Care Home: 178 London Road

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What the care home does well People who use the service are well supported by the staff team. Support is delivered in a comfortable and tidy house which people at the service use freely. People who use the service are provided with and engage in a wide range of recreational activities and are supported to be part of the local community. Staff are recruited safely and well trained to carry out their job roles. Quality assurance systems in place provide the manager and responsible individual with information to assist them with continually improving the service. What has improved since the last inspection? Fire safety training has been carried out and records evidence this is ongoing. Staffing levels are consistent and this enables people who receive the service to receive an agreed service which is not changed due to staffing levels.Repairs have been carried out through the service to improve the decor and people who use the service are involved in choosing colour schemes for their rooms. Recruitment files are in place for all staff who work at the service including staff who work for the organisation as bank staff. The manager is now registered and is working with the RI (responsible individual)representative to improve the quality assurance programme to enable the service to move forward and evolve. What the care home could do better: While work has been carried out to improve the care plan files, recording of activities and progress in relation to achieving personal goals needs to improve so it can be clear what action has been taken. A record of notifications in respect of incidents and accidents needs to be completed and sent to the Commission and the RI so an audit trail can be maintained of what action has been taken to minimise reoccurrence of the incident. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 178 London Road 178 London Road Waterlooville Hampshire PO7 5SP     The quality rating for this care home is:   one star adequate 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: Kathryn Emmons     Date: 1 1 0 5 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 27 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: 178 London Road 178 London Road Waterlooville Hampshire PO7 5SP 02392231983 Telephone number: Fax number: Email address: Provider web address: www.mencap.org.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Smith Type of registration: Number of places registered: Royal Mencap Society care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 178 London Road is a converted detached property owned and managed by The Royal Mencap Society. The home has been refurbished to provide an environment for three service users who Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 3 2 1 1 1 2 0 0 8 Brief description of the care home have a learning disability. This includes a seperate self-contained unit with a lounge, bedroom, kitchen and bathroom for one service user and en suite facilities for other service users. The home is staffed twenty-four hours a day and has its own vehicle to assist service users to access the community. The registerd manger is Mrs Karen Smith. Weekly fees start from #1750 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 27 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 peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The visit to the service was undertaken by one inspector who spent six hours at the home. The care received by all three people who use the service was looked at in detail. This is a method called case tracking. This included looking at their personal records a range of general records and staff details. This forms part of a key inspection and focused on the standards in the key areas that most effect the quality of life for the people who use the service. Information already held such as a service history and the providers self -audit which is called an AQAA (Annual Quality Assessment Audit) were used to plan the visit. During the visit the inspector spoke to the responsible individuals representative, deputy manager and five staff and observed staffs interactions with the people who use the service. We also sent comment cards for staff and people who use the service to complete and we also considered the comments these contained when writing the report. Care Homes for Adults (18-65 years) Page 6 of 27 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.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 7 of 27 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 8 of 27 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. Information has been obtained to ensure that the people who use the service will have their assessed needs met while living in the service. Contacts uphold the people who use the services rights to receive the service outlined in the service user guide and statement of purpose. Evidence: The three people who use the service have been living in the services homes since they were children. The service does not anticipate admitting anymore people and the people who currently live at the service will continue to do so. We could see that when the people moved into the service ,when it opened a few years ago,assessments were carried out. The staff who had previously cared for the people and the peoples relatives were involved in the assessments. Staff who are new to the service will read a copy of the services statement of purpose and service user guide so they can gain an understanding of the ethos and operation of the service. Contracts are in place and these have been entered into by the service and the person who uses the services representative or the funding authority., This means that the person using the service and their supporters can be confident that care needs will be Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: understood and met. