Care Home: Ashwood Avenue

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What the care home does well The atmosphere at the home was quiet and pleasant. People who live at the home appeared relaxed and contented.The staff are helpful to the people who live at the home.A health document has been provided for everyone at the bungalows should they need assistance or admission to a hospital. This is very helpful to people with communication difficulties. What has improved since the last inspection? The management of medications has been improved. What the care home could do better: Health and Safety actions have been delayed and such delays could lead to unsatisfactory outcomes for the people who live at the bungalows. This includes the checking of water temperatures andresponding to any fire recommendations. Key inspection report Care homes for adults (18-65 years) Name: Address: Ashwood Avenue 36 - 38 Ashwood Avenue Kirkby in Ashfield Nottingham Nottinghamshire NG17 7QA The quality rating for this care home is: one star adequate 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: Lesley Allison-White Date: 1 9 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 34 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 34 Information about the care home Name of care home: Address: Ashwood Avenue 36 - 38 Ashwood Avenue Kirkby in Ashfield Nottingham Nottinghamshire NG17 7QA 01623754527 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) : www.mencap.org.uk Royal Mencap Society care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: The Royal Mencap Society is registered to provide accommodation and personal care at Ashwood Avenue, 36 - 38 Ashwood Avenue, Kirkby in Ashfield, Nottingham, NG17 7QA for a maximum of 12 people whose primary care needs fall within the following numbers and categories: Learning Disabilities (LD) - 12. Date of last inspection 2 7 0 5 2 0 0 8 A bit about the care home 36/38 Ashwood Avenue is a care home consisting of two purpose built bungalows Care Homes for Adults (18-65 years) Page 4 of 34 providing care and support for up to twelve adults with a learning disability. The home was registered with Mencap on 1st November 2006. Nottinghamshire Community Housing Association owns the building. The home is located on the outskirts of Kirkby in Ashfield not too far from shops, pubs, the post office and other local amenities. All of the bedrooms are single; none are en-suite. Residents with mobility difficulties are assessed by an occupational therapist for any equipment they need to be able to live and be supported safely in the home. The home has a garden area, which is accessible and there is car parking available to the front of the bungalows. Care Homes for Adults (18-65 years) Page 5 of 34 The fees for the home for 2009 are from £350 to £374.00 per week. The fees do not include toiletries, and clothing. A copy of the Care Quality Commission (CQC) report is available upon request and is located in the office. Each person has their own copy of the Statement of Purpose and Service User Guide. This is information about the service. Care Homes for Adults (18-65 years) Page 6 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: one star adequate service Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home The focus of inspections undertaken by the Care Quality Commission is on outcomes for the people who use the service and their views of the service provided. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced inspection that took place in three hours. The Primary method of inspection used was case tracking. This involved speaking with the people who use the service provided, looking at two peoples care plans Care Homes for Adults (18-65 years) Page 8 of 34 and talking with them at the home. We also spoke with visitors at the home and staff members. The inspection focused on checking existing records kept by Ashwood Avenue, looking at their service history and the Annual Quality Assurance Assessment (AQQA) completed by the care home. The inspection was assisted by the deputy manager on duty at the time. Care Homes for Adults (18-65 years) Page 9 of 34 What the care home does well The atmosphere at the home was quiet and pleasant. People who live at the home appeared relaxed and contented. The staff are helpful to the people who live at the home. A health document has been provided for everyone at the bungalows should they need assistance or admission to a hospital. This is very helpful to people with communication difficulties. Care Homes for Adults (18-65 years) Page 10 of 34 What has got better from the last inspection What the care home could do better Health and Safety actions have been delayed and such delays could lead to unsatisfactory outcomes for the people who live at the bungalows. This includes the checking of water temperatures and Care Homes for Adults (18-65 years) Page 11 of 34 responding to any fire recommendations. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 12 of 34 If you want to speak to the inspector please contact Lesley Allison-White CQC East Midlands Citygate Gallowgate Newcastle upon Tyne Tel: 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 34 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 14 of 34 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. People living at Ashwood Avenue have their needs assessed before they move into the home. In this way staff are able to ensure that their needs can be met. Evidence: People who spoke with us told us that they were able to visit the home before hand if they had wanted to. Family members present also confirmed that this was possible. The AQAA tell us: A family charter exists and outlines the way in which the organisation works with families in the best interests of the person that they are supporting and directs them to share information and insights to help us meet an individuals needs. All individuals have a full needs assessment before coming into the home and are welcome to visit the home. We ensure peoples needs are accommodated. We involve family carers and previous care providers. Page 15 of 34 Care Homes for Adults (18-65 years) Evidence: We liaise with the various community teams including contractors of health and social care. We saw records that supported this at inspection. Family members present also confirmed this and people who live at the home who we spoke with said that they felt involved in their care packages. We looked at the Service User Guide and combined Statement Of Purpose. It included information about what the service offers, a contract and tenancy agreement. In this way people have the required information that they need. As part of the person centred approach the Service User Guides were available to each person in different formats using pictures, a combination of pictures and words and large print if required. Staff explained that the Service User Guide would be made available in different languages or in braille if this is what the person needed. Other specialists are consulted as required as part of the assessment process for ongoing support and we saw that speech and languages specialists were involved with people at the home. People are provided with their own person centred care plan and a programme is created to match individual needs. Care Homes for Adults (18-65 years) Page 16 of 34 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. People are involved in decisions made about their lives, and play an active role in planning the care and support they receive. Evidence: We saw that each care plan has an assessment of the needs, the likes and dislikes of each person including their life experiences, and aspirations. It sets out the goals they can hope to achieve and that by working with staff and by making use of the key worker one to one assistance they can be assisted to achieve their goals. Parents told us:Our relative was very unsettled where they lived before and left the building without an escort but now we find them contented, feeling safe and secure and they no longer attempt to leave the home. This gives us peace of mind knowing that they are cared for and happy here. The parents explained that: At Ashwood the doors to the bungalow can be left open during the sunny days and our relative will sit happily in the garden either alone, with other people or us as parents when we visit. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Staff explained: It is important to get to know each person well and for the key worker to get to know the person well and work with them to achieve their goals. A key worker is a member of staff who takes a special interest in ensuring that the individual allocated to their care is encouraged to develop as a person and to meet their needs. One of the key workers who was present said for someone with communication difficulties we would find out how best to communicate with that person, then design the care and support plan in a way that they could use and own. This can mean using different methods of communication such as the use of pictures only, pictures and words or sign language if appropriate. She then took a copy of the signs and symbols for Ashwood and demonstrated how it can be used with a person in the bungalow who was selecting their meal. Staff said over a period of time people become more settled feel happier when they are encouraged to make choices for themselves knowing that we are always there to help and support any one. We saw individual care plans that identified when people needed help, including how to identify emotional changes for that person. This included an understanding of patterns of behaviour, and how to respond to the person such as to sit down and talk with them, to use pictures to explain things to the person, to use pictures of the person doing different activities that the person can relate to within a situation. Comments from someone at the home included: I am included in things about me. Parents told us that people are included in activities that stimulate them. Staff will go on holiday with different individuals at the home. Our relative went way for a week and was really happy when they returned. We saw copies of house meetings that involved decisions made by the people at the home this included someone saying that they enjoyed their birthday party, others a recent holiday, others saying what they liked about the holiday using pictures of the person for example swimming as part of their holiday activity. At the end of the meeting the minutes summarised peoples overall findings about the home as being: happy with holidays, outings and activities. The AQAA tells us: As a Mencap Service all service users have support plans and risk assessments which are current and reviewed regularly. A lot of work has taken place to introduce detailed support plans in Mencap format, these are person centred and identify what support individuals need in all aspects of their life. The AQAA tells us: All individuals have various risk assessments in place enabling them to undertake activities of enjoyment. All care plans and risk assessments are reviewed and updated regularly. In the sample we saw this was seen. People at the service are encouraged and supported to make informed decisions and are encouraged to exercise their rights to do this. Care Homes for Adults (18-65 years) Page 18 of 34 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. People are able to make choices about their lifestyle and receive support to develop their life skills. Evidence: We observed people taking part in every day activities such as preparing and baking small cakes that they would all enjoy later at the party that evening. Other activities included going smimming. In the annual assessment form the provider tells us service users have good links with the local area including going to restaurants, shops, pubs and the park all of which are near by. At the visit we saw that different people were out doing activities in the community supported by staff. Later in the evening a birthday party took place and friends and families were invited to attend the celebration and they did so. We saw a leisure file of activities showing people from the bungalows enjoying themselves in the community or doing activities at one of the bungalows. People told us their families will visit. The Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: parents who we saw also said the same and that staff made them feel welcome whenever they visited. We saw people at the bungalows being treated by staff with respect when they spoke with them. We saw people who said that they were encouraged to manage their money for themselves. We saw people arriving for the party and being assisted to get into a change of clothing for the party. We saw pictures of people on holiday in their records and within the house minute meetings. We saw records of people at a number of events during the week with some people going out to day centres and others on other visits. Staff told us that they had received training in person centred care. We saw records of training to meet the needs of the people at the bungalows. People living at the home said that staff were good or that staff were kind to them. We observed a lunchtime meal that someone had chosen and later saw people at the party people eating the food that they had helped to prepare. People were seen enjoying the meal and the menus that we saw appeared to satisfy the needs of the people who live there. The assessment completed by the provider told us that: Service users are offered a healthy diet at meal times. Care Homes for Adults (18-65 years) Page 20 of 34 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. Health and personal care is based on peoples individual needs and delivered in accordance with the principles of respect, dignity and privacy. Evidence: The assessment sent to us explained : It is Mencaps policy to tailor the support we provide around the unique needs and wishes of the people we support. This means that we focus on the individual and agree the support and how this will be delivered with the person and those who are important to them. We use the process of person centred support planning to guide the way that we work with an individual in line with their preferences and beliefs. We saw this in the care records. The AQAA informs us that: All service users have a health action plan and involvement from other professionals as required. Examples of this included attending medical appointments, health review meetings, visits by the chiropodist. A hospital information document has been produced for everyone to have. This includes important information for staff at a hospital to read so that they can help care for the person when in hospital. It is based on a traffic light system red being every important to amber to green. In the red section it includes contact details, important medical Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: information such as past illnesses, current medicines, allergies and conditions. Amber details are details that are important to the person such as how the person communicates, what they need to help others understand them, eating and swallowing, drinking and swallowing, going to the toilet, how they move around, taking medicines and express pain. In the green section the likes and dislikes are included about the person. This is an effective way of helping someone when they are admitted to hospital and should reduce any anxieties that they may have about being in an unfamiliar environment. We saw completed hospital information sheets for both people observed and case tracked. A pen picture is completed for each person this uses pictures and descriptions of the medicines and any adverse effects from them. Staff said that it is helpful to them and would be helpful to anyone at the home who is able, and chooses to take their own medicines. We saw that there were no Controlled Drugs(CDs) on the premises at inspection. Controlled Drugs(CDs) are medicines that require special storage arrangements. Medicines are housed in medicine cabinets compliant with the guidelines relating to the storage of medicines. We looked at the medication sheets and saw that people received medications as prescribed. Care Homes for Adults (18-65 years) Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure but they are not always acted on by the staff. This means that their rights may not always be protected. Evidence: The AQQA tell us Our policies and processes requires staff to actively engage with local vulnerable adult processes and ensure that any threat to people with a learning disability is identified and reported promptly and appropriately within our organisation, so that appropriate action can be taken. There is a Compliments and Complaints procedure at the service with an action plan on what actions to take and procedures to follow. The complaint procedure is displayed in the bungalows. As part of the improvements made by Mecap we saw photographs of managers at this service. This means that people at the home and their relatives can identify who to go to if they have a concern that they wish to discuss. People at the home said that they would talk to a staff member or the head person. Family members told us that they knew who to go to about a concern and said that they believe that it would be acted on. The self assessment completed by the provider said: We are currently extending this to a more robust and behaviour led feedback and complaints management system. On being Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: able to deal with Adult Protection issues they said: We have an Adult Protection policy and are clear about our responsibility to work within the Local Authority Vulnerable Adults procedure. We hold a copy of the No secrets document in our service. We actively seek to gather the views of service users, families and stakeholders. Managers and deputy managers have attended complaints policy training. The deputy manager told us that the new complaints policy was being sent out to all families. When we spoke with staff they said that they were aware of the abuse policy and were able to explain what they would need to do to protect someone at the bungalow from this. They said that they had received training in this area and when we looked at their records we saw that training had taken place for the majority of staff. The Care Quality Commission (CQC) has been informed of two safeguarding referrals and the issues arising from them have not been completed. However, safeguarding referrals indicated that not everyone at the home has their needs listened to and that key workers may be chosen for them even though they may not like the person. In this way they are given a limited choice and the home is unable to show how they have met some individual’s needs. We saw that money was stored in a safe environment. Care Homes for Adults (18-65 years) Page 24 of 34 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. People live in a homely, comfortable environment. Evidence: As part of a recent notification to the Commission we were informed that the gate to the front of the building had been broken as a result of vandalism. Security cameras were installed two years ago to improve security further. Staff told us that during an incident they were unable to replay the camera film to assist the Police. They told us that they had not been shown how to operate it. We looked at two bedrooms and two public places. We saw two bedrooms. They were decorated to suit individual tastes and were kept clean and homely. One room a real bachelors room and was age appropriate. The other room was clean and plain and could be made more homely. The bathroom was clean and pleasant including an Arjo bath and bath chair for use as required. We noticed that there was no thermometer in the bathroom. The staff explained that they do test the temperatures of the baths taken, however they explained that there is someone at the home that likes to collect things such as pens, thermometers and other small but unnoticeable items. A shower room is also provided. An electric hoist is Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: provided for anyone who needs assistance in this way. We saw that the home is kept clean and tidy, people told us that they like to live and work there and we looked at the communal areas of the home and of the people who live there. The home is kept clean and tidy by people living at the bungalow and by the care staff. Care Homes for Adults (18-65 years) Page 26 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training for their roles however not everyone at the home feels that they are listened to by the staff that provide support for them. Evidence: The provider assessment also tells us: Our policies and processes around supervision, attendance and performance review actively encourage a supportive but focused approach to staff performance and development within the service. The AQAA told us staff records have: Employment checks, induction, supervision, clear job roles, annual appraisal, training and progression programmes. At inspection the staff records that we saw were satisfactory and confirmed that the necessary checks had been made. The AQQA tells us: As a Mencap service rotas are completed by the manager in advance. Consideration is taken for outings, appointments etc. All staff complete an in depth induction programme and are provided with necessary training to support the needs of the individuals, including all mandatory training. Mencap have a comprehensive recruitment procedure. All staff receive a Criminal Records Bureau check(CRB) and two references when commencing work with the organisation. All staff receive induction and Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: training. Staff have regular training and are supported with their Continuous Professional Development. Copies of staff meetings were available. A copy of the rota was seen it was untidy and difficult to follow and the trip for Sunday was cancelled due to staff being on leave or off sick. (rota dated 17/08/09 to 23/08/09). Agency staff were being used to assist. On staff receiving training to be able to support people in a satisfactory manner, the AQQA states that: 19 out of 20 permanent staff have an NVQ level 2 or above in care. We were told that 3 staff were started on the NVQ 4. (NVQ is a National Vocational Qualification in care). Supervision records for staff was seen at inspection. However, the safeguarding issues suggest that not all staff have