Care Home: 51a Chapel Park Road

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What the care home does well The service provides a good standard of accommodation to the resident. He receives an excellent personalised service tailored to his specific needs and responsive to his wishes and preferences. The resident benefits from the stability and continuity of a familiar staff team. There is good communication within the team to ensure that the residents care and health needs are supported. The home takes a responsible attitude to risk that ensures the resident is not prevented from exercising his choices around the range of activity he experiences. What has improved since the last inspection? Since the last inspection the service has addressed all outstanding requirements and implemented recommendations. The resident has made good progress and no longer requires a sleep in staff member at night. A skills programme has been implemented to enable the resident to increase independence and promote self esteem and self confidence. The resident has been actively involved in the selection of a replacement staff member. A programme of redecoration has been undertaken albeit not to a good standard and this is to be redone by the contractor. A new sofa and a rug have been been purchased for the lounge, a new hob has been installed in the kitchen. Staff report increased opportunities for the resident to attend outings to the theatre, and other day time events. A patio has been constructed which was a project involving the resident and staff, the resident has been actively involved in choosing garden furniture and ornaments for this area. What the care home could do better: We have expressed concerns that the risk of the resident leaving the premises when staff are absent has not been sufficiently assessed and we have asked the manager to do this. We have asked the home to be proactive in recording concerns expressed by the resident through the complaints process. The content of staff files needs further development to ensure that all files contain a current photograph and evidence of personal Identity in compliance with legislation, the manager has agreed to ensure these omissions are addressed. Key inspection report Care homes for adults (18-65 years) Name: Address: 51a Chapel Park Road 51a Chapel Park Road St Leonards-on-sea East Sussex TN37 6JB     The quality rating for this care home is:   three star excellent 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: Michele Etherton     Date: 1 7 1 1 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 28 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 28 Information about the care home Name of care home: Address: 51a Chapel Park Road 51a Chapel Park Road St Leonards-on-sea East Sussex TN37 6JB 01424204033 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: sgardhouse.evh@tiscali.co.uk www.eastviewhousing.co.uk East View Housing Management Ltd care home 1 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 1 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home is within the following category: Learning disability (LD) Date of last inspection Brief description of the care home 51a Chapel Park Road is a registered service for one service user with learning disabilities. It is a self-contained one bedroom flat with a separate kitchen and bathroom. The flat is next door to 51 Chapel Park Road another registered service for people with learning disabilities, but has a separate entrance to the main building. East View Housing (EVH) manages both services. The flat is situated in a residential area of St Leonards on sea. It is a short distance from local amenities and shops and has easy access to public transport. The fee for this service has been negotiated with the funding authority based on the needs of the resident concerned, who also makes a contribution toward the cost of care Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 1 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: A routine key inspection of this service has been undertaken. This has taken account of information received from and about the service since the last inspection. This information includes the receipt of an Annual quality assurance assessment(AQAA) completed by the previous manager and returned to us on time. We found the AQAA has not been completed to a good standard and failed to provide us with all the information we needed , we have discussed the shortfalls with the new manager who understands the level of detail required and will undertake to ensure this is provided in future versions. Our inspection of this service has also included a site visit to the premises on 17th November 2009 when we met with the resident, support staff and the new manager. We have also surveyed the resident, staff and other stakeholders to obtain their views Care Homes for Adults (18-65 years) Page 5 of 28 about the service. We have received a good response to the surveys, analysis of these indicates that overall the service is viewed positively. Feedback from surveys has been influential in planning and reporting on the inspection, and individual comments made have been incorporated into the report. At our site visit the resident who lives there was able to show us the accommodation and we were able to examine a range of records. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: We have expressed concerns that the risk of the resident leaving the premises when staff are absent has not been sufficiently assessed and we have asked the manager to do this. We have asked the home to be proactive in recording concerns expressed by the resident through the complaints process. The content of staff files needs further development to ensure that all files contain a current photograph and evidence of personal Identity in compliance with legislation, the manager has agreed to ensure these omissions are addressed. Care Homes for Adults (18-65 years) Page 7 of 28 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 28 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 28 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. Systems are in place to ensure that prospective residents receive a thorough assessment of need prior to admission. Evidence: This is a single person service established specifically to meet the needs of the current resident. The service responds flexibly to any changes in need and discussion