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have improved but more detail needs to be recorded in reviews of care plans. Risk assessments are in comprehensive detail and enable staff to provide support to keep people who use the service safe. Evidence: Since the last inspection visit the care plans for the people who use the service have been reviewed and developed. We could see that they contained information regarding abilities and capabilities and support needed. We could see the details regarding how people expressed their preferences and needs.There had been reviews of the care plans by the staff who cared for the people and there were also reviews which had involved the peoples supporters.There was a section detailing peoples choices and goals for the future. For one person this involved attending a football match and being involved in a fun run. These plans had been in place for over three months and no entries had been recorded to suggest that any action had been taken. On speaking to the deputy manager we were informed that the person had attended a football match but the plan had not been updated to reflect this or how the person had enjoyed or Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: reacted to the activity. This means that people who use the service may not have accurate information regarding their participation is an activity therfor making it difficult to assess if the goal was achieved or if the plan needed reviewing. There had been an intention since the last inspection visit to introduce a new multi media system so that people who use the service could more easily express their choices regarding their lifestyles. This system is being piloted in another service and the RI representative said there is still an intention to use this at the service. We saw risk assessments which had been completed by senior staff in the service who were aware of the people who use the service ,needs and how to mininmse risk to them while they undertook certain tasks . We saw examples such as risks associated with walks in the local community, using the kitchen and being provided with staff support. The risk assessments had been updated to provide clear information regarding the number of support workers needed to support the people and how this could vary depending on which staff were supporting the person at the time and what the activity was.All of the people who use the service are not aware of risk taking and are not able to make decisions to undertake a task or not. Decisions to be involved in tasks are decided by the persons supporters and multi disciplinary approach from staff and heath care professionals. Care Homes for Adults (18-65 years) Page 12 of 27 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 who use the service are supported to have community inclusion and opportunities to maintain links with their families and peers. A key worker system enables the right care staff to provide a robust support network.Meals are provided which are nutritionally balanced and cater for the peole who use the services preferences. Evidence: We saw that one person who uses the service attends a day service for several days a week. The staff at the service keep in close contact with the day service to review the persons progress and to ensure their needs are continually being met. We saw many examples of community inclusion and during our visit another person who uses the service went for a walk to local shops. We could see evidence of other trips out such as a visit to a local cafe and visiting with the people who use the registered service next door. The staff we spoke with felt that all three of the people who use the service Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: had developed in their skills in making relationships with the staff team and other people who use the service next door. One staff commented in a comment card, it is quite amazing what can be achieved if you give people respect and earn their trust. We saw some very good interactions between care staff and the people who use the service. One person who uses the service had photographs of activities and objects which they could to point to to indicate their needs. Another person who uses the service would use one word replies and non verbal gestures to indicate their needs.Each person who uses the service has two key workers who work with the person to provide them with the support they need. The different personalities of staff enable a more flexible approach to providing the support. This means that people who use the service are able to build relationships with staff who they have a good rapport with rather than having their needs met by anyone who is on duty at the time. There are various leisure opportunities available and during the visit one person who uses the service was using the swing in the garden and later playing music in their lounge. This person also has weekly one to one music therapy sessions which they clearly express their enjoyment for. We saw that another person had been on holiday and was planning future days out. Two other people who use the service had been on a weeks holiday to a holiday park and another holiday was being planned. Relatives of people who use the service are kept informed of relevant information in respect of the people and they supporters and relatives are invited to reviews where appropriate. At the last inspection we found that staff felt that the opportunities for people who use the service were limited due to the occasions one of the people who uses the service needed extra support. We spoke to staff about this on this visit and were told that there were always three staff on a shift so there were no longer any limitations on taking people out of the service. Since the last inspection the menus provided in the service have been reviewed by a dietitian to ensure they are nutritionally balanced and provide people who use the service with the food they prefer and include the necessary balanced diet. We could see that staff understood the food choices people indicated and we saw that one person had been involved in preparing the vegetables for their evening meal. Care Homes for Adults (18-65 years) Page 14 of 27 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 who use the service receive the support they need in a way which is satisfactory to them. Medication records and systems ensure people who use the service receive their medication in a safe way. Access to heath care professionals is good and meets the people who use the services needs. Evidence: We could see during our visit that staff had a very good understanding of the needs of the people who use the service. Non verbal gestures were used by the people to indicate if they were feeling unwell and one staff was able to give examples of what gestures one person showed to reflect they were not happy or feeling unwell. During our visit one person was supported to attend a doctors appointment . Staff said they supported people who use the service for all of their appointments with