Care Home: Adrian House

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What the care home does well Care plans are of very good quality, detailed and personalised to assist in meeting individual identified needs. People in the home are supported to take risks and their independence is fully promoted. Individuals in the home have a choice of activities inside and outside of the home, are encouraged to maintain their independence and to develop interests. The personal and healthcare support needs of individuals are assessed and met. Good medication procedures are observed in the home. The health and wellbeing of individuals are promoted in the home. Staff supervision is good and staff recieve good training. What has improved since the last inspection? Requirements made at the previous inspection have all been met. What the care home could do better: Whilst the environment is suitable overall for individuals there are some health and safety issues that need to be addressed to provide a safe environment for residents. Changes in staffing arrangements present some challenges for the management of the service and to the consistency of service provision for individuals in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Adrian House 44 Eldon Road London London N22 5DX     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: Nurcan Culleton     Date: 0 8 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 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: Adrian House 44 Eldon Road London London N22 5DX 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wimborne House Limited Name of registered manager (if applicable) Mr Joe Kwadwo Acheamong Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person 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 to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Adrian House is a privately owned registered care home for five adults with mental health needs. It is part of a group of homes run by Mr Kwame Adusei under the name of Wimborne House Limited. Adrian House was opened in 2000. The Responsible Individual is a Registered Mental Nurse. The Registered Manager heads a staff team comprised of care workers, an activity co-ordinator and a domestic. The home is staffed 24 hours per day with waking night staff. The Statement of Purpose states that Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 Brief description of the care home the service aims to ensure that service users are relaxed and settled in the home. We will continue to undertake performance reviews in all areas of operation to ensure that we are maximising our potential and fulfilling our service users needs and expectations. The service aims to support and enable people to live independently in the community. The home is a large converted two storey premises in a residential area. Each resident in the home has a single bedroom either on the ground or on the first floor. The communal facilities include kitchen/ diner, a shower room/ toilet, and office accommodation on the ground floor and a lounge and a bathroom/ toilet, on the first floor. An activity centre on the ground floor is shared by residents from Wimbornes other homes. The home does not have a back garden, but there is a small paved patio area. The home is located in a quiet residential area close to Wood Green shopping and transport facilities. Placements at the home for the current tresidents cost between £850 and £1400 for each person per week. Care Homes for Adults (18-65 years) Page 5 of 28 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 key unannounced inspection took place over one day on 8th December 2009. We spoke with the registered manager, people living in the home and staff. We examined five randomly chosen files of people using the service and three staff files. We looked at a range of records and documents, such as daily observation and medication records and health and safety certificates. 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: 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 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 8 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. Prospective residents are provided with sufficient information about the home to help their decision making about moving in. People are informed about their rights and responsibilities about their admission to the home. The home demonstrates its capacity to meet individually assessed needs. Evidence: Further to a requirement made at the last inspection the registration certificate now shows the new provider name of Wimborne House Ltd. The Statement of Purpose and Service Users Guide were available and updated with the new contact details of the Care Quality Commission. There have been no new admissions to the home since the last inspection therefore there were no new assessments to be examined. We did however see an assessment completed in 2005 by the manager in the file of one individual. This was client centred asking the individual for their views and signed and dated by the manager and the individual. Signed contracts were available in files examined. Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: Five files seen contained an equality and diversity monitoring form, recording the ethnicity of individuals and any cultural, sexual, religious and disability needs which had been explored in key working sessions with each person. The manager informed that English was the first language of the people currently living in the home and there were no religious needs. Some individuals preferred to eat Caribbean food which a care worker cooked for them. The overriding needs of the individuals in the home was as a result of their mental and physical health. Overall the evidence available on the day of inspection demonstrated that the home was able to support people with those needs. 