activities, both local and farther afield. What has improved since the last inspection? Window restrictors had been fitted to first floor windows. The lounge and dining roomshad been redecorated and there was a new TV and a new fish aquarium in the lounge. There were new sofas in the lounge and new dining furniture in the dining room. What the care home could do better: We need to see evidence of the content and syllabus of the medication training provided to staff since our last inspection, and of when this training was completed.Service users views on the running of the home should be sought and recorded, and used to inform the home`s quality monitoring processes. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 16 Vista Road 16 Vista Road Wickford Essex SS11 8EJ The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Thompson Date: 2 1 0 5 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 35 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 Inspection report CSCI Page 3 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 4 of 35 Information about the care home Name of care home: Address: 16 Vista Road 16 Vista Road Wickford Essex SS11 8EJ 01268767210 01268767210 stephen.robson@estuary.co.uk 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) : Estuary Housing Association Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: No more than three (3) Younger Adults with a learning disability to be accommodated. Date of last inspection 1 9 0 5 2 0 0 7 A bit about the care home 16 Vista Road provides accommodation and personal care for three adults over the age of eighteen with learning disabilities. Care Homes for Adults (18-65 years) Page 5 of 35 The home is situated in a residential area, close to local shops and public transport links. Each service user is provided with their own single room within this two storey detached house. There is a garden to the rear of the property, and a parking area for vehicles at the front. The home has its own transport, which takes service users to and from their community based activities and leisure pursuits. Service users have the opportunity to pursue interests if they so wish. The range of fees charged to individual service users is according to assessed needs and the agreed care package provided. Additional charges incurred to service users includes toiletries and personal items. Care Homes for Adults (18-65 years) Page 6 of 35 CQC inspection reports can be obtained from the home, or via the CQC internet website, www.cqc.org.uk Care Homes for Adults (18-65 years) Page 7 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 35 How we did our inspection: This is what the inspector did when they were at the care home We did this inspection on Thursday 21st May 2009 and this report reflects our findings on that day along with information provided by the manager and feedback by service users and staff. The manager was at the home on the day of the inspection. The manager had completed and returned the Annual Quality Assurance Assessment AQAA to us before the inspection. This document gives homes the opportunity of recording what they do well, what they could do better, what has improved in the time since our last inspection as well as their future plans for improving the service. Some of the information and detail provided within the AQAA has been included in this report. During our visit we met with service users and spoke with the manager and staff on duty. We also asked for surveys to be completed by service users and staff. We received six completed surveys back and reference to what was said in these has also been made in this report. Care Homes for Adults (18-65 years) Page 9 of 35 We looked at some records and policies and procedures and were were shown around parts of the home and grounds. What the care home does well This home had a calm and friendly atmosphere, and was light, bright and airy. The lounge and dining rooms were decorated and furnished to a good standard. Staff on duty were knowledgeable about service users care needs and the staff team worked together well. Care plans are informative and help Care Homes for Adults (18-65 years) Page 10 of 35 staff to understand the level of assistance service users want and need. The staff team encourages service users to enjoy a variety of activities, both local and farther afield. What has got better from the last inspection Window restrictors had been fitted to first floor windows. The lounge and dining rooms Care Homes for Adults (18-65 years) Page 11 of 35 had been redecorated and there was a new TV and a new fish aquarium in the lounge. There were new sofas in the lounge and new dining furniture in the dining room. What the care home could do better We need to see evidence of the content and syllabus of the medication training provided to staff since our last inspection, and of when this training was completed. Care Homes for Adults (18-65 years) Page 12 of 35 Service users views on the running of the home should be sought and recorded, and used to inform the homes quality monitoring processes. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 13 of 35 If you want to speak to the inspector please contact Alan Thompson Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Telephone: 03000 616161 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 Care Homes for Adults (18-65 years) Page 14 of 35 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 15 of 35 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 . People considering moving into the home can be confident that the admission processes ensures that the home can meet their needs. Evidence: The current service users are placed and funded by local authorities. Records confirmed that these organisations had provided a full assessment of needs to the home before admission. In addition to this the manager will undertake a written assessment of needs for all prospective service users prior to admission. One new service user had moved into the home since the last inspection and admission information for this person was looked at. Included was information on the individuals background, with assessed areas under headings of, self care, leisure and social interest/needs, communication, continence, eating and drinking, bathing, mobility, self help, behaviours, family and professional involvement, physical, daily living, medical