doctors and nurses and hospital appointments. The AQAA records that there are good relationships with psychologists, community teams and for one person who receives support from the epilepsy team. People who use the service are not able to communicate how they prefer their support to be given. Staff work hard to met needs while trying to enable the people who use Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: the service to maintain as much independence as is possible. An example of this is the work one staff member had been doing with a person who uses the service to pour their own cup of tea. This task is a great achievement for the person who uses the service and staff have positively encouraged and motivated the person to achieve this. We looked at the medication administration sheets for all of the people who use the service. These had been completed correctly and where a signing error had occurred this had been clearly highlighted and recorded. All staff who administer medication have received training and their competency is reviewed regularly through supervision and observation of administering medication. Those medications which are prescribed to be given when necessary were supported by a clear care plan with indicators of when to administer the medication.This means that people who use the service will receive a consistent approach when receiving this medication. A medication policy is in place and available for staff to refer to. Medication records are reviewed regularly by the RI representative to ensure they are completed in accordance with the services policy.This will ensure that people receive their prescribed medication correctly and safely. Care Homes for Adults (18-65 years) Page 16 of 27 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. A complaints policy enables supporters and relatives to the service to raise any issues. They can be confident that their concerns will be listened to and dealt with. Further development of the system for people who use the service to raise any concerns will enable concerns to be identified in a clearer way. Safeguarding adult procedures are robust so this means that people who use the service are kept safe. Financial audit systems keep peoples monies safe. Evidence: There is a complaints procedure in place which is available to supporters and people who are involved with the service. Any complaint or concern is logged and the manager will investigate immediately. The current format is not suitable for the people who use the service and further development is needed to provide a more appropriate system for people who use the service to raise any concerns they have. Staff we spoke with were very clear that they always had to have an awareness of how they supported people to ensure that any support could not be seen to be punitive or abusive. Staff told us that because the people who use the service were not able to verbally express any concern they may have the staff had to use their own understanding of how the people who use the service expressed concern and use this as an indicator that there may be an issue. When we spoke to staff about this and what action they would take we were told If i thought there was an issue between Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: one of the people and a staff member I would not hesitate in raising it and Its important we look out for non verbal signs that things might not be right, we are here to keep people safe. Staff records and confirmation from staff we spoke with evidence that all staff had received training in safeguarding adults and were aware of the services policy and procedure in respect of safeguarding adults. Small amounts of monies are retained in the service for the people who use the service. We could see that money checks were carried out at the handover of each shift to ensure that the peoples monies were correct. Care Homes for Adults (18-65 years) Page 18 of 27 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 who use the service live in a clean, tidy and comfortable house. Risk assessments for the environment and training in areas such as infection control measures keep people safe. Evidence: The service is provided in a large detached house with another registered service occupying the house next door. There is a flat let on the ground floor of the service which is occupied by one of the people who uses the service. The other two people share the main house. The bedrooms we looked at had been furnished in accordance with the persons needs. One room has minimal furniture due to the person being more comfortable with this. Another person had a electric piano in their bedroom so staff could engage the person in musical based activities. One room was due to be redecorated and the person had been involved in choosing the colour scheme. Most areas of the service were well decorated but the lounge and entrance hall walls would benefit from redecoration and minor repairs.This is a constant task and one of the staff said the repairs were carried out fairly soon after they were recorded in the maintenance book. The house was clean and tidy and fresh and staff said they were responsible for maintaining a clean environment. Where risk assessments had identified people may be at risk from their environment items have been removed or adapted such as locked wardrobes for one service user so their clothing is not Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: removed. Staff told us they had received training in promoting infection control and the use of cleaning materials in the service. There is a garden at the back of the house and this was tidy and of a good size. Care Homes for Adults (18-65 years) Page 20 of 27 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. There is a stable and enthusiastic staff group who provide a good level of support to the people who use the service. People are kept safe by the staffing levels. Rapport between people who use the service and staff is good. Robust recruitment practices ensure the right people are recruited to keep people safe. Ongoing training and supervision enables staff skills and knowledge to increase and development needs identified.This means that the quality of care may increase. Evidence: At the last inspection staff indicated that there was an issue with staffing levels which meant that people who use the service could not always do the activities they wanted to do. Comment cards we received back this time indicated that staff felt there were enough staff on duty at all time and activities were taking place. We spoke to five staff during our visit and asked them about staffing levels and if these were sufficient . We were told we always have at least three on and its plenty and If we have someone call in sick we will normally be able to cover this and its much better that a few months ago . We looked at the duty rota and could see that there were always at least three staff on and this did not include the manager . We saw no evidence through reading daily notes for the three people that use the service that activities had been canceled due to staff changes or shortages. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: We reviewed staff records for two new staff and one member of staff who had been employed for a few years. We could see that all necessary checks had been carried out such as references and CRB (criminal record Bureau ). We were told by the RI Representative that interviews take a day to conduct and people who use services within the organisation form part of the interview panel. This means that the organisatin can gain an insight into the rapport the prospective staff member will have with people who use the service. We observed many of the interactions between staff and people who use the service.We saw that the staff had a good understanding of the communication of the people who use the service and how they expressed their needs and choices. A key worker system is very effective and a couple of the relationships we saw between staff and people were very good. From facial expressions of one person we could see how they enjoyed the company and support they received from one member of staff in particular. Staff told us that if took a long time to gain a good rapport with the people who use the service and the work could be hard but rewarding. We spoke with a new member of staff who told us about the training they had received as part of their induction and of the other training that was planned for them to attend along with staff from other services the orgainisation operates. There were supervision records in place and we could see that these were carried out regularly and reviewed by the RI representative to ensure that staff training and development needs are identified and addressed in order to continually improve the staffs skills and knowledge. Care Homes for Adults (18-65 years) Page 22 of 27 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. The service may operate better if the registered manager is based at the service so they can monitor the needs of the people who use the service and staff performance . The manager has a good rapport with staff. Polices and procedures are current and keep people who use the service safe.Quality assurance systems enable the service to continually improve and evolve. Fire safety arrangements keep people who live and work at the service safe.The manager needs to ensure notifications are produced and sent to us in respect of any accident or incident which affect the wellbeing of the people who use the service and staff. Evidence: Since our last visit in November 2008 the manager has now become the registered manager.The manager was on leave when we did the visit to the service but we were assisted by the deputy manger and the RIs Representative. A couple of staff said the manager was supportive and and approachable and that they could discuss any issues with her. The managers office is located in a registered service next door to this service as the manager is registered in respect of both services. a staff member said they felt the manager tended to spend more time at the other service. There is an Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: office in this service but one person who uses the service finds it difficult to see lots of paper work in view . This office was viewed by us and was found to be quite untidy with paper work on display.This does not fit in with the assessment of the persons need to not see paperwork n view, so we discussed this with the RI representative who said the manager was looking at ways of using both offices to work from so she could be based in the service more regularly to monitor how the service was operating. This means that staff will be able to work alongside the manager and not have to wait for the manager to come over to the service. Since the last inspection work has been carried out to comply with the previous inspection immediate requirements regarding fire. We found through looking at the fire log book and staff training records that all staff including night staff had all recently attended fire training. A new member of staff had received training on the morning of the visit and a certificate was in their file to show this. A quality assurance programme is in place and the RI representative said work was being carried out on this to find ways of involving people who use the service to obtain their views and experiences of the service. The RI representative visits the service two to three times a week and during out visit they were reviewing care plans and risk assessments to ensure they contained the correct level of detail. The RI representative said that they sampled polices and procedure to ensure these were up to date and reflected current practices within the service. Staff we spoke to were aware of polices and procedure and the new member of staff had been reading some of these during her shift. Since the last visit we made in November 2008 we have not received any notifications regarding any accidents or incidents which affect the people who use the service.We need to be told about incidents so we can monitor what the service is doing to protect the people who use the service and improve the service. We found incidents had occurred with one person who uses the service which involved changes in their behaviour which placed them and staff at possible risk. The RI representative confirmed that these incidents would now be reported to us. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 41 37 Any incident or accident which affects the wellbeing of service users must be reported within 24 hours. Reporting of incidents means we can monitor what action has been taken to minimise the risk of the incident reoccurring. 26/06/2009 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 26 of 27 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 27 of 27 - 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!