Care Home: Arnold House

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What the care home does well The manager has made significant progress in addressing the requirements made at the previous inspection and Arnold house can now demonstrate that service users receive a good service which is based on service users identified needs and aspirations. What has improved since the last inspection? Risk assessments and care plans are now in place which shows that sercice users holistic needs are identified and managed effectively. The revised Nottinghamshie Safeguarding Adults policy is now in place. The staff induction is now in place which is based on "Skills for Care" common induction standards. The manager is now registered with the Care Quality Commission. Quality auditing procedures are now in place to determine the service users satisfaction levels with the service provided. Staff supervision is now performed. What the care home could do better: All the key standards were found to be met on this occasion. Key inspection report Care homes for adults (18-65 years) Name: Address: Arnold House 168a Oxclose Lane Arnold Notts NG5 6FD     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: Steve Keeling     Date: 2 5 0 6 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: Arnold House 168a Oxclose Lane Arnold Notts NG5 6FD 07841144195 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St John`s Care Ltd Name of registered manager (if applicable) Ms Manjit Bram Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Learning Disability - Code LD. Date of last inspection Brief description of the care home Arnold house is a newly furbished and modernised four-bedded long term residential home for adults aged 18-65 with learning disabilities requiring a minimum of 1:1 support. The home has three ground floor bedrooms of which one has en-suite facilities. A forth bedroom is on the first floor, which has an en-suite facility. Communal spaces comprise of a lounge/dining room and a separate external social activities room. The home is situated in Arnold, which has a comprehensive public transport system and has amenities such as a post office, supermarket, optician, dentist, General practitioners surgery, churches, a library and leisure facilities. The Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 4 Brief description of the care home fees currently being charged at the home are £1200 per week plus additional charges for one to one care which is currently £10.52 per hour. 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: The focus of the inspection undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practise, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting people who use the service and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager, two members of staff and two service users were spoken with as part of the visit, records relating to medication management was also inspected to form an Care Homes for Adults (18-65 years) Page 6 of 28 opinion about the quality of care provided. A partial tour of the building was undertaken which included serice users bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since the last key inspection performed on the 13.05.2008 was considered in planning this visit which included the Annual Quality Assurance Assessment which was provided by the registered manager on the 14.04.2008. In addition we also utilised two responses the the Have your Say pre inspection service users questionnaires and two Have your Say staff surveys. Care Homes for Adults (18-65 years) Page 7 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 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. Effective needs assessments are performed prior to service users being admitted to the home to ensure service users needs can be identified and met. Evidence: The pre inspection questionnaires asked service users Did you receive enough information about this home before you moved in so you could decide if it was the right place for you, both respondents stated yes. Information provided by the registered manager within the Annual Quality Assurance Assessment states We ensure that we carry out a full needs assessment when we match the service users to the accommodation, the experience/qualification of staff and the needs of the individual. At this stage we will also ensure that the service users will be compatible to each other, ensuring that we have a happy medium and good atmosphere within the home. We also provide information to the service users their family/friends/others so that they are able to make an informed choice. This is done so that the service user is aware of the service we provide and will we be able to meet Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: their level of need. Records were available to support this. Potential service users are always offered a trial visit and their family and significant others are involved in the admission process. Where possible potential service users are invited to stay over for a few nights to trial out what it would be like to live at Arnold House. At the trial period potential service users are able to look around, meet the other service users and have the opportunity to discuss service provision. Care Homes for Adults (18-65 years) Page 11 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. Service users are assured that their changing needs and aspirations are reflected in their individual risk assessments and care plans. Service users are supported to make their own choices, take risks, and have an active independent lifestyle. Evidence: The Have your Say surveys asked service users Do you make decisions about what you do each day, one service user stated Always and one service user stated Sometimes. Information provided by the registered manager within the Annual Quality Assurance Assessment stated We involve our service users in all aspects of their life. We dont just provide a service, we provide a way of life, that we hope is to a high standard. We encourage our service users to be house proud and look after their home with support. Individual care plans are produced with the service users to enable us to find out what works best and what doesnt. At no point do we de-skill the service users, we promote them toward independence. All activities are risk assessed, all risk Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: assessments are reviewed regularly and care plans are changed according to need. Service users spoken with on the day of the inspection confirmed that can take control of their lives and are encouraged to be as independent as possible whilst being supported by the care staff. Service users commented I can do what I want, I can come and go as please, I go to see my boyfriend and stay their at weekends which is good and I have so much to do, the staff support me to do thinks like shopping, laundry and cleaning my room. Service users have a weekly activity planner which shows they are supported to go shopping with members of staff to promote their independence and encourage then to contribute to the choice of food provision at the home. The case tracked care plans were well presented, person centred and stored securely to promote service users confidentiality. The care plans also included effective risk assessments to promote service users safety in the home and in the community. The care planning and risk assessment documentation had been reviewed appropriately to ensure service users needs and aspirations can be identified and met. Staff spoken with confirmed that the service users care plans and risk assessments are always available for reference and guidance. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can participate in a comprehensive range of social activities. Service users rights and responsibilities are upheld and they can maintain contact with their family and friends as they wish. A well-balanced menu is provided which promotes service users choice and preferences. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states Our service users are encouraged to enrol onto college courses of interest. These activities are fully supported and we ensure that the programme or activity meets the individual needs, we have risk assessments for each activity and we work closely with other service providers to share information with each other to promote the safety of the service users and other around them. We also have a weekly activity planner that is specific to each service user and this activity planner shows the daily activities of the service user, from cleaning bedrooms, laundry, going Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: to college, chilling out, baking cakes, washing the vehicle, cleaning the activity room, etc. We encourage our service users to use public transport and integrate fully within the community they live in. We also have a vehicle that is available to the service users. All our service users are given a front door key to the home and a key for their bedroom doors. If they require support to use them this is provided. All service users are encouraged to take part in all aspects of running the home, they are involved in menu planning, shopping, healthy eating, preparation of meals and maintaining the cleanliness of the home. Meals are prepared in line with the health care needs of service users and we prepare two different types of meals if need be, to cater for individual needs. Service users spoken with stated that they enjoyed the social activities provided at the home and within the broader community which includes attending college, going out to the cinema, attending drama sessions, sports clubs and social clubs. Service users also confirmed that they are provided with annual holidays to destinations of their choice. Service users can also benefits from a secure garden area which can be used in the summer months for social activities. The manager and staff said that an open door policy is encouraged at the home. Service users confirmed the open door policy and said that their friends and relatives are always made very welcome. One service user said that the staff actively support her to maintain relationships beyond the homes immediate environment which promote her independence. All service users spoken with stated that they were very satisfied with the provision of food at the home. A set menu is not provided as service users are encouraged to choose what they want eat on a daily basis. Service users also stated that the can have a drink or snack whenever they wish and their choice is always respected by the care staff. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care support is of a good standard. Medicine management promotes the service users safety and independence. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment stated Service users are able to direct us in their personal care needs and if they are unable to do so, we then consult those who best know them. If a service user requests that they are able to independently manage their personal care needs, we would ensure that this is documented in their care plan and risk assessments are set in place for staff to support the service user. However staff would still prompt and encourage service users with their health needs, through reminders about their personal health needs and the importance of personal hygiene. All our service users are registered with a General Practitioner, dentist, Chiropodist and have access to other health care professionals. Staff support all service users to attend all appointments and these are recorded in their care plan. Support plans showed and service users confirmed that they have access to health care services from members of the multi-disciplinary health team, both within the Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: home and the local community and expressed no concern in this area. Information provided by the registered manager within the Annual Quality Assurance Assessment stated We have ensured that staff are trained in medication and those not trained have received medication training, through the in-house induction process. Staff who have not received official training have been booked to attend training. We have ensured that all medication is recorded appropriately on medicating administration records. There are risk assessments in place around medication and administration of medication. A service users spoken with confirmed that he receives his medication on time. We observed the morning medication round and it was shown that the it was performed in a compitant manner by a suitably qualified member of staff. Records relating to the administration of medications were filled in appropriately, well maintained and stored in a safe environment 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. Service users feel safe in the home and systems are in place to protect service users. Evidence: Information within the Annual Quality Assurance Assessment stated, We listen to every complaint that is made to us, even if it may seem very small and very trivial. Any official complaint is dealt with directly by the responsible individual, who would collate his evidence by speaking directly with the person making the complaint. We also listen to concerns and complaints during our house meetings from our service users, service users are aware that they do not need to be in a formalised setting to raise any concerns and concerns can be relayed at any point. We try to deal with all complaints fairly and efficiently. We would explain our complaints procedure to all new service users and inform their family and friends on how to make a complaint. We have the complaints policy on our notice board and we are an open and transparent care provider. We ensure that all staff have received accredited Safeguarding Adults training and where this is not available immediately, we will inform our staff during the induction process what is expected and how they are to deal with a safeguarding issue. We have a copy of the Nottingham and Nottinghamshire Safeguarding Adults policy and staff are aware of how to make a referral to the Safeguarding Adults team. All staff have an enhanced Criminal Records Bureau checks before they start their employment with us and have been cleared through Protection of Vulnerable Adults checks. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The Have your Say surveys asked service users Do you know who to speak to if you are not happy both services users stated yes. The survey also asked Do you know how to make a complaint one service user stated Always and one service user stated Sometimes. Service users spoken with on the day of the inspection stated I feel very safe, I have no complaints. Both service users spoken with expressed confidence that the staff and the registered manager would address any concerns effectively. The registered manager has notified the Care Quality Commission that one referral has been made to the Nottinghmamshire Safeguarding Adult team, records showed that the issue had been managed effectively thus promoting the health and wellbeing of the service users. Staff training records showed, and staff confirmed, that accredited training in relation to Safeguarding Adults has been provided. We discussed issues relating to Safeguarding Adults with two members of staff. The members of staff had a clear understanding of their roles and responsibilities in this area and demonstrated a clear knowledge of Safeguarding Adult issues. The members of staff also stated that the revised Nottinghamshire Safeguarding Adult procedure is available to all staff for further guidance and reference should it be required. 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. Service users live in a homely well maintained environment which is clean, pleasant and hygienic throughout. Evidence: The pre inspection questionnaires asked service users Is the home fresh and clean, both service users stated Always. Information provided by the registered manager within the Annual Quality Assurance Assessment states We provide a very comfortable and homely environment for our service users, first impressions definitely count for us and we always get positive feed back that the home has a homely feel about it, its comfortable, stylish in decor and furniture and mostly we get visitors who are pleasantly surprised and who would be happy to live here. We provide a home that is safe for our service user. The home is decorated in a manner that has a home from home feel about it. All bedroom are comfortable and decorated to the choice of service users. Our service users have access to the utility area in the house, although cleaning products are not available to them directly, they are available on request and service users are supervised at all times. We asked two service users if they were satisfied with the standard of cleanliness at Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: the home, comments included its alway clean and tidy, I help with the cleaning my room and in the home. We performed a partial inspection of the premises, which included service users bedrooms, the communal areas they frequent and the kitchen facility. All areas were very well maintained, clean and fresh. Service users bedrooms were homely, safe and personalised withfamily pictures, small items of furniture, a television and family pictures. 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. Service users are supported by competent and qualified staff and staff recruitment practises promotes service users safety. Evidence: The pre inspection questionnaires asked szervice users Do staff treat you well one service users stated Always and one service users stated Sometimes. Comments made by service users on the day of the inspection included I am very happy with the way things are, I love the staff and think they are great and The staff are always available when I need them, they are a great I trust them all. Information provided by the registered manager within the Annual Quality Assurance Assessment stated As a service provider organisation, we recognise that the people who provide support critically influence the quality of service that people receive. Our policies and processes in recruitment and training, guide and inform effective recruitment practises ,that include thorough pre employment checks, induction and ongoing training to ensure staff fully understand their responsibilities and how to effectively support people with a learning disability. We examined staff recruitment records, they were very well maintained, stored Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: securely and showed that members of staff only commence employment once Criminal Record Bureau checks have been obtained, together with two satisfactory references, proof of identity and the individuals qualifications, thus promoting the safety and wellbeing of service users. Information provided by the manager, within the Annual Quality Assurance Assessment showed that 90 of staff have a National Vocational Qualification (NVQ) level two and above in care to ensure a suitably qualified workforce is employed at the home. Staff training records showed, and staff confirmed that a comprehensive stafftraining programme is also provided. A person who uses the service stated that she felt that all the staff are very well trained and had every confidence in their abilities. 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. Service users benefit from a well run home which takes into account service users views. The health, safety and welfare of service users is promoted and protected. Evidence: The registered manager has had a number of years experience in the social care sector, working with offenders, people with mental health issues and in Domiciliary Care for people with learning difficulties as care co-coordinator and branch manager. The manager has completed the degree level Registered Managers Award and is also National Vocational Qualification (NVQ) assessor. The pre inspection questionnaire as care staff What does the home do well responses included Supports all our service users and encourage them to live independent lives with our support and Paying attention to the basic needs such as medication, cooking and washing. We try to get residents involved in these activities as much as possible Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The pre inspection questionnaire asked service users Is there anything else that you would like to tell us. One service users commented I am so busy living in Arnold House I get all the help I need and I need more support with cleaning my room and washing. Service users expressed confidence in the managers abilities to provide a safe well managed service, and comments included she is great. Staff employed at the home also stated that they feel the manager is supportive and very competent in performing her managerial duties to the full. Records showed and staff confirmed that the manager provides effective staff supervision sessions on a regular basis to encourage a supportive, focused approach to staff performance and development. Records showed that the manager performs effective quality auditing process to ensure the service is meeting its aims and objectives and those of the service users accommodated. It was also confirmed by service users that they attend service users meetings, (usually on Sunday afternoons) to provide them with a forum for open discussion in relation to service provision at the home. Policies and procedures are available at all times and information provided by the registered manager within the Annual Quality Assurance Assessment showed they have been reviewed appropriately to ensure they remain pertinent. Staff confirmed that the policies could be assessed at any time for reference and guidance. Information provided within the Annual Quality Assurance Assessment showed that peoples health, safety and wellbeing is promoted by the provision of effective routine maintenance. 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 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). 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