and health needs. Service users were unable, because of their disabilities, to tell us about when they moved in. However comments in relatives surveys returned to us confirmed that Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: people were fully involved in the admission process which included visiting the home for day and overnight stays before deciding to move in. Care Homes for Adults (18-65 years) Page 17 of 35 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 information in care plans ensures that peoples needs could be met in a way they would wish. Evidence: At the time of this inspection there were three service users living at Vista Road. Two of their supportcare plan files were inspected. These had risk assessments with guidelines for staff on methods to minimise risk, and these had been reviewed. The manager said that currently no service users present challenging behaviours but staff have been trained on this subject in case the need arises. Training records seen confirmed this. Daily assessed needs were listed under individual headings including, personal care, communication, relationships, food and eating, activities, finances, work and/or day activities, environment and health. These were broken down into sub headings with detailed information on objectives, who would implement the agreed needs and how the support would be offered. Care plans included picture guides for service users benefit. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: All care plans had been regularly reviewed with a daily record completed by staff. Care reviews included records of the outcomes although these did not include the views of service users as, because of their disabilities, they do not take an active part in the care planning process. Healthcare issues were seen to be recorded on service users files including visits to medical professionals, social workers, GP consultations, dentists, opticians and chiropodists. Also seen recorded were notes of full reviews of placement undertaken with the placing authority and the service user. Service users could not tell us if they are included in day to day decision making within the home, but comments from relatives and visitors indicated that they are satisfied with the way the home is run and with staff attitudes towards service users. Care Homes for Adults (18-65 years) Page 19 of 35 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 . Service users are encouraged to participate in a range of social and leisure opportunities that meet their expectations. Meals and mealtimes are flexible and suite the lifestyle of service users living at the home. Evidence: The manager confirmed that none of the service users is able to attend any type of paid or voluntary employment. One person does attend college with staff support to take part in music, dance and sports sessions. All service users need full staff support to access any community activities and facilities. Each service user had their own pictorial style activity chart in their room. Written activity records were kept on files in the office, interests offered were attendance at a day centre in Shoeburyness, pub lunches, parties, outings including a boat trip to see seals and a zoo trip, walks, drives out, aromatherapy, clubs, music sessions, films and inviting friends from other homes over for Sunday lunch. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: Service users were not able to tell us if they enjoyed the activities provided, but observations at the inspection indicated that they chose to take part in what was planned that day. The organisation owning Vista Road provides a vehicle based at the home for the benefit of service users, enabling ease of community access with full staff support. One service users sees their family regularly and stays overnight with staff offering to drive the service user home to ensure regular contact is supported. Throughout this inspection staff were observed to interact appropriately with service users and appeared to always use the individuals preferred form of address. Service users were included when discussions took place about activities and routines, and the atmosphere in the home was supportive and friendly. Nutrition records were looked at and evidenced a varied and balanced diet. The manager said that service users usually eat in the dining room, but may sometimes eat in the lounge. Breakfast and lunch are taken at times according to service users choices and their daily routines. The main daily meal is in the evening, when generally everyone eats together. Menus are on a two week rotation. Menus are based on service users likes and from background knowledge of peoples preferences. Service users sometimes accompany staff on food shopping trips and some will take part in simple meal preparation as part of a planned activity to encourage choice and independence. Care Homes for Adults (18-65 years) Page 21 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at 16 Vista Road can expect to receive support in an appropriate and dignified way that meets their needs. Evidence: Care records and discussion with staff confirm that service users are encouraged to make their own choices around clothing styles and general appearance. Care plans had peoples known preferences around rising and retiring times and details of the levels of personal care support they needed. Service users were unable, because of their disabilities, to tell us about the support provided them by staff, however comments in surveys from relatives included, (the home) cares for every need in a pleasant and friendly manner. Care plans contained assessment of healthcare needs. The current service user group are offered full staff support and guidance in recognition of their individual healthcare needs and to access community healthcare facilities. Service users regularly visit community based healthcare services including consultant psychiatrists and dentists, with staff support. Service users healthcare needs were Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: recorded within individual care plans and updated in the daily care notes and health action plans. All service users were receiving full staff support with their medication needs. Service user files include an assessment of medication needs which is signed by staff and the service users representative. Service