with the manager indicates that the placement is continuing to meet the needs of the resident. There are no anticipated changes to the present arrangements, East View Housing has appropriate procedures in place for the admission of prospective residents and this ensures that admission is subject to completion of a thorough assessment to ensure needs can be met within the service. Care Homes for Adults (18-65 years) Page 10 of 28 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. Detailed support plans are in place to inform staff but clarity is needed to ensure these are routinely updated within timescale or when changes occur however minor. The support staff are enabling and supportive of residents taking greater control of their everyday lives and promote the development of independence skills. A responsible approach to risk is generally taken, but the risks to the resident in the absence of staff has not been fully explored and assessed and measures implemented to reduce risk levels. Evidence: A detailed plan of care is in place that makes clear the individual needs and personal routines of the resident and his preferences about how support is provided, we noted that there have been recent minor changes in needs and the level of assistance needed from staff yet these changes have not been recorded in the support plan, the date given at the bottom of each page of the plan indicates an update of August 2008, however other evidence within the plan confirms this has been updated in some areas more recently, whilst we are confident that formal updating of the support plan is Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: taking place a minimum of six monthly., we would recommend as good practise that this is more clearly evidenced within the support plan, and that where changes occur in between these review dates the home can evidence that the support plan is being updated to reflect these thus ensuring consistency from staff in the support they provide. The service informs us that the resident receives official reviews by the local authority but these are conducted usually by someone from the duty team who may not be specifically acquainted with the resident. The staff are enabling and supportive of the resident exercising control over his daily routines and developing his independence skills, but acknowledge that his motivation to do so is variable and needs encouragement at times. The resident confirmed that he sometimes Hoovers, and washes up, he is also assisted to do his own laundry, and takes an active role in shopping for weekly food. Staff reported that they are going to be offering more opportunities for the resident to undertake cooking with staff support and assistance. staff asked about what the service does well reported that: provides a comfortable safe and friendly environment, plenty of support for individual clients Interact with clients really well We asked health and social care professionals what they thought the home does well, they said: Staff are always friendly and pleasant Service users always seem happy and at ease in the home Clear risk information is recorded in respect of activities and daily routines the resident participates in, staff take a responsible attitude to risk, taking care not to restrict or limit the range of experiences the resident has. We have expressed some concern that the risk attached to leaving the resident unattended throughout the night without means of monitoring the comings and goings from the flat has not been assessed. The resident is not considered to be safe if travelling independently in the community. Previous measures put in place to alert staff of the resident leaving the flat have been discontinued as they proved ineffective. Whilst staff who work with the resident feel confident that there is a low risk of his leaving the flat when staff are absent, they do Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: not deny that such a risk exists. We have discussed with the manager and support staff other ways in which other staff in the main house may need to be alerted and have recommended that the risks are fully assessed. Care Homes for Adults (18-65 years) Page 13 of 28 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. The resident is supported to lead the lifestyle he wishes to. Evidence: A weekly programme of activities has been developed that takes account of his individual interests and preferences and also enables him to build on life skills he already has, this helps him with increasing personal confidence in dealing with his day to day life. Longer serving staff report that this has been measurable with the resident spending increasingly longer amounts of time out of his room engaging with staff. Although anxious around strangers we found him welcoming and willing to give some time to responding to our questions about living in the home. Since living in the home his confidence in talking with strangers has grown and his engagement with staff has greatly improved. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: When we visited the resident was waiting to go to a trampoline session, and staff reported that they tried to be responsive to expressions of interest made by the resident to try new things and this had also included trying out a rock climbing wall. In some cases, however, his inability to concentrate has meant some activities are not viable or in others although activity is appropriate the cost has become prohibitive and new activities have to be found. The resident enjoys church attendance each week and staff are aware that this is very important to him and seek to ensure that this is always supported. Mini communication systems are in place around the home to inform the resident of which staff are on duty, what day of the week it is and the date, and what activities may be happening that day. Staff reported that the resident maintains excellent links with his family who remain actively involved and interested in all aspects of his care, he has opportunities to spend time away from the flat with family members and is included in family holidays. The resident confirmed he was going home at the weekend. The resident likes people to pop around to see him but does not necessarily seek out the company of others. A formal menu is not developed, staff are aware of the individual residents preferences and shopping for food and preparation of