Care Home: 3 The Glade

What the care home does well The service recognised the importance of ensuring that a new resident could be looked after by the staff team, and would also `fit in` with those already residing at the home. Each of the residents had a contract with the housing association and with Fremantle. These documents were in pictorial form and were clear about what was provided. Care plans and risk assessments were reviewed and updated as required. The staff understood the importance of involving the home`s advocate at times of decision making. Comprehensive daily record sheets were completed for each individual resident with information about how the person had spent their day, reacted to situations, and what they had eaten. Each resident had a personal activity plan and it was apparent that changes to the plan and the introduction to new activities were discussed and decided at key worker sessions. Residents were encouraged to maintain links with their families and friends. Where possible staff supported residents to be as independent as possible and would allow them to decide when they got up and went to bed and how they spent their free time. The health needs of residents were managed by the appropriate health care services. Residents had the aids and equipment they needed to support daily living. The manager told us that she was particularly interested in end of life, palliative, and dementia care and had undertaken additional training to ensure that the staff team could care for people with aging conditions such as dementia. The complaints procedure was available to everyone in the home. Policies and procedures to safeguard residents were also available. There were enough qualified, competent and experienced staff to meet the needs of people using the service. Staffing rotas were flexible to the needs and routines of the people using the service. The manager had the required qualifications and experience and was competent to run the home. Staff spoke highly of her commitment to the home. What has improved since the last inspection? Since the last inspection the people living at 3 The Glade had been involved in many more activities both inside and outside of the home. The home had been altered and adapted. In addition to being homely it was now accessible to all of the residents living at 3 The Glade. Overhead tracking had been installed in many areas of the home allowing people with limited mobility to be moved safely and easily. A snoozelam area had been developed in one of the communal areas. This meant that people could have a `chill out` time as and when needed, and not as part of a booked session There had been a marked improvement in the standard of record keeping since the last inspections and staff were ensuring that all documentation was correctly completed and signed and dated. All staff had been correctly recruited and checked before being offered employment. The medication systems had improved and could be audited at any time. What the care home could do better: There were few requirements made as a result of this inspection. Some risk assessment were in place, however these tendered to be quiet generic and did not cover all the risks that people were taking so these should be built upon. The position of the home did not make access to the community easy and the manager was aware of the need to develop this more in the coming year. The staff team was new and the manager needed to build up their experience and ensure that they attended appropriate training. staff team Key inspection report Care homes for adults (18-65 years) Name: Address: 3 The Glade 3, The Glade Bromham Beds MK43 8HJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Snelson     Date: 2 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: 3 The Glade 3, The Glade Bromham Beds MK43 8HJ 01234828704 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.fremantletrust.org The Fremantle Trust care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care home code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD Date of last inspection Brief description of the care home 3 The Glade is a home for up to eight adults with learning disabilities, managed by Fremantle in conjunction with Bedfordshire Pilgrims Housing Association - who are responsible for the maintenance of the building. The home is a large bungalow situated on the outskirts of Bromham village, approximately 5 miles from Bedford town centre. There are eight bedrooms, a kitchen/diner, 2 lounges, an activity/quiet room, a staff office, laundry, and bathing/toilet facilities. There are some facilities for people with a physical disability. The bungalow is set in substantial grounds, with parking for several cars to the front of the building. The home provides it own transport.The home has developed some user-friendly documents for current and prospective people using the service. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 3 0 0 9 2 0 0 8 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 peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for adults that takes account of residents views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgments made within the main body of the report include information from this visit. The registered Manager Mrs Caroline Earey was present throughout the visit to assist with any required information. Verbal feedback was given periodically throughout the inspection and at the end of the visit to the manager and the operational manager. During the inspection the care of two people, including the most recent admission to Care Homes for Adults (18-65 years) Page 5 of 29 the home, was case tracked. This involved reading their records and comparing what was documented to the care that was being provided. Documentation relating to: staff recruitment, training and supervision and medication administration, complaints, quality assurance and health and safety in the home were also examined. We also had a tour of the premises and spent some time in the communal areas of the home, talking to the residents and observing the care practices and interventions that were carried out during this five and a half hour inspection hour inspection. We would like to thank everyone involved for their support and assistance during this visit to the home. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? Since the last inspection the people living at 3 The Glade had been involved in many more activities both inside and outside of the home. The home had been altered and adapted. In addition to being homely it was now accessible to all of the residents living at 3 The Glade. Overhead tracking had been installed in many areas of the home allowing people with limited mobility to be moved Care Homes for Adults (18-65 years) Page 7 of 29 safely and easily. A snoozelam area had been developed in one of the communal areas. This meant that people could have a chill out time as and when needed, and not as part of a booked session There had been a marked improvement in the standard of record keeping since the last inspections and staff were ensuring that all documentation was correctly completed and signed and dated. All staff had been correctly recruited and checked before being offered employment. The medication systems had improved and could be audited at any time. 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 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 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recognised the importance of ensuring that a new resident could be looked after by the staff team, and would also fit in with those already residing at the home. Evidence: The home had a statement of purpose and Service Users Guide that covered all the areas required by the National Minimum Standards. These documents outlined what the home provided and information about any additional costs, such as hairdressing, magazines and petrol when using the homes transport. The Service Users Guide was in pictorial format and had been given to each of the residents. However the manager told us that this format would only suit two of the current residents. Consideration was being given to the documents being in audio format. There had been no new admissions to the home since the last inspection, but if there was a vacancy the AQAA clearly detailed how a prospective resident would be assessed to ensure that the home could meet his or her needs, and that the person would integrate with the people already living at the home. Ideally the pre-admission Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: assessment would allow time for a number of visits before any decision was made. Currently there was one resident at the home whose needs were very different from the others and the manager was requesting appropriate reviews of this placement in the best interest of all concerned. We saw that a multi-professional approach was being taken. The staffs ability to meet the needs of the people using the service will be discussed in the staffing section of this report. Each of the residents had a contract with the housing association and with Fremantle. These documents were in pictorial form and again were clear about what was provided. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments were reviewed and updated as required. The staff understood the importance of involving the homes advocate at times of decision making. Evidence: During the inspection we looked in detail at the care plans of two people living at the home and also looked at how the care described reflected the care delivered and met their needs. People using the service had new, clear, well-written, plans of care that identified needs. The staff team had made the plans more person centred and intended to continue to make improvements. We believed that in order to ensure that residents were provided with a consistent level of care, particularly if the care was provided by someone outside of the regular staff team, more information and even more detail would be beneficial. Care plans were kept under review every month and were altered as care needs changed. The two residents who would benefit from having their care plans in pictorial format had these in place, some others had audio versions. Comprehensive daily record sheets were completed for each individual resident with Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: information about how the person had spent their day, reacted to situations, and what they had eaten at mealtimes. The staff team had ensured that wherever possible how a person using the service made a decision was recorded. For example, we saw comments such as, (persons name) was looking at a catalogue and smiled when a particular item was pointed out. This told us how a decision had been made to purchase a particular item. We saw example of best interest decisions being recorded in advance and of advocates being used to support these. We therefore believed that where possible a personalised approach to care was considered at all times. Some risk assessment were in place, however these tendered to be quiet generic and did not cover all the risks that people were taking. For example there was a risk assessment that covered a residents habit of taking food out of the kitchen cupboards which also assessed the risk of being in the kitchen, but we did not see one for this persons habit of entering other residents rooms and taking items out of drawers. We did note that the other residents had an assessment around this but from reading the files we were not sure how we should be supporting the person doing the entering of rooms and emptying of drawers. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were being supported to develop skills at their own pace. People who use the service were supported to maintain important family relationships. Evidence: Since the last inspection the people living at 3 The Glade had been involved in many more activities both inside and outside of the home. At the start of this inspection four of the residents were out of the home participating in various activities. Each resident had a personal activity plan and it was apparent that changes to the plan and the introduction to new activities were discussed and decided at key worker sessions. We noted that residents were encouraged to maintain links with their families and friends and we were aware that one resident was taken regularly to meet with a friend she had made while living at another residential setting. We were told that a family had been particularly pleased when their daughter had arrived unexpectedly on mothers Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: day with flowers for mum. In addition to planning activities the key worker session was used to plan day trips and holidays. Some of the people living at 3 The Glade benefited more from days out than holidays away from home. There was documented evidence as to how decisions like this had been made and how families or advocates had been involved in the process. The position of the home did not make access to the community easy and the manager was aware of the need to develop this more in the coming year. Some of the resident chose to attend a local church. Where possible staff supported residents to be as independent as possible and would allow them to decide when they got up and went to bed and how they spent their free time. The re-positioning of the kitchen (as discussed in the environmental section of the report) had supported residents to be more involved in meal preparation and what it involved. There was a four week menu plan which had been agreed by residents. An alternative option was available at each meal. Menus were displayed along with photographs or pictures of the meals for the day. Staff supported those who needed help with eating sensitively and mealtimes were a social time for staff and residents. Care Homes for Adults (18-65 years) Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health needs of residents were managed by the appropriate health care services. Residents had the aids and equipment they needed to support daily living. Evidence: All of the people living at 3 The Glade needed some degree of assistance with care and health needs. Over the past few years the care needs of some of the residents had altered and were now more associated with old age than with their learning disability. It was apparent that the staff training programme had altered to reflect this change. Each resident had a GP and staff would support visits to the surgery and to other health professionals, such as specialists and dentists; The dentist would also visit people in the home if this was considered necessary. Since the last inspection ceiling tracking has been fitted into much of the home to allow people to be moved via hoists into areas that a standard hoist may not fit with ease. Staff had been trained to use this equipment and said it was beneficial to all concerned. The manager hoped in time that more could be installed Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Each of the care files included a health action plan. It did appear that in some cases the questionnaire had been completed but a plan had not been clearly formulated. For example the documentation recognised the fact that a female resident had not had a breast examination, but it was not clear how this was to be rectified. Each resident had a medication storage cabinet in their bedroom. The medication policy suggested that the administration of medication process should start with the right of the resident to self medicate. None of the residents in the home were able to self-medicate currently. During this inspection we examined two of the residents medication files. Medication records (MAR) sheets were all appropriately completed with signatures and omission codes, and the reverse of the sheets had been appropriately completed. A sheet in each file identified how the resident chose to take their medication. All were clearly dated and signed. Staff kept a running audit of the number of tablets or the amount of medicine held by the home, and this was completed daily. The manager told us that she was particularly interested in end of life, palliative, and dementia care and felt the future of the home could be to support people at this stage of the life. The manager and staff had undertaken additional training to ensure that they could care for people with aging conditions such as dementia. Care Homes for Adults (18-65 years) Page 17 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. The complaints procedure was available to everyone in the home. Policies and procedures to safeguard residents were also available. Evidence: The home had a clear complaints policy in place; this was on display and easily accessible to all residents and visitors to the home. Residents had a pictorial version of the procedure as part of the Service Users Guide. There had been no formal complaint made to, or about, the home since the last inspection. Observations of the interactions between staff and residents gave an impression of trust and mutually respectful friendships. The records of residents personal expenditures were examined. These were all accurately recorded and balanced with funds available. This was a pleasing contrast to the last inspection when we had been concerned that residents were paying for staff to have meals out and for fuel costs without this being agreed or part of the contract. The outcome of the changes were that if a resident choose to have a meal away from the home Fremantle would re-imburse the estimated cost of the missed meal. At the time of the last inspection there had been concerns raised which had resulted in safeguarding meetings (SoVA). The manager had acted correctly and had disciplined staff as necessary. There had been no such activity recently and staff had all had the necessary training to ensure that they knew how to protect people and recognise possible abuse. Staff had also undertaken Non-Aggressive Physical and Psychological Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: Intervention (NAPPI) training, which was a method to de-escalate potentially confrontational situations. Care Homes for Adults (18-65 years) Page 19 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. The home had been altered and adapted. In addition to being homely it was accessible to all of the residents living at 3 The Glade. Evidence: The home was clean and tidy throughout. All areas of the home, with the exception of the shower rooms, which were bland and clinical, had been redecorated and we were told that residents had used charts and pictures to make their choices of colours furnishing and fittings. As already stated the kitchen had been moved and in addition to it now being accessible to all, it was also in the hub of the home so that even those residents who showed no interest in food preparation were part of mealtimes and aware of the preparation. In addition the laundry had been made accessible to all and some reside ts were starting to use the area. Overhead tracking had been installed in many areas of the home allowing people with limited mobility to be moved safely and easily. A snoozelam area had been developed in one of the communal areas. This meant that people could have a chill out time as and when needed, and not as part of a booked session. The area had a number of lights and beams and a large flat screen TV had been placed on the wall so that soothing videos could be shown during sessions. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: At the last inspection staff had identified an interest in gardening and requested a patch of the garden be converted to a vegetable garden. It was disappointing that this had not yet been completed by the housing association. However staff and residents had grown a number of vegetables and flowers in containers on the patio area at the back of the home. Care Homes for Adults (18-65 years) Page 21 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. There were enough qualified, competent and experienced staff to meet the needs of people using the service. Staffing rotas were flexible to the needs and routines of the people using the service. Evidence: The staff team had changed and few of the staff who were employed at the time of the last inspection were still employed. Those that were still in post had a commitment to the care and support of people with learning difficulties. Three staff files were looked at and it was apparent that staff had been recruited correctly and had not started work until all the appropriate checks and references had been undertaken. The manager had a robust system for ensuring that staff had the necessary training and that any training that was provided was updated as necessary. The training included mandatory training and also training specific to the needs of the people using the service such as dementia management, and palliative care. The manager and the deputy manager were qualified to provide SOVA, infection control and moving and handling training between them. All of the new staff had or were booked onto the companys induction training. However because the team were new there were few staff who had completed NVQ Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: training to level 2 or above. All staff had regular supervision that was recorded. The files looked at showed that supervision had taken place at least 2 monthly and sometimes more frequently. The manager also held regular staff meetings and encouraged staff participation. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager had the required qualifications and experience and was competent to run the home. She was working to continually improve the services and the outcomes for the people living at 3 The Glade. Evidence: The registered manager had completed her NVQ 4 and continued to do additional training to update her knowledge and skills. She told us she enjoyed the challenge. The staff team spoke highly of the manager and the support she provided and her commitment to the home, the residents, and themselves. The manager regularly assessed the quality of the service provided and fed back to her line manager. We did not see how client satisfaction was measured. Policies and procedures were in place. There had been a marked improvement in the standard of record keeping since the last inspections and staff were ensuring that all documentation was correctly completed and signed and dated. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Health and safety checks including fire call point and equipment testing and emergency lighting had been carried out and correctly documented in line with these policies. The correct insurance certificate was displayed. Care Homes for Adults (18-65 years) Page 25 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 26 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 1 9 14 The registered person must ensure that all risks that a client might take are assessed. This ensures that it is documented how a risk should be managed 01/11/2009 2 32 18 This refers to regulation 18 (1)(a) The staff team must be supported to gain NVQs and other relevant qualifications. This is so that the staff team have the necessary skills and experience to provide the appropriate care. 01/12/2009 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 1 13 The manager should try to develop more links with the Page 27 of 29 Care Homes for Adults (18-65 years) 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 local community. 2 3 4 19 27 39 The manager should ensure that concerns raised in Health Action Plans are addressed. Toilets and bathrooms could appear more homely There should be a record of establishing if residents are satisfied with their care. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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