Care Home: 70 Castleton Road

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What the care home does well The service has many strengths. It has a knowledgeable and dedicated manager and a committed staff. There is a great understanding of working with people who have sensory loss and learning disability. The service users are truly valued. The home has collected a great deal of information about the individual service users and care is tailored to their needs. The environment is also geared to the needs of the individuals particularly in their own rooms. The home is good at communicating with service users and supporting them to change behaviours. Service users have made significant progress at the home and these achievements are apreciated and celebrated with staff. What has improved since the last inspection? The home has met the requirements of the previous inspection. Care plans are dated and reviewed and over 50% of staff now have NVQ 2. Regulation 26 visits are taking place. The home has successfully obtained funding for a sensory room and it is hoped that work will start on this in January 2010. What the care home could do better: This inspection resulted in four statutory requirements and seven good practice recommendations. The manager must ensure that fire exits are not locked and can be opened easily. Staff must have up to date mandatory training in core basic topics. Control of Substances Hazardous to Health (COSHH) substances must be locked away, and so must information about service users. Key inspection report Care homes for adults (18-65 years) Name: Address: 70 Castleton Road 70 Castleton Road Walthamstow London E17 4AR     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: Anne Chamberlain     Date: 0 2 1 2 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: 70 Castleton Road 70 Castleton Road Walthamstow London E17 4AR 02085315561 02085315574 castletonavenue@sky.com www.sense.org.uk Sense, The National Deafblind and Rubella Association care home 6 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Castleton Road is a six-bed home for adults with learning disabilities and sensory impairments. The service users all have complex needs and some have additional physical disabilities and challenging behaviour. The home is part of SENSE and is situated in a residential area of Walthamstow in the London Borough of Waltham Forest, and is close to shops and other local amenities. The house is similar to others in the locality. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 was an unannounced key inspection carried out on behalf of the Care Quality Commission (CQC). The words we and us will be used throughout the report. Before the inspection we received an Annual Quality Assurance Assessment (AQAA), completed by the home. The is a self assessment tool and gave us a great deal of useful information. The inspection lasted some seven and a half hours. We spoke with service users and observed them working with staff. We spoke with the manager and staff, also relatives and a stakeholder by telephone. The home had had a ceiling collapse in the office only days before the inspection and some documentation was not easily to hand. However we examined key documentation, files and records. We viewed the environment of the home, and the arrangements for the administration of medication. Care Homes for Adults (18-65 years) Page 5 of 29 We would like to take this opportunity to thank the service users manager and staff of the home for their assistance and co-operation with the inspection. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 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 8 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 manager has the knowledge and ability to make in depth assessment of any prospective resident and she would do this. Evidence: The home has six residents and has not admitted anyone new recently. The manager knows her residents very well. She has known one resident for seventeen years. She demonstrated a comprehensive knowledge of their needs. She also described how she would go about assessing a prospective resident and the transition process which would be offered to them, including visits to the home, meals and an overnight stay. Residents are given a statement of purpose document and a service user guide. The manager told us that the home now has a widget so that all information for service users can be presented in a pictoral form. We felt quite satisfied that no individual would be offered a place in the home without proper assessment of their needs and also of their compatibility with the existing resident group. Care Homes for Adults (18-65 years) Page 9 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. Work with service users is supported by careful planning and risk assessment. Service users are supported to make decisions wherever possible. Evidence: We viewed the files of two residents. They evidenced a thorough approach to assessment and care planning. Service user plans were very detailed, individualised and comprehensive. Service users had communication passports and lists of likes and dislikes in their files.The residents at the home have progressed in their time there. Negative behaviours have decreased significantly and new skills have been mastered. We were satisfied that the home has supported this process through skilled work including assessment, and care planning. There was evidence that the changing needs of residents are reviewed and their care plans updated accordingly. We were told that social workers and relatives are invited to care plan reviews. Reviews are stored on the computer. We feel that the most recent review should be stored on the file. The manager stated that staff can easily Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: access the reviews as they have a computer in the sleep in room. However on the day of the inspection the computer was not working properly. One service user had a document All abut Me on her file which was slightly out of date. The manager stated that it had been reviewed and amended in August 2009 and was on the computer. We recommend that updated documents be filed in hard copy on the files as well as being saved on the computer. Out of date copies should be destroyed or archived. Risk assessments were thorough and meaningful and we were quite satisfied that service users are supported to take risks and extend their independence. Service users at the home are encouraged to take as many decisions as possible. As an example of this we were told that