meals are undertaken with this in mind. The resident is encouraged to be involved in these activities as much as he wants to be. Staff reported that they ensure the resident has a healthy lifestyle and meals reflect this. Records of food eaten are recorded. Staff reported that they are trying to involve the resident more in meal preparation and cooking. Care Homes for Adults (18-65 years) Page 15 of 28 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 emotional well being of the resident are well supported Evidence: The resident receives 1-1 support from a dedicated staff team, who are familiar with his routines and preferences. Staff shortages are accommodated from the main house to ensure that the resident retains support from staff he knows. Guidelines are in place to help staff communicate using agreed responses. The support plan contains a health section and this makes clear any health needs the resident may have and how these are to be supported. The health plan records health contacts the resident may have and ensures that routine health checks are routinely supported. Staff encourage the resident to lead a healthy lifestyle both through leading an active life but also eating healthily. A regular check is made of his weight. The resident does not have any prescribed medications and is in good health, some over the counter homely remedies agreed for use by the GP are available to help with Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: the usual range of headaches, coughs, stomach upsets that may occur. Staff are trained to administer all medications. In survey feedback a care professional reports that: Appointments are recorded and staff are informed of when people are coming Staff comment within survey feedback that they: Share information about clients and medication Some consideration should be given to enabling the resident to become more actively involved in administering medication whether over the counter or prescribed, lack of capacity to do so should be clearly recorded within the support plan with evidence available to support the need for staff to take on this function. Care Homes for Adults (18-65 years) Page 17 of 28 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. Opportunities are provided to the resident to express his views, but there is no recorded evidence that staff are acting upon all the concerns raised. Staff have an awareness of adult safeguarding issues and take steps to ensure the resident is safeguarded from harm. Evidence: A complaints procedure is in place and the resident is consulted about everything that happens in the home, the resident and his family have recently made known their concerns about the quality of redecoration undertaken in the flat and staff have also added their concerns about this. East View Housing have taken up these concerns with the builders concerns and the flat is to be completely redecorated and damage to the patio created by the resident and staff caused by building works is to be addressed also. No complaints are recorded in the complaints book although clearly staff are aware and have acted upon the residents concerns over this matter, in survey feedback the resident indicated that he did not know how to complain, and we discussed whether the resident has an understanding of what a complaint is, clearly he is able to make known things that make him unhappy or distress him and we discussed the need for staff to be more proactive in recording incidents that cause the resident to be unhappy and which in a more able resident may have precipitated a complaint and recommend that this is implemented. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: There are no recorded adult alerts. Staff have all received training in regard to safeguarding adults and the management of the service have demonstrated an understanding of the process and a willingness to report incidents relating to other services. In a survey response a care professional informs us that: Incidents and concerns are reported in a timely way We are satisfied that the home has taken appropriate action to bring the financial arrangements of the resident to the attention of social services and this is still under discussion with all relevant parties. An appropriate system is in place to ensure that cash sums held by the home on the residents behalf are administered properly, recent strengthening of procedures in respect of how residents monies are handled by staff have been implemented by the organisation. We checked the cash sum held by the service on the day of our visit against the recorded balances and found this to be accurate. We have expressed some concerns about the un-assessed risk of the resident leaving the flat when staff are absent, previously a pressure alarm mat was installed near the front door to alert staff of such an incident, however this proved ineffective and has been discontinued, in the event that the assessment of this risk identifies other precautionary measures that may need to be implemented , the registered person should ensure these are fully discussed and agreed with all relevant parties, are recorded in the support plan and are subject to review. Care Homes for Adults (18-65 years) Page 19 of 28 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 resident enjoys living in a comfortable, clean, safe and homely environment, he is consulted about and actively involved in decisions about changes to the home. Evidence: The AQAA informs us that there has been some investment in upgrading the home recently and this has included the purchase of a new sofa, rugs and a new kitchen hob. Redecoration of the flat has been undertaken and the resident informed us at the visit that he had chosen the colour scheme of his bedroom, and he liked this and has displayed posters from his favourite films around the room. Unfortunately the standard of the recent redecoration has been undertaken to a poor standard by the contractors and the resident his family and staff have raised concerns about this, and also the lack of respect contractors had in regard to the flat and its surroundings. A recently completed patio by the resident and staff has been ruined by the contractors and compensation in the form of replacement patio is being sought. The organisation has discussed the standard of work undertaken in the flat with the contractors and this is to be redone. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The resident is encouraged to take an active role in maintaining the cleanliness of the flat, The resident undertakes small household tasks with staff prompting and some assistance.He undertakes his own laundry again with staff assistance. There is no longer a sleep in staff member on duty at night and therefore the absence of staff sleeping accommodation is no longer a problem, however staff indicated that on rare occasions they have had to sleep at the home and this has sometimes been on the sofa, this should be discouraged and the provision of a camp bed made available for these occasions should always be utilised. Monthly health and safety checks are undertaken by the organisation and staff adhere to company policies and procedures in maintaining checks and tests on fire alarm and fire equipment and that regular drills are maintained. Care Homes for Adults (18-65 years) Page 21 of 28 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 are enough qualified staff to support the resident. Systems are in place to ensure they receive induction, training, and supervision to required standards. Staff tell us they feel generally well supported at local level but some do not always feel the organisation demonstrates its appreciation of their work. Evidence: The resident receives 1-1 staffing during the day time. In view of the progress made by the resident a sleep in staff member has been discontinued. The staffing of the home is provided by a dedicated team who do not work in the main house. Occasionally if there are shortfalls in staffing through staff sickness or absence, staff from the main house provide cover as they are familiar with the resident and he is accepting of this arrangement. We looked at staff records for the team and found that whilst all staff had appropriate references and criminal record checks, some omissions of information required by regulation to be included in staff files remains outstanding. Namely,evidence of Identity and current photographs. We discussed this with the new manager who has agreed to address this and we recommend this is progressed. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: A rolling programme of training is in place and all staff have completed mandatory training; two out of three have attained NVQ3. A newer staff member is currently completing induction that includes the completion of the Learning disability qualification and will commence NVQ training once this is completed. Staff generally expressed satisfaction with working at the home, one survey response highlighted a view that staff would welcome more overt gestures of appreciation from the organisation at the work staff do as this would help boost morale. The manager has been made aware of this view and may wish to explore how staff can feel valued by the organisation. Staff we spoke with confirmed they have access to regular staff meetings both with staff in the main house and those specific to the home at 51A Chapel Park Road, Staff commented that they receive regular supervision with the manager and are satisfied that issues raised are dealt with quickly. Care Homes for Adults (18-65 years) Page 23 of 28 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 home is run in the best interests of the resident Evidence: A new experienced and qualified manager has been appointed and an application for registration is underway. An annual quality assurance assessment (AQAA) was returned to us when we requested it, this was not completed by the current manager. The AQAA has not been completed to a good standard and we have discussed the omissions in information with the new manager who has an awareness of the standard we would expect to see in future from a service of this quality rating. The organisation is undertaking regular regulation 26 visits and follows up on any issues identified at successive visits to ensure these are addressed. Staff feedback suggests that whilst they accept these visits are important they feel the one to one time sometimes spent by an area manager with the resident is far more representative of the quality of service he is experiencing, but it is unclear if these Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: meetings are recorded and influence quality assurance of the service. The views of the resident and other stake holders are sought and the manager should ensure these are incorporated into the annual quality assurance report produced by the home which we did not view on this occasion. As stated the organisation employs a health and safety officer and monthly visits are conducted to ensure health and safety checks are being maintained.The AQAA informs us that all health and safety servicing and checks have been undertaken and are current. Records needed for inspection were accessible within the unit and maintained to ensure all entries are current. Policies and procedures have been updated the manager reports these are reviewed and updated organisationally. There is a current Employers Liability insurance in place. We asked the manager to inform us about the number of accidents that have occurred since our last inspection and we advised this is none. The organisation continues to tell us about things that happen and manage any such issues well.They work well with us and other stakeholders and have shown us that their service continues to provide good outcomes for the resident who uses it. Care Homes for Adults (18-65 years) Page 25 of 28 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 28 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 9 An assessment of risk to the resident should be undertaken in respect of whether he is likely to leave the flat when the flat is unstaffed in the evening, and should incorporate any precautionary measures deemed necessary. Where the resident expresses verbally or through behaviour distress or concerns and staff can link this to a specific incident that in a more able person would precipitate a complaint, they should treat the resident in the same manner and be proactive in recording and acting upon a complaint on behalf of the resident where he lacks the capacity to do so himself. The manager to ensure that omissions within staff files of current photographs and evidence of personal identity are addressed. 2 22 3 34 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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