users did not appear to have a full understanding or awareness of the medical reasons for medication regimes prescribed to them. The manager confirmed that if service users refused medication then encouragement is offered to them to understand the reason for the prescribed dosage. The homes written medication procedure policy clarified policies on homely remedies, side effects of the medicines prescribed, the storage of medicines and of administering prescribed dosages. Records were seen relating to the re-ordering and returns of unused medication. A random sample of medication administration records and stocks of current medication were inspected. No errors were noted. The manager said that since our last inspection staff had received update training relating to the medication practices and procedures used in the home. This training had been provided by the providers own trainer and the homes training record showed that this took place in September 2008. However there was no actual evidence of completion or of the content/syllabus of what was covered, or that staff had successfully completed the syllabus. The manager had ensured that staffs ongoing competency to administered medication was assessed. Records of assessments carried out in January 2009 were seen. Care Homes for Adults (18-65 years) Page 23 of 35 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 . Practices in the home safeguard service users and ensure that concerns are listened to and addressed. Evidence: The provider had a complaints procedure in place, which clarified the complaints process and the timescales that the manager should respond to the complainant. There was some basic pictorial style complaints information seen in the home. Service users would not have the ability to follow any written procedure, but the document displayed indicates to service users that they have a right to make a complaint to staff. The manager said that one service user has regular contact with their family. The home also has active links with a local advocacy service and was able to demonstrate that this service is used as appropriate to ensure that service users wellbeing is paramount to any given situation. There was a set template form for recording complaints and a complaints record book. There had not been any formal complaints recorded since our last inspection. Also seen in the home was a copy of the safeguarding adults guidance and policy produced by the registered provider, and a copy of the latest joint safeguarding procedural guidelines issued by the Essex joint authorities on abuse issues. These documents included detailed guidance for staff on the adult protection procedures and on types of abuse that may occur. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: Staff have safeguarding adult abuse training, certificates were seen to evidence this. The manager is a safeguarding trainer and provides this training to staff at other homes owned by the provider. Staff spoken with understood what was meant by safeguarding adults from harm and said that if they suspected an issue then they would contact the manager or on call manager. Also seen was a policy issued by the provided on protected disclosures which included some guidance to staff on whistleblowing if they suspected poor practice had taken place. This document was quite long and complex to follow and we think that the whistleblowing element would be easier for staff to refer too if the overall document was shortened. Care Homes for Adults (18-65 years) Page 25 of 35 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 . Service users live in a comfortable, clean and homely environment. Evidence: During the inspection a partial tour of the home was made accompanied by the manager. The home was clean, bright, homely and overall was acceptably maintained, furnished and decorated. All three bedrooms are singles with one on the ground floor and two on the first floor. Bathing facilities comprised of a walk-in shower and wc on the groundfloor, and a bath and wc on the first floor. The shower room was in need on refurbishment and the manager had already indentified this room for improvement. Evidence of refurbishment works planned to take place were shown to us at the inspection. Private rooms were furnished and equipped to an acceptable level and the manager confirmed that service users are encouraged to become involved when changes in decor and furnishings are made in the home. Because of their disabilities service users were unable to tell us what they thought of their surroundings, however on the day we were there people looked comfortable and relaxed in their home. Since our last inspection new sofas and a new fish aquarium had been put into the lounge. The dining room was well furnished and equipment and cupboard units in the kitchen looked in good condition. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: The garden was well maintained and had a patio area with BBQ and seating. The garden could be accessed through either the dining room patio doors or the kitchen. The homes vehicles are parked on the drive and although the street outside the home is narrow there is still sufficient parking for visitors. Care Homes for Adults (18-65 years) Page 27 of 35 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 . Service users benefit from being supported by an experienced staff team who had received training for their roles. Evidence: A clear organised staff rota was available for inspection. On the day of the inspection three service users were living at Vista Road and daytime staffing was a minimum of two staff on duty. At night there is one person on waking duty with a manager on-call outside of the home as support. The manager and staff spoken with confirmed that staff meetings take place. Minutes of a meeting held in April 2009 were seen. Discussion had included service user issues, training, menus, team work, responsibilities and health and safety. Staff records that we looked at showed that staff had proof of ID and CRB checks on file. However most of the team had worked for Estuary Housing for several years and some had transferred over with continuos service rights from NHS Trusts when the home first opened. Because of these circumstances we could not fully inspect the recruitment procedures or the induction training of new staff. The manager said that