Care Home: 20 Newlands Close

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 20 Newlands Close 20 Newlands Close Hastings East Sussex TN34 2QW     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: Michele Etherton     Date: 0 8 0 4 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 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.cqc.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: 20 Newlands Close 20 Newlands Close Hastings East Sussex TN34 2QW 01424755717 Telephone number: Fax number: Email address: Provider web address: www.eastviewhousing.co.uk Name of registered provider(s): East View Housing Management Ltd Name of registered manager (if applicable) Ms Heather Moller Type of registration: Number of places registered: 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 three (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 20 Newlands Close is a detached bungalow registered for three service users with learning disabilities. The home is part of the East View Housing Ltd. (EVH). The home has been extended and adapted to provide care for people with mobility difficulties. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 3 Brief description of the care home The accommodation consists of four bedrooms (one bedroom is used as the general office and staff sleep-in room) one bathroom with toilet, shower room and separate toilet. The communal areas are a large kitchen diner, lounge and a conservatory. There is a back garden that is used by the service users and there is an open frontage. The bungalow is situated in a quiet residential close, there are bus routes to the town of Hastings and there are two local shops in walking distance. 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: The reader should note that whilst the Care Standards Act 2000 refers to Service users in regard to those who use and live in registered services people living in this home prefer to be referred to as Residents and this is the term we shall use for them throughout this report. A key inspection of this service has been undertaken that has taken account of information from the service and about the service since the last inspection, including an annual quality assurance assessment (AQAA) We found the AQAA to be completed to a reasonable standard but additional detail would have helped illustrate better the activities of the service on a day to day basis and future planning. In addition to analysis of information received about the service we have also undertaken a site visit to the home. We visited the home 6th April 2009 Care Homes for Adults (18-65 years) Page 6 of 29 unfortunately no staff or residents were available to speak with us and a further visit was arranged at short notice on 8th April 2009 between 3.00 pm and 6.15 pm when two residents were present in addition to the manager and a member of care staff. We have also surveyed residents, staff relatives, care managers and health professionals to find out what they think about the service on a day to day basis and any suggestions they may have for improvement. We have received a good response to our surveys and these tell us that people who live, work or are involved with the home have a very positive view of the overall service. Survey feedback and interviews with residents and staff have been influential in the compilation of this report and we would like to thank those who have contributed their views. For the purposes of this inspection all key inspection standards have been looked at. In arriving at our judgment we have tried to be proportionate in considering the impacts and risks on overall outcomes to residents of identified shortfalls and general compliance with regulations. What the care home does well: What has improved since the last inspection? Since the last inspection our inspection of this service confirms that the service has addressed previous outstanding requirements, in that the manager has registered with the Commission and a compromise has been reached in providing some male staff hours to support a male resident for activities in the community. The laundry has been relocated outside into a utility area and external lights fitted to light the path. Care Homes for Adults (18-65 years) Page 8 of 29 The AQAA tells us that New fire plans have been implemented, the office has been reorganized to provide more effective use of space, new life plans have been introduced and successfully implemented for all residents. A new medical waste system has been introduced. Residents have been actively involved in making decisions about how they wish to improve upon furnishings in their rooms or purchase computer games to enhance their understanding of numeracy and literacy. The AQAA tells us that all policies have been rewritten and staff have familiarized themselves with these. The home has ensured that documentation is fully accessible to a member of staff with a disability to aid their work with residents. 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 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 and existing residents can be confident that they will be provided with information about the service in an accessible format and that their current and future needs will be assessed to ensure these can be supported now and in the future. Evidence: Prospective residents can be confident that they will be provided with accessible information about the service and provided with opportunities to visit and meet staff and other residents before deciding to move to the home. The home should ensure that it does not expend time and effort in making documentation accessible in formats that are not used by the current residents but should retain the facility to do so if needs change. The Home manager undertakes to ensure that a full assessment of prospective residents needs is undertaken to ensure these can be met. Discussion with residents and staff at the visit confirmed that the home has responded well to short term changes in mobility and health needs of some residents, and there is evidence of good pre planning to ensure that satisfactory staffing, aids and adaptations are in place to Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: support the affected resident, good partnership working and liaison with local hospitals and health professionals has been of benefit to residents in ensuring their recuperation and rehabilitation runs smoothly. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to lead the life they wish within a responsible risk taking strategy Evidence: We viewed randomly an example of care plan information maintained for all residents, this has recently had a change in format and some information is still being added, however we found the information to be detailed and informative providing a good reflection of personal preferences for residents support around daily routines. Established goals and aspirations were also noted, discussion with staff and residents indicates that all the residents have achieved greater independence since coming to live at the home but some residents find this difficult to sustain, we found goals established for some residents to be too broad, a conclusion also arrived at by the home who are in the process of considering how to make goals smaller and more achievable and we would recommend this is progressed. Residents have informed us through survey feedback that they make their own Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: decisions about their daily routines and are consulted about their preferences, progress has been made in empowering residents to become more independent of staff in their decision making. A comprehensive risk assessment strategy is in place that does not inhibit residents from experiencing risk or focuses only on keeping residents safe. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All the residents are supported to lead the life they wish and pursue their own interests, they lead busy active lives making full use of the community and social and educational opportunities. A healthy diet is provided that takes account of individual preferences but some residents may need encouragement to vary this from time to time. Evidence: Residents we spoke with confirmed they lead busy active lives making full use of day centres, and community facilities during the day time, at evenings and weekends . Use of bus passes, disabled parking badges and use of dial a ride schemes ensures residents enjoy good access to the community at large, staff rotas are also adjusted if necessary to ensure car drivers are available. Two residents now have their own lap tops and make use of these for playing Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: computer games and accessing numeracy and literacy software, one resident reported that they understood how to use email and would like to have an INTERNET facility at the home, in discussion the manager has confirmed to us that this is being progressed for the resident concerned. We found the manager and staff to demonstrate a commitment and enthusiasm for promoting the independence of the residents and enabling them to exert control over their daily lives within responsible risk taking strategies. There have been previous concerns that the only male resident may lack male company in view of the predominence of femal staff and residents, a relative has also commented that the resident concerned would benefit from some dedicated time with a male staff member for outings from the home, some hours have now been available to provide this support, this has been a positive development and we consider this should be increased further if the resident concerned indicates they would like more support of this kind. Residents and staff we spoke with confirmed positive relationships are in place for all residents with regular contact and visits arranged, one resident was holidaying in Greece with their family during our visit. Residents also enjoy holidays in this country and abroad with each other and staff and are fully involved in decisions about where to go, one resident reported that they had flown on an airplane for the first time last year and although initially very nervous greatly enjoyed the experience and would like to go again. We spent time with residents and staff over a lunch period and residents informed us how decisions are made about the menu, this has been devised with their individual likes incorporated so that favorite meals are catered for, one resident does not keep a good diet and has a limited range of preferred foods, a review of resident food intake records indicates that on most days residents ate a varied menu but more encouragement is needed to ensure that this resident in particular alternates their preferences each day to maintain a healthy diet. 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. The personal physical and health care needs of residents are well documented and understood by the staff team who ensure that residents have full access to routine and more specialized health care. Evidence: Good continuity within the staff team has been of benefit to residents in that staff have a good understanding of their personal and health care needs, and this has ensured a consistent delivery of staff support and practice, residents have been actively encouraged to become more involved in their health care and the decisions around this. Residents we spoke with confirmed access to routine health care checks with some retaining their own dentists in the community, residents are encouraged to make their own appointments, one resident we spoke with would like to make their own GP appointments but surgery times coincide with those of the day centre, we spoke with the manager about this and whether the home and day centre can work together to facilitate this for the resident whilst at the day centre. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: The manager acknowledges that whilst the residents are still fit and active they are aging and consideration will need to be given to ensuring staff awareness of possible changes in nutrition, tissue viability, falls and weight is maintained and monitoring introduced when changes occur. The manager has pre-empted the future need for aids and adaptations for residents by pursuing the installation of a bath aid and the provision of a ramp from the house to the rear garden to meet their future needs. A resident informed us about an impending operation and that they had spoken with social services and health care staff about the implications of this in the short term and the period of recuperation they will need a capacity assessment has been completed for this. The manager has been actively involved in the planning and discussions with health staff as to how post operative aftercare will be provided and plans are in hand for additional staffing and adaptations and aids to support the resident through their period of rehabilitation. A health professional has told us that staff are proactive in seeking medication reviews and reduction in medication for residents where possible. Staff are trained in medication and their competencies are routinely checked but the home is actively involved in working with those residents who are able to take more control of their medication regime and consequently all residents now have their own medication cabinets allowing for greater privacy and dignity within medication routines. One resident showed us their medication, was able to discuss with us what the medications were for and how medication is taken and recorded. The resident told us that they take their medication their selves under the supervision of staff and record medication they have taken on the MAR sheet although they sometimes forget to fill this in and staff are working with them around this, it is hoped that the resident will become sufficiently independent to hold their own medication key in the near future and risk information is in place to support this practice. We discussed the standard of photocopied MAR sheets which had the key codes missed off and have recommended copies are used only with key codes on to inform staff and ensure that codes are used consistently and appropriately by staff. 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. Good systems are in place to safeguard the personal and financial well being of residents. Evidence: Resident survey feedback informs us that residents feel confident about making a complaint and would approach staff or the manager with any concerns. They tell us: I would talk to any member of staff at the home or I can also speak to a member of the senior management team if I want to I like the manager of the home We received responses from two relatives one of whom felt they did understand how to complain and another who said they did not, clearly relatives would benefit from being reminded of the complaints procedure and we recommend this is progressed by the service with them. The AQAA tells us there have been no complaints, complaints are initially recorded in a complaints record which is accessible to residents and visitors we have expressed some concern that this may breach confidentiality of complainants and thereby inhibit either residents or others from complaining, the manager agreed to ensure that complaint information is anonomised and maintained as an index only which can be Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: cross referenced to complaint information held more securely in the office The home has been proactive in making safeguarding alerts on behalf of residents although none are currently open. Staff have all received safeguarding adults training. Staff have access to guidelines for the management of some behaviours appropriately and safely and ABC charts are used to monitor some resident behaviours, these are analyzed by the manager and the area manager as to whether staff practice needs to change to support behaviours more effectively and consultation with other health and social care professionals may also be undertaken. The manager has awareness of recent legislation regarding deprivation of liberty and mental capacity, and how these are to be implemented.Some restrictions are in place for one resident these are well documented within care plan information and risk assessments and are reviewed with placing authority staff and the resident regularly. Systems are in place to safeguard residents monies and regular audits are conducted, staff are working with residents to take greater control and responsibility for managing their own finances where able to. 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. Residents enjoy living in a peaceful well maintained and homely environment that is suited to their current needs, they can be confident that their changing needs will be supported through changes to the environment where possible to support their continued stay in the home Evidence: We undertook a tour of the home in the company of the manager initially but also spent time with a resident in their bedroom. The Home is well maintained and is decorated to a high standard, providing a modern homely and comfortable environment for residents to live in. Residents personal space is arranged to suit their own preferences and tastes and they make decisions about whether they wish to purchase additional furnishings for their room over and above minimum requirements. A resident who was happy to show their room to us commented that they had decided to buy new furniture because they wanted similar furnishings to other residents, the home had bought them a new bed but they didnt like it and wanted one that raised them up and down because of a progressive deterioration in mobility, the resident commented that they had decided how they wanted their room to look. We were able to view all bedrooms in the company of either residents or staff and found them to be decorated and maintained Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: to a very good standard being filled with residents personal possessions, and photographs, we found that residents all have keys to the front door of the home but no facility exists currently for them to be able to lock their bedroom door if they wish, the manager commented that this is an oversight and could see no reason why residents should not be provided with the ability to lock their bedrooms if they wish as an added security and this is a recommendation. Residents have a choice of a shower or bath and an electric bath seat is on order for residents to gain easier access in and out of the bath. The shower room is spacious and plans are in hand to adapt this further to provide improved access for a resident who will in the short term have reduced mobility through surgery. The promotion of good infection control through provision of paper towels and liquid soaps is maintained but noted that supplies of clean bath towels are stacked in an open shelving arrangement within the shower room close