they choose food, not on a menu planning basis but individually at each meal. Service users have severe sensory losses and learning disabilities and none are verbal. Their sense of smell is important as is body language. On the day of the inspection three service users were going out for a meal and we asked the manager how they would choose food in a restaurant. She stated that the staff would ask for a sample plate and pass it around. The service users would be able to make choices of foods by smelling them and staff would be able to interpret their preferences from their body language. We observed service users choosing drinks in the kitchen and making their preferences known. Care Homes for Adults (18-65 years) Page 11 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. The home provides service users with recreational, social and leisure activities to suit their needs. It supports contact with families. Meals are nutritious and varied and mealtimes are enjoyable. Evidence: The manager explained to us how the home supports contact with families of service users. They take one service user to Chelmsford to see her family, another to Kent and another to Southend. They have a long term goal to support a service user to visit his family abroad and we saw the planning for this. One service user goes home for overnight visits. Parents who visit the home were spoken to and said they were very happy with the home and the staff and that their daughter is always well cared for and happy, and has a nice room. We viewed evidence in the form of activity sheets for how service users spend their Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: days. We also saw photographs of service users undertaking a big variety of activities, one on a bicycle, another shopping for a card for his Mother, on a beach, at centre parks, in a caravan, at the fun fair, in a museum in London, at a barbecue in the garden, at the local riding stables and at Southend. Service users also go to the Gateway club sometimes. Service users take holiday according to their individual preferences. On the day of the inspection three service users were going to a party at another Sense home, followed by dinner at a restaurant. One service users goes down to the local shop where the owners speak Turkish to him. He does not necessarily understand what they say, but it reminds him of his mother who speaks Turkish to him. The home has its own tranport but service users also use cabs and public transsport. The manager stated that the service users needs would not be met by day centres or colleges, so they dont attend these. We were satisfied that the home meets their recreational, social and leisure needs well. As previously mentioned the home produces meals for service users according to what they prefer at the time. One service user goes out for Turkish meals because that is his culture. We noted that the home has a nice friendly kitchen diner with a big table and enough chairs for everyone to sit down together. We observed a service user sitting at the table feeding herself lunch and indicating that she would like another drink. There was a really wide range of cereals kept and lots of dry, tinned and fresh foods, including plenty of fruit. Care Homes for Adults (18-65 years) Page 13 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. Personal care is delivered in a sensitive, individualised way and the physical and emotional health needs of service users are well met. Medication practice is generally sound but two important recommendations have been made. Evidence: The service user plans viewed provided evidence that personal support is individualised for service users complex and different needs. The manager explained that in all areas of working with service users staff study their body language, because this is a main form of expression. Service users have varying levels of indpendence in personal care but we found that their needs are managed discreetly and competently by the staff. On the day of the inspection three service users were going out and all got dressed up accordingly. We met with two of the service users in their rooms. They had both had one to one attention of staff and were looking and apparently feeling very smart. They were both having their hair styled as a finishing touch. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: Service user files evidence the input of a range of health professionals, including speech and language therapist, physiotherapist, occupational therapist, general practitioner, psychiatrist, psychologist, district nurse, chiropodist and dentist. We spoke to a therapist who visits. She said that the manager is very obliging and dedicated, and that service users always look well cared for. We noted hoists and other equipment like bathing aids. One service user has a bed alarm because he suffers from sleep apnoea. The service users have been assisted to behave in postive and more socially acceptable ways, and this has opened many doors of opportunity to them, for example being able to travel on transport, including public transport. They can now go on holidays and do. We viewed the arrangements for the administration of medication. Service users have their medication stored in their rooms in locked cabinets. The keys to these locked cabinets were kept in a kitchen cupboard which was not locked. This is not good practice. The keys to medication should be kept on the senior member of staff at each shift. Medication Administration Record (MAR) sheets are completed and signed by two staff. Most medications come in bubble packs but some are loose and some in liquid form. We checked the stock balances of several medications and found no discrepancies. One service user is allergic to penicillin. This was recorded in a her medical information log but was not obvious on the MAR chart. We asked the manager to ensure that every MAR chart is noted with this information, and other MAR charts are noted No Allergies Known where this is applicable. Two service users had analgesics in their cabinets which were not on MAR charts. We were told that these were prn medications and one had been prescribed for a particular condition which had resolved. There was no protocol available for the administration of these medications so we asked a staff member in what circumstances what he would administer the medication and how much he would administer. He made a reasonable answer but did not give exactly the same information as we had already been given by the deputy manager. We therefore stressed to the manager that staff need a clear protocol available to them for the administration of prn medication, and if the condition a prn was prescribed for has resolved then the medicaiton should be returned to the pharmacist. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: We were told that the medications are counted into the home and that the pharmacist signs a returns book for medications returned to him. Care Homes for Adults (18-65 years) Page 16 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. Service users views are listened to and acted upon, complaints would be taken seriously. Service users are protected from abuse, neglect and self harm. Evidence: We viewed the complaints policy. It had stages but we could not readily see timescales for responses. The complaints information needs to be amended to reflect the new name and contact details of the CQC. The manager stated that she has had no complaints. She stated that should someone wish to complain she would run them off a complaints form from the computer. We would like the manager to run off some complaints forms and make them available in the home to further facilitate complaints. We felt that given the standard of the rest of the service the manager would do a thorough job of handling a complaint and would report back appropriately to the complainant. The home has a safeguarding policy which the manager stated refers to the local authority policy with which it should be followed in conjunction. The manager was able to give a good account of what she would do should a safeguarding allegation be reported to her. We emphasised to her that she must advise the local authority safeguarding team in the first instance. The home does have Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: a local authority safeguarding policy and it also has the No Secrets guidance which the manager stated they refer to constantly. The manager said that the issue of safeguarding is visited by senior managers when they are carrying out regulation 26 visits. Staff are routinely trained in adult protection. The service users at the home are very vulnerable and the manager stated that if they should leave the home and will not be with staff all the time, then a body map is completed before they go, and the service user is checked on their return, to ensure they have no bruises or marks on them. Some service users do self harm and the manager explained to us the various strategies staff employ to divert them from this and redirect their behaviour. We felt that the home had a creative approach to problem solving. Service users are assisted by the home to manage their monies. There are everyday cash boxes and cash boxes which remain in the safe. The head office of Sense looks after the service users individual bank accounts but the home cashes cheques. The systems for keeping account of these monies were viewed and appeared quite satisfactory. We were told that the cash balances are checked by staff at every handover. The manager stated that she and her deputy do spot checks on cash balances. Care Homes for Adults (18-65 years) Page 18 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 is homely, comfortable and safe. It is clean and hygienic. Evidence: We viewed the environment of the home. It has a wheelchair accessible lift. The service users bedrooms are personalised, some with nice easy chairs. The manager was able to point out subtle choices service users had made for having certain objects in certain places. One service user has a broken video player. Staff have observed that it is dear to him, perhaps because his father gave it to him, so it remains in his room. One service users likes to spend a lot of time in her room listening to music but she has a preference for having the door open at times and closed at other times. The manager explained how she indicates this and how it is respected. The standard of decor is generally good except for the upstairs rooms, corridors and landings where there is ongoing work to repair walls which service users sometimes punch. We understand that this behaviour can be an unavoidable safety valve and the home does its best to keep up with repairs. One chest of drawers needed repair but the manager stated that she is expecting to have new furniture upstairs in the new year and in the meantime the chest of drawers will have a temporary repair. One bathroom needs some discoloured tiles descaled. One side of a handle was loose Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: on a kitchen cupboard. The manager stated that someone was coming the next day and would repair this. The home has a conservatory which is not useful to them and this is going to be demolished and a sensory room built which we believe will be of great benefit to the service users. A fire exit issue is discussed in another part of the report but apart from this we had no issues with the environment. There were no offensive odours in the home. There are industrial washing and drying machines and the washing machine has a soil cycle. The home has a clinical waste bin which is collected by the local authority. Staff have infection control training. The home is clean and hygienic. Care Homes for Adults (18-65 years) Page 20 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. The staff at the home are safely recruited and competent to meet the service users needs, some of their core basic training needs to be updated. Evidence: The staff group at the home consists of the manager, the deputy manager, two seniors and fifteen support workers, all but one of whom are full time. The manager stated that a high proportion of the permanent staff have been with the home for some considerable time. The manager stated in her AQAA that twelve staff have achieved NVQ level 2 or above. The deputy manager has NVQ3. The home occasionally uses agency staff but keeps to particular individuals who are familiar with the home. The night staffing is one waking and one sleeping staff and the manager and her deputy are always on call. The staffing ratio is the manager and four staff to the six service users. However if service users go out of the home they have one to one support. The manager stated that she makes it very clear to prospective staff that service users may display severe challenging behaviour. We viewed two staff files which evidenced a safe and robust recruitment process with two references and Criminal Records Bureau checks. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: The manager agreed with us that the core basic topics of training which should be renewed within two years are as follows: health and safety, moving and handling, first aid, fire, food hygiene, safeguarding, and infection control. In addition to these topics staff undertake training in other relevant topics, like crisis intervention , oral hygiene, medication and the mental capacity act. The training is delievered by the Sense organisation but they do bring in specialist trainers. It was not possible on the day of the inspection to access sufficient evidence that all staff have had all core basic training updated. We know that the training officer has training planned for the staff for next year. We have therefore made a requirement that mandatory training is updated. Care Homes for Adults (18-65 years) Page 22 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 home monitors quality assurance and working practices are generally safe. Evidence: The manager stated that there is a quality assurance policy and that the organisation sends her surveys which she passes on to relatives. These are returned direct to the organisaiton so she does not see them. However a relative confirmed to us that he had received a survey to complete. Regulation 26 visits do take place on a monthly basis and we viewed records of these. We viewed the record of unannounced night visits which the manager conducts every three months. The Control of Substances Hazardous to Health (COSHH) products were stored in a lockable cupboard in the kitchen. However the key had been taken by a service user and lost. The products must be locked away and the key inaccessible to service users. The home has COSHH data sheets but of the vast number they have, only a few are relevant as they only use a few products. We asked the manager to separate these Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: relevant sheets and keep them somewhere accessible to staff so that in the event of a spillage the correct procedure to follow can be found quickly and easily. The home does not have a business development plan but the manager has well formed ideas about where she want to take the home in the next year, including the development of the sensory room. She also has goals for the service to increase their independence and have a wider range of experiences and contacts. As mentioned before one service user is working towards travelling on a aircraft to his family in another country. On our tour of the environment we noted a cupboard on a landing which had service user information stored in it. It was unlocked. This is a breach of confidentiality and service users information must be locked away. We viewed the safety records for the home. The home has a fire risk assessment dated 2009, also day and night prodedures for fire and plans of the house. There are weekly fire checks of all zones, including flashing lights, emergency lighting door closers, and fire alarms. In addition an outside contractor calls every three months to check the whole fire safety system including smoke detectors and the emergency lighting. The last fire evacuation exercise was carried out in May 2009, a record was kept and the time taken for the evacuation was noted as well as the names of everyone involved. We were told that every door in the house is a fire door. All doors have door guards so that they can be left ajar but will close if the fire alarm sounds. The fire extinguishers were checked on 9/12/2008. We observed a fire exit door to be locked on the ground floor. This is not acceptable. The door must be easy to open with no locks. There are various ways to achieve this and we discussed them with the manager. The door could have a keypad and be wired so as to release when the fire alarm sounds. A break glass override would be needed for this. The door could have a simple handle or bar but also an alarm so that should a service user pass through it, staff would be alerted. We were told by the manager that the front door is a fire exit and has an auto release and a break glass override in place already. It was made clear to the manager and her deputy that the fire exits must be up to safety standard with a short timescale, and this was followed up with an e-mail after the inspection. Portable appliances were tested in December 2008 and gas safety was checked on 15/5/09. The electrical circuits were done in 2005 and are due for retesting in 2010. We viewed the water and fridge and freezer temperature records which were Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: satisfactory. The hoists were checked in August 2009. 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 35 18 The manager must ensure 01/04/2010 that all staff have up to date mandatory training in core basics: health and safety, food hygiene, infection control, moving and handling, fire, first aid and safeguarding. So that they are able to meet the needs of service users. 2 42 23 The manager must ensure that fire exit doors are not locked and can be opened easily. To safeguard service users and staff. 20/12/2009 3 42 17 Service user information must be locked away. To safeguard confidentiality of service users. 01/01/2010 Care Homes for Adults (18-65 years) Page 27 of 29 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 4 42 13 The manager must ensure that COSHH products are locked away and the key is not accessible to service users. To safeguard service users. 20/12/2009 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 6 Updated documents concerning service users should be filed in hard copy on their files, as well as existing on the computer. Outdated information can be archived or destroyed. We strongly recommend that the keys to the medication cabinets are kept on the person of the senior member of staff on each shift. We strongly recommend that staff have available a protocol for prn medication and that if a condition for which it was prescribed has resolved then the medication is disposed of to the pharmacist. We strongly recommend that the MAR charts are noted with allergy information, particularly for the service user who is known to be allergic to penicillin. We recommend that the manager run off some complaints forms and make them available in the home to further facilitate complaints. One identified bathrrom has discoloured tiles which need to be descaled. We recommend that the COSHH data sheets relevent to the products in use are separated and kept somewhere accessible to staff. 2 20 3 20 4 20 5 22 6 7 24 42 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. 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