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. Individuals are consulted about their care plans. Care plans are of very good quality, detailed and personalised to assist in meeting individual identified needs. People in the home are supported to take risks and their independence is fully promoted. Evidence: The five files we examined each contained comprehensive care plans detailing individual identified needs in numbered order, interventions, by whom, how often, objectives of the plan, identified risks and risk management. The review date for each care plan was also stated. Additionally we noted that the positive attributes of each individual had been identified, for exam, an individual who enjoyed contributing towards group discussions and related well to staff. We saw that care plans were evaluated on a three monthly basis, with objectives noted, signed by each resident and staff. There was evidence that individuals were involved and consulted about the development of their care plans. Daily progress notes were quite detailed noting physical, mental health and daily Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: activities of each person. Risk assessments were detailed and up to date covering any history of violent, aggressive behavior, early warning signs, a summary of assessment of risks, the management of identified risks, and updated on a three monthly basis. Evidence seen in the home demonstrated that individuals are supported to take responsible risks. Care Homes for Adults (18-65 years) Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals in the home have a choice of activities inside and outside of the home. Residents are enabled and encouraged to maintain their independence, develop interests and to keep links with family, friends and significant personal relationships. Evidence: The manager reported that individuals are encouraged to do structured activities. The service has an activities coordinator on Mondays and Wednesdays who assists in organising activities outside such as football, local trips out and day trips to the seaside as well as activities in the activities room in the house. During the day people in the home are encouraged to do normal daily activities that promote their self-care and independence, such as domestic chores, cooking. The manager said that some of the people do not like to go shopping though they are encouraged to do so. One person who is able does their own shopping, budgets and Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: cooks for them self. At the time of inspection no one was working or attending day centres. There was evidence of previous engagement in such activities however. We examined records of one to one sessions happening on a weekly basis with key workers, noting issues discussed and any action taken, including their daily activities. The activities folder contained well recorded activities, completed by the Activities Coordinator and or staff. Activities were reviewed every three months. It contained evidence of activities programmes chosen by individuals, including cycling, visits to the cinema, pub, snooker, leisure centre, places of interest in addition to advice and assistance with educational or employment needs. The centre contains an exercise bicycle, a road bicycle, a personal computer, an electric organ, board games and art materials for which the home is commended. The manager said that there has been family contact for some individuals where this is requested. Visits to the home from family members, close personal friends are encouraged. The manager stated that individuals are able to stay overnight with family or friends for a couple of nights provided contact details are given and the home would need to monitor medication. All have independent advocates and correspondence was seen from them in individual files. We saw a sheet which the individuals are given on Mondays to plan the menu for the week. Individuals cultural needs are assessed and met through the provision of ethnically appropriate food. Residents are encouraged to help in the house by shopping and cooking. The kitchen contained a food menu that demonstrated choice. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and healthcare support needs of individuals are assessed and met in the way they choose. Good medication procedures are observed in the home. The health and wellbeing of individuals are promoted in the home. Evidence: The health and wellbeing of individuals are encouraged and promoted, for example we saw in one persons file a certificate for their attendance at a session on drug counselling. In another file we saw a letter from the manager stating that they do not allow the use of drugs in their bedroom and that this would be discussed at their next review. Care plans contained detailed information about healthcare and personal support needs. The manager reported that most of the residents were fully self-caring. The care plans contained details of physical and mental health needs, and how these were to be met. The home was able to demonstrate how they respect the privacy, dignity and independence of individuals in the home. We saw, for example, a letter signed by one Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: person in their file of their wish expressing that staff do not enter their room unless in an emergency. Files contained a health section, including contact with a range of health professionals including GPs, clinic and hospital appointments. Files also recorded incidents where individuals refused to cooperate with medical procedures by health professionals. We saw in one persons file a weight chart which had been regularly recorded. The manager informed that he was a trained counsellor and that individuals have counselling with the manager if needs arise in addition to their key working sessions. These were seen recorded in individual files. We examined the homes storage of medication, and the records being kept. The home met a previous requirement for medication administration records to state reasons why any medication has been missed. One person continues to self medicate. All individuals had medication risk assessments, including a medication risk assessment for the person who self-medicates. We recommended however that records showing medication, such as Risperidone and Ibuprofen, that may be prescribed by a hospital physician or or GP on temporary basis also record who authorised the medicine and on what date. The home currently has no controlled drugs. The home were able to demonstrate that they consult with individuals over the subjects of their ageing, illness and death with respect to their wishes. We saw a signed statement from one individual for example requesting that issues regarding their will is discussed with their solicitors or next of kin. Care Homes for Adults (18-65 years) Page 16 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. Individuals know how to complain and their complaints are taken seriously. The service has appropriate procedures in place to safeguard individuals in the home. Evidence: The home has an established complaints procedure in place which is used when individuals make complaints. These are recorded and examined during this inspection. and When we spoke with one individual their main complaint