to the handbasin and shower and have recommended that consideration is given to providing some form of cover for these in compliance with infection control. The manager demonstrates an awareness of the changing needs of the residents and how the home environment may need to respond to this, and is already consulting with the company about what changes may need to be made including the purchase of additional aids and adaptations and consultation with occupational therapists and other health professionals. The laundry is separate from the home being accessed through the garden, whilst there are mild continence issues these are well managed through active toileting programmes reducing the need for continence aids to be used, the manager reported minimal soiled laundry occurrences which if they occur are managed in accordance with infection control procedures from our discussion with the manager and our observation of the laundry arrangements we are satisfied this is well managed. 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. Residents are safeguarded by the homes staff recruitment training and supervision procedures Evidence: Residents benefit from good continuity of staff who know and understand their needs and support routines well. The staff team is small but sufficient to ensure that residents are enabled to lead busy fulfilling lives, there is evidence that the staffing complement is increased in response to changes in resident need and tis is well planned for. Some concerns at the lack of male staff to support the only male resident have been addressed through the provision of support hours by a male worker from another home, and we consider that the number of hours should be extended if the resident concerned identifies the need for this. The home has an active training programme to maintain staff knowledge and skills around mandatory areas of training and more than 50 of the staff team have now achieved NVQ2. Newer staff confirm receipt of a thorough induction accessing both LDAF and common induction standards. Staff feedback indicates they feel satisfied with the overall amount and frequency of training, but would like the service to progress some additional training around mental health to help with understanding and awarenss in respect of one resident in particular, and this is already being looked Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: into. Staff have told us in survey feedback and during our visit that they have received a thorough recruitment and vetting by the service, our examination of staff records confirmed this. Staff confirmed they meet regularly with their manager and their is evidence of regular monitoring of staff practice through this process, staff have informed us that they participate in regular staff meeting s and feel able to express their views and comment and feel these are taken account of. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is very well managed and run in the best interests of the residents who live there. Evidence: The manager is registered, experienced and knowledgeable about the client group and individual residents, Staff survey feedback indicates staff find the manager approachable and available, she works the same shifts as them and they respect this, new staff feel they have been given a thorough and comprehensive induction by her instilling confidence in their ability to support residents appropriately. Staff feedback indicates a sense of achievement and pride in the proactive way in which the service is working with residents to exert more control over their daily lives at every level e.g making their own packed lunch to taking greater control of their medication arrangements or finances where appropriate. The manager demonstrates a good understanding of value for money and is able to evidence where cost effciencky savings have been of benefit to residents in freeing up monies for additional activities. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: We found that AQAA information provided to us to inform our inspection planning lacked content and did not provide us with all the information we needed, deficiencies in the AQAA information have been discussed with the manager during our visit, and we are assured that improvements will be made to subsequent AQAAs submitted. Residents have told us in survey information and from our discussion during out visit that they feel listened to and are able to influence changes in their daily routines, there is evidence that changes in residents needs are influential in changing the service offered.Staff are empowered to think for themselves and to take responsibility for organizing aspects of household routines resident support. AQAA information tells us that all policies and procedures have been updated and our examination of samples of documentation found these to be updated. The manager has informed us within the AQAA that all health and safety servicing and checks have been undertaken and a random sampling of electrical installation servicing confirmed this to be the case. Home records indicate a low level of accident to residents and these have been managed appropriately, in discussion the manager demonstrates an awareness of falls management for older residents and has been proactive in making a referral to the falls assessment team for one resident. 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 2 6 20 Established goals should be broken down into smaller more achievable elements. Care should be taken to ensure that photocopies of MAR sheets contain to key codes to inform staff and ensure codes are used consistently and appropriately Relatives to be reminded of complaints procedure Complaints record kept for use of residents, and others who may wish to record complaints should have anonymity of complainants protected and cross referenced to more detailed complaint information kept secure in the office 3 22 4 26 The home is to progress plans to provide locks on bedroom doors for residents to choose whether they wish to lock doors or not Clean towels in the shower room are to be covered to minimize risk of infection in accordance with infection control procedures 5 30 Care Homes for Adults (18-65 years) Page 28 of 29 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. 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