new staff would be given induction training and produced a template for this, but as our last report included a statutory requirement that covered induction training records we needed to look at induction records for the most recently employed person. We Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: therefore looked at the file for the person employed in 2005 and could not find any record of induction training having been provided. We recognise that this was well before the current manager was in post and so he could not explain the reason for this, but without the necessary evidence in place we must include a statutory requirement on this issue in this report. Agency staff are used regularly at Vista Road. All new agency staff have basic induction orientation training in the home and the manager ensures that the agency used provides a training and recruitment record for all staff sent. Evidence of these records were seen and included confirmation that CRB checks had been carried out and that staff had manual handling, medication, risk assessment and first aid skills appropriate to the service at Vista Road. Staff spoken with and comments in surveys return to us by staff confirmed they were well supported by the manager They also said that they had been offered training opportunities appropriate to their roles and in understanding and meeting service users needs. Staff training records had been kept in files with certificates of attendance on various courses seen. These included, manual handling, role of the support worker, safeguarding, medication, food safety, health and safety, first aid, fire safety, downs syndrome awareness, risk assessment, autism, communication skills, nutrition and diet, OCD, assessment and care planning. Staff were open, friendly and demonstrated sound care values. All seen had a good understanding of work practices and routines and the observed rapport between staff and service users was friendly and supportive. Regular staff supervision meetings had taken place, with records kept of the agenda discussions and actions. Areas included had been work role, responsibilities, key worker role, performance and training needs. The homes written supervision policy provided clear guidance to staff on the reasons for regular 1 to 1 meetings and there was a managers practice guide to use for reference on this subject. Care Homes for Adults (18-65 years) Page 29 of 35 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 . People live in a home that is managed and run in their best interests. Evidence: Since our last inspection a new manager had commenced working at Vista Road in February 2008. The new manager said he had fourteen years experience of working in social care, with over four years of this in a management/supervisory position. The manager has an NVQ 3 award and is studying for an NVQ 4 and the Registered Managers Awards. The manager said he is going to apply for registration with the Commission Comments in staff surveys returned to us about management of the home confirmed that staff thought they were supported by the new manager. The registered providers quality assurance process for the home mainly involves taking account of reports generated from the monthly registered provider visits. These reports were detailed and had some reference to service users views. However this did not amount to a regular quality monitoring exercise and we recommend that the manager considered how to survey service users, their representatives and others at Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: least annually. With a record kept of the findings and of any actions taken. Random samples of records required to be kept by regulation were inspected. These included, the statement of purpose and service users guide, regulation 26 reports (monthly registered person report), staff rota, visitor book, nutrition records, assessments, care plans, staff recruitment, complaints, medication records, regulation 37 notifications, fire procedures and fire drills. We could not properly look at service users monies held for safekeeping as the provider has a bank account set up for the home from which cash is used to purchase items and goods for service users. Receipts are obtained but are sent to the providers head office after being reconciled against account expenditure. Reconciliation records were kept at the home, these were shown to us by the manager and looked in order. Staff had received training in first aid, fire safety, health and safety and food safety. Service records were seen to show that the homes fire alarms, fire equipment, emergency lights, gas systems and portable electrical appliances had all been tested/serviced within recommended timescales. The electrical installation supply should be checked every five years and had been due for renewal in April this year. The manager said that this work had been carried out by a contractor on 15.05.2009. No completion certificate was available, but evidence of the contractors visit was provided at the inspection. The manager is going to confirm to us in writing when the certificate confirming that the electrical installation is safe is received at the home. The homes environment and fire risk assessment formats were seen. These were regarded as comprehensively compiled documents. Care Homes for Adults (18-65 years) Page 31 of 35 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 Care Homes for Adults (18-65 years) Page 32 of 35 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 20 18 Evidence needs to be available for inspection to confirm that all staff are trained in the safe handling of medicines. 30/09/2009 This is to show they are trained for the duties they perform. 2 35 18 30/09/2009 Evidence must be available for inspection to confirm that induction training is given to new staff when they are employed. This is to show that staff are trained for their roles. 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 33 of 35 1 39 Service users views on the service provided them should be sought and used to inform the homes quality assurance processes. Care Homes for Adults (18-65 years) Page 34 of 35 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. 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 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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