was feeling that they wished to have their physical and healthcare needs as well as their mental health needs given the same priority, which in their view, was not the case. In other respects they found that staff were friendly and supportive and they did not wish to make a formal complaint. The Manager reported that there had been one safeguarding adults referral to the local safeguarding team since the last inspection, the papers of which were seen during the inspection. There was evidence of staff receiving training on safeguarding adults. The Manager reported that each person has a bank account and manages their own finances. One individuals social worker is a trustee of their money due to their assessed need and the home assists with forwarding their money to them and each person goes to the bank themselves and use their own cash cards. Care Homes for Adults (18-65 years) Page 17 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 environment is suitable overall for individuals in the room however there are some health and safety issues that need to be addressed to provide a safe environment for residents of the home. Evidence: We toured the premises in the company of a staff member. The home has all the appropriate communal areas and facilities such as a lounge, kitchen/diner, bathroom, separate toilet and a telephone for residents to use. One room on the ground floor continues to be used as an activities room. We viewed one bedroom at the invitation of an occupant whom we also interviewed. The upstairs lounge is also used as a smoking room by residents. The manager reported that it is difficult to stop residents smoking where they choose as it is their home. We discussed with the manager must take into account their responsibilities under the smoke free legislation and how this applies to care homes. The manager needs to consider the impact of smoking and the living environment on individuals, particularly any non-smokers in the house, who must have a designated area in the house where there is no smoking. The manager must consider any environmental adjustments that may need to be made as a result of the legislation. The homes Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: smoking policy must be clearly included in the Statement of Purpose. If we find evidence to show that a lack of proper arrangements for smoking is adversely affecting people, we will consider making requirements or recommendations. A cleaner who was working on the day of inspection is employed to clean the communal areas on Mondays to Thursdays. On Fridays to Sundays the support staff do the cleaning. We discussed with the manager our concern at the disheveled and unclean appearance of the bedroom of one individual and the lack of appropriate, clean bedding. We were advised that staff worked with the individual about their personal hygiene and cleanliness of their room on an ongoing basis and this was part of their care plan. We saw this recorded in the individuals care plan, their daily observation records and one to one sessions. The observation notes however did not specify whether any cleaning of the room actually took place or whether the individual refused to cooperate, only that staff attended to their personal hygiene. In this case we were of the view that it would have been important in the case of this individual for records to clearly indicate whether any cleaning took place in their room, when and whether or not the individual refused to cooperate with cleaning as reflected in their care plan. Carers records need to make clear what support tasks are actually given or to state if the individual refused to engage. We recommend that further ways are explored with this individual and other residents who may be in a similar situation to improve the cleanliness of their rooms. We further recommended that the flooring in the downstairs toilet to be repaired or renewed and for the disused toilet roll dispenser to be removed to improve the appearance of the room. Overall the home was clean and tidy. To improve the environment further we recommended the kitchen to have a deep clean to eliminate a stale odour of oil which we found on the day of inspection and was present after the kitchen had been cleaned. We expressed our view of some environmental health and safety concerns during a tour of the premises. In the bedroom we viewed which we referred to above we observed an exposed electric oil heater situated in the middle of the room. We found that the top of the heater was very hot to the touch and could present a risk to the person in the room. The manager informed that the radiator in the room was not working and an electrical contractor had been booked to fix it. We informed that this heater could present a health and safety risk to the individual living in the room and would not be acceptable under legislation covering in a care home environment. We also expressed concerns about the radiator in the lounge with no cover, the top of Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: which was also very hot and the portable radiator in the middle of the activities room, also with no cover. We assumed this would have to become very hot in order to heat the activities room which was noticeably cold when we entered it. Care Homes for Adults (18-65 years) Page 20 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. Staff recruitment procedures are good. Changes resulting in current staffing arrangements present some challenges for the management of the service and to the consistency of service provision for individuals in the home. Staff supervision is good and staff receive good training. Evidence: We examined the staff rota which accurately reflected the staff on duty at the time of inspection. The manager explained that all staff were permanent and there had been some changes in staffing but that there were no vacancies. The manager expressed dissatisfaction that there are now different care workers in the home on a daily basis. Staff from other homes now rotate around to work at the homes following the departure of a care worker at Adrian House. The manager stated that this was disruptive to the management of the service, particularly monitoring the quality of work and staff performance as he would not see staff for a week at a time. The manager did state however that depending on the gravity of the situation the manager could get hold of the staff the next day if he needed to. We agreed that more consistency in staffing arrangements would also be more beneficial for the individuals in the home. We saw in three