Care Home: 48 Heath Road

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What the care home could do better: More staff need to have a qualification. More staff need special training so they can understand people better.The service should think about making a garden for people to grow plants.The service should make sure everyone knows how to make a complaint. Key inspection report Care homes for adults (18-65 years) Name: Address: 48 Heath Road 48 Heath Road Holmewood Chesterfield Derbyshire S42 5SW 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: Janet Morrow Date: 1 4 1 2 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 35 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 © (2010) 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 35 Information about the care home Name of care home: Address: 48 Heath Road 48 Heath Road Holmewood Chesterfield Derbyshire S42 5SW 01246857620 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : 48heathroad@tiscali.co.uk www.voyagecare.com Milbury Care Services Ltd care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 10. The maximum number of service users who can be accomodated is: 10 The registered person may provide the following category/ies of service only: Care Home Only - Code PC The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Learning disability - Code LD. To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection 1 3 1 0 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Heath Road is a large detached home. It has several lounges and a large dining room. Each bedroom has a bathroom. There is a bedroom provided for relatives if they need to stay. Care Homes for Adults (18-65 years) Page 5 of 35 There is plenty of parking space and pleasant outdoor areas. Heath Road is home to people with a learning disability. All service users can have specialist help from outside the service. Information about the service, including Care Quality Commission reports, is available in the Service User Guide, and from the manager or the provider. Fees at the service are based on peoples needs and the support they receive. Care Homes for Adults (18-65 years) Page 6 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: two star good service Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home We looked at the information in files for staff on how to support people. These are called support plans. We watched how people spent their day and what the meals were like. Care Homes for Adults (18-65 years) Page 8 of 35 We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. A visiting professional was contacted by telephone after the inspection visit. We also talked to staff in the home. Care Homes for Adults (18-65 years) Page 9 of 35 What the care home does well Everyone likes living at the home. They say they are happy there and it is friendly. People living there said on surveys: I like my home, its nice, and allows me to make choices. One person said there was good food. People who live at the home can choose which activities they want to do. Care Homes for Adults (18-65 years) Page 10 of 35 The home is clean and comfortable. Staff are well trained. This means they know what to do if someone is upset or worried. They help them to feel better and sort out problems. Care Homes for Adults (18-65 years) Page 11 of 35 What has got better since the last inspection? The written records were better. They had more information about peoples health needs. Staff can use sign language. A room has been changed so it has things people can touch and feel. Care Homes for Adults (18-65 years) Page 12 of 35 A new manager has started to work at the home. What the care home could do better More staff need to have a qualification. More staff need special training so they can understand people better. Care Homes for Adults (18-65 years) Page 13 of 35 The service should think about making a garden for people to grow plants. The service should make sure everyone knows how to make a complaint. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 14 of 35 If you want to speak to the inspector please contact Janet Morrow Care Quality Commission Citygate Gallowgate Newcastle upon Tyne telephone 03000 616161. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 15 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 16 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient admission information was available to ensure that the service was suitable and could meet peoples needs. Evidence: The Annual Quality Assurance Assessment (AQAA) stated that All service users have detailed assessments prior to moving into the home and all had the opportunity to visit the home to help make a decision as to whether it would be suitable. One persons care and support file was examined and had an assessment in place. Information from external professionals was also available. Discussion with staff confirmed that visits to the person concerned had taken place before the service arranged their admission. A relative also confirmed this. Detailed information about individual needs was available in the file examined. Good use had also been made of information obtained from health care professionals, previous placements and families in the assessment of needs of each individual. Page 17 of 35 Care Homes for Adults (18-65 years) Evidence: Two of the three surveys received from people using the service responded that they were asked if they wanted to move into the service and one responded that they were not asked. Care Homes for Adults (18-65 years) Page 18 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear record keeping and procedures for enabling independence ensured people using the service had their support needs met in a consistent way. Evidence: The AQAA stated that Service user support plans contain information about how best to communicate with the service user - for example, one service user has a personalised how to communicate with me book, and a guide for staff about what certain actions may mean and Service users are enabled and supported to make decisions in all areas of their lives. One care and support file was examined and showed that a comprehensive support plan was in place that demonstrated how individual needs would be met. The details provided in the plan contained sufficient information to enable staff to deliver care in a consistent way and encouraged independence. For example, it stated to always offer me choice in the area covering living skills and preferences were also recorded. There was also a communication support plan that stated Makaton symbols were to be used. Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: Staff spoken with confirmed that they had received training in non verbal communication, including British Sign Language, and that this had improved communication with people with positive results, for example, fewer episodes of challenging behaviour. There were some areas of the support plan examined that were not fully completed but staff stated that it was a work in progress and was updated as new needs were identified. The plan had been reviewed in October 2009. A visiting professional spoken with stated that the service was acting on specialist advice and that staff had had good ideas about developing strategies around individual needs. They confirmed that the proper strategies for communication were in place for the person they were involved with. A risk assessment was also available for each identified support area in the care and support plan examined that showed how identified risks were minimised. They were detailed and gave clear instructions to staff. There was a specific risk assessment for an identified health need and this gave comprehensive information and instruction to staff to ensure the persons safety. The manager stated that no-one currently had an advocate and there was no one whose liberty was deprived in any way. A social skills support plan on the file examined stated that the access code on the main entrance was to be explained to the service user, i.e. it was not to prevent leaving the premises but for a safe and secure environment. The manager stated that she and the deputy manager were attending training on the Deprivation of Liberty Safeguards (DOLS) in February 2010. There was information about DOLS available in the service. Two of the three surveys received from people living at the home responded that they usually made decisions about what they did each day and one responded that they always did. A relative spoken with described the service as aspirational because of the efforts they made to increase peoples skills and independence. Care Homes for Adults (18-65 years) Page 20 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well-managed meals, contacts with the community and activities ensured people had a good quality of life. Evidence: The AQAA stated that We provide individual activity plans, and facilitate attendance at the local library, hydrotherapy, sensory rooms, horse-riding, rebound therapy, swimming, going to Markeaton and Queens Parks, attending a disco, walking the Five Pits Trail. It also said We ensure that staff are trained in relevant areas and are aware of our aim to include service users in their local community. A staff survey commented that one of the things the service did well was accessing a wide range of activities to promote independence and to involve service users in the community. People using the service were observed to have their own routines as far as possible, with Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: some choosing to go out and some choosing to remain in the building pursuing their own interests. Local facilities such as shops, the library and pubs were used by the service. Each person had a weekly plan of activities, although this was still being developed for the person whose care and support record was examined. A living skills support plan was in place in the record examined and the corresponding risk assessment stated that all staff to be trained in first aid and non-violent crisis intervention. Staff spoken with confirmed that this training took place. The risk assessment also addressed behavioural issues for the person concerned. A spiritual and cultural plan was also in place and indicated the persons preferences, for example to celebrate birthdays and Christmas, and that they did not wish to attend religious services. Staff confirmed that one service user attended the local church and participated in its associated social activities. The record examined had a social skills support plan that included access in and out of the building and one for meals indicated the persons individual preferences, for example it stated I like tea with two sugars. All three surveys received from people using the service said they could do what they wanted during the day, in the evenings and at weekends. Two of the four staff surveys received commented that a way the service could improve would be having a sensory garden and an area to grow plants and vegetables. The manager stated that this was an area under discussion for the future. There was a sensory room available for use and a range of tactile equipment was in use during the inspection visit. It was clear from interactions with staff that those people with limited communication had a good rapport with staff, showing spontaneous positive responses. A relative commented that the person they were involved with was developing good relationships and that they were much happier. The preparation of the lunchtime meal was observed and the meal was plentiful and healthy and took into account peoples individual likes and dislikes. The menus seen appeared varied and balanced with choices available. Food stocks in the kitchen were good and staff spoken with confirmed that the food budget was sufficient for the planned meals. The care and support record examined had a relationship support plan that reflected the visits to family. A relative spoken with confirmed that they were able to visit when they wanted and that the service was welcoming. Care Homes for Adults (18-65 years) Page 22 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person centred approach to planning and delivering support ensured that peoples personal and health care needs were met. Evidence: The AQAA stated that Individual health needs are risk assessed and a support plan in place so that staff know how to manage any health needs such as epilepsy. One persons care and support records were examined and showed that there were details about the type of assistance and guidance needed to meet health care needs. It was personalised and covered specific health needs and had a risk assessment for each health need. This had been reviewed in December 2009. Records showed that visits to specialist health professionals were made. A relative spoken with stated that they thought the health of the person they were involved with had improved. They commented that they were very impressed with the standard of care. Weight was recorded for people on a regular basis, generally monthly. Two of the three surveys received from people using the service responded that staff always treated them well and one said they sometimes did. One responded that staff Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: always listened and acted on what they said and two responded that they usually did. Medication records were examined and one persons medication administration record (MAR) chart was looked at in detail. These were completed accurately and the amount of medicines received was recorded. There were no controlled drugs in the home at the time of the visit but there were secure storage facilities for them should they be required. A general check on medication stocks showed that this was satisfactory and those medicines seen were well within expiry dates. Staff training certificates showed that medication training had taken place in September and October 2009. All four staff surveys received responded that they received training that gave enough knowledge about health care and medication. Care Homes for Adults (18-65 years) Page 24 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory policies and procedures and good staff awareness ensured that people using the service were safeguarded and their concerns dealt with objectively. Evidence: The AQAA stated that We consistently update and provide a clear and effective complaints policy and ensure that people are aware of its existence and how to use it and Complaints have been dealt with in a specified time frame. The complaints procedure was included in the Service User Guide and it stated complaints would be resolved within twenty-eight days. There had been no complaints received at the office of the Care Quality Commission since the last key inspection visit in October 2008 and the AQAA stated that there had been no complaints received at the service. A relative spoken with confirmed that they knew how to make a complaint. Two of the three surveys received from service users said they knew how to make a complaint and one said they did not know. There was a policy and procedure in place to address safeguarding vulnerable adults. Staff training records showed that training in safeguarding adults issues had taken place during 2009 and staff spoken with confirmed they had received training in this area. They were also aware of their responsibilities in reporting any allegations of abuse. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: Staff spoken with confirmed that they received training in non-violent crisis intervention and training certificates seen showed that this had occurred in 2009. Records of incidents were recorded and showed that a range of diversionary techniques were used to manage challenging behaviour. A relative spoken with commented that the service was safety conscious and that they had observed incidents of challenging behaviour being dealt with in a calm and professional manner. One persons financial records were examined. This showed that signatures were in place on transactions and there were receipts available for specific purchases. The record corresponded accurately with the cash held. The companys policy on handling peoples money was clear and the cash held was checked on each shift. The cash was stored securely. Care Homes for Adults (18-65 years) Page 26 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises were generally well maintained, clean and suitably equipped so that people enjoyed a safe and pleasant environment. Evidence: The AQAA stated that We provide an accessible, homely, clean, hygienic, safe, well maintained, and comfortable environment to meet individual service users needs and The home is well located to access local facilities of Holmewood and nearby Chesterfield, with good transport networks and is fit for purpose. The building was clean and tidy and free from odour at the time of the inspection visit. One persons bedroom was seen and staff stated that the person concerned liked to spend time in their room. The person confirmed this. It was decorated to the individuals taste and was personalised with individual possessions. The lounges and dining room were furnished in a domestic and contemporary style. There was a sensory room that had been developed to provide stimulation for a specific person using the service. Laundry facilities were suitable for the needs of the people using the service. Staff spoken Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: with were knowledgeable about how to control the spread of infection and stated that there were plentiful supplies of protective equipment such as gloves and aprons. Two surveys from people using the service responded that the premises were always fresh and clean and one responded that they usually were. Care Homes for Adults (18-65 years) Page 28 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient, well trained staff ensured that people using the service were supported by competent staff. Evidence: The staff rota for the week beginning 14th - 19th December 2009 was examined and showed that there were five staff to cover each shift in the day. The manager was supernumerary and confirmed in discussion that there were two waking staff at night. The operational manager stated that there had been no issues regarding staffing and three of the four staff surveys received responded that there were usually enough staff and one responded that there always were. One survey commented if staff are ever ill, other staff would be phoned to cover that shift. This way service users still have consistency. The AQAA stated We follow the Companys robust recruitment policy and practice adhering to relevant current standards and legislation. Due to the managers absence, however, staff recruitment files were not accessible during the inspection visit. The operational manager stated during the visit that no one was allowed to commence work before all the necessary checks were undertaken and the manager confirmed this by Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: telephone and in writing shortly after the inspection visit. The AQAA stated that nine of twenty staff had achieved a National Vocational Qualification (NVQ) at level 2 or above in April 2009 and that this had now increased to ten of twenty-two staff. This meant the service was almost meeting the target of having 50 of staff with an NVQ at level 2 or above. Staff confirmed in discussion that they had undertaken mandatory health and safety training as well as training applicable to the job, such as non-violent crisis intervention, epilepsy and British Sign Language (BSL). The staff training matrix showed that mandatory health and safety training had taken place in 2009. All four staff surveys received confirmed that relevant training was undertaken and one commented we do any training needed specific to service users needs and all mandatory training is undertaken at regular intervals. However, additional training to ensure more staff could understand people with non-verbal communication better, known as intensive interaction training, had been identified as an additional area of training required. Care Homes for Adults (18-65 years) Page 30 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service was well managed and run in the best interests of people living there. Evidence: The service had had a period of instability regarding managers over the last two to three years and the AQAA stated that one of the things it could do better was to recruit and retain a manager. A new manager had been appointed in 2009 and had applied to be registered with the Care Quality Commission. Feedback from staff was positive; one member of staff described the new manager as great and all four surveys responded that they received regular support from the manager. One survey commented that staff now have the feeling of continuity after experiencing several changes of manager. A relative spoken with described the manager as fantastic. A visiting professional spoken with commented that the service had made progress since the managers appointment. The company had well established quality assurance procedures that included surveys and monthly audits as well as monthly visits undertaken in response to Regulation 26 of Care Homes Regulations 2001. Clear actions in response to visits and comments were documented on the quality assurance records. Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: Staff spoken with confirmed that health and safety training was undertaken in food hygiene, moving and handling, infection control, first aid and fire safety in 2009 and this was confirmed on the staff training matrix and on certificates seen. The AQAA stated that All relevant certificates (gas, electricity, portable electrical appliances (PAT) etc) are in place and in date. A random sample of safety certificates showed that maintenance checks were undertaken regularly; for example, portable electrical appliances (PAT) had been checked in February 2009, gas safety in November 2008 and the five yearly electrical wiring check had been undertaken in October 2009. Fire fighting equipment had been checked in April 2009 and fire alarms in June 2009. Care Homes for Adults (18-65 years) Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 35 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 3 4 12 22 32 35 The service should consider developing a sensory garden for service users to access. The service should ensure that all people using the service know how to make a complaint. The service should have 50 of staff with an National Vocational Qualification (NVQ) at level 2 as a minimum. More staff should receive additional training in intensive interaction. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 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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