staff files that staff had undertaken a range of training courses, Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: including health and safety, moving and handling, fire safety, food hygiene, infection control, first aid, and counselling. Staff had also undertaken a range of training courses on mental health including mental health awareness and challenging behaviour. The manager stated that all staff had NVQ 3 qualifications. Training was arranged mostly through the London Borough of Haringey The manager informed that the organisation does not pay for any training at all. He informed that there is a training manager in the organisation and an in house trainer. who trains on most subjects. Medication training was provided by Napclan Chemists. As at the last inspection it is recommended that the future training needs of staff should be identified in a training and development plan rather than solely held in records such as supervision and annual appraisals, though we could see evidence of such discussions during these meetings. We found that all essential recruitment documents were available in three randomly chosen staff files and that each care worker had six recorded supervision sessions and annual appraisals. Care Homes for Adults (18-65 years) Page 22 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 managed well overall by an experienced and competent manager. Health and safety issues are generally observed however the service must ensure that residents are safe at all times. Evidence: The manager has worked in the home since 2001 as the registered manager. Recently the provider name of the service had changed however there had been no other management changes to the service. The manager has an NVQ 4 qualification and is currently undertaking the Leadership, Management and Care Award course. Staff we spoke with said the manager was approachable and supportive. We discussed how the manager ascertains views of individuals using the service and others who have contact with the service. He explained that residents have one to one meetings, counselling sessions with the manager and residents meetings to express their views. The manager stated that they encourage visitors to give feedback on the Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: service and to write their views down. We noted that a report from the organisations of the completions of surveys by residents in the home and that 2 out of 5 residents had responded. These contained mostly positive comments. Every morning the manager conducts an audit of all records of the previous day and night to check on staff performance. Once a month internal audits takes place from within the organisation by Registered Mental Health Nurses, one of whom who visited the home on the day of inspection and we spoke with. However reports of the visits, their outcomes and recommendations are not produced and we recommended that any internal audits and their outcomes should be recorded to benefit the management of the service and for the purpose of inspection. We found that the majority of records we asked for were available and any shortfalls have been highlighted in this report. The manager conducts health and safety audits in the home and we found evidence that health and safety matters were generally observed, including records or certificates for food safety, fire alarm servicing, gas safety, fire safety three monthly fire drills, fridge freezer temperature and emergency lighting. The home does not take water temperatures as the manager stated that the electrical contractor visits every 6 months and checks and if necessary adjusts the water valve. However we recommend that staff also take water temperatures to ensure residents health and safety. We have highlighted in the section on the environment the health and safety concerns which we expressed with the manager and which impact on the health and safety standard in this outcome group. We also informed him that opened foods in the fridge must be labelled. We noted that the insurance viability certificate was in date. Care Homes for Adults (18-65 years) Page 24 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 25 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 1 24 Ensure that the home is safely heated at all times. The premises must be suitable, safe and wellmaintained for its stated purpose. The warmth, health and safety of individuals in the home must be ensured. 04/03/2011 2 42 The service must ensure that all heating systems in the home are safe to residents at all times. Radiators must have protective covers on them unless it can be ascertained through risk assessments that heating systems present little or no risk to residents. The manager must ensure the health and safety of residents. 31/01/2010 Care Homes for Adults (18-65 years) Page 26 of 28 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 20 Records showing medication, such as Risperidone and Ibuprofen, that may be prescribed by a hospital physician or or GP on temporary Basis to state who authorised the medicine and on what date. The service must consider any environmental adjustments that may need to be made as a result of the legislation. The homes smoking policy must be clearly included in the Statement of Purpose. The flooring in the downstairs toilet to be repaired or renewed and the disused toilet roll dispenser to be removed to improve the appearance of the room. It is recommended that further ways are explored with individuals to ensure the cleanliness of their rooms and their personal hygiene. Observation notes should record whether any cleaning of individual rooms take place if known or if assisted with staff support, or whether the individual refuses to cooperate. A deep clean of the kitchen is recommended to eliminate the stale odour of cooking oil. The home to have more consistency in staffing arrangements to ensure improved management of the service, the monitoring of staff performance and to benefit the individuals in the home. The future training needs of staff should be identified in a training and development plan. Any internal audits and their outcomes should be recorded to benefit the management and ongoing development and planning of the service and for the purpose of inspection. Staff to take water temperatures periodically to ensure that water temperatures are safe for residents in the home. All opened foods in the fridge to be labelled. 2 24 3 24 4 30 5 30 6 7 30 33 8 9 35 39 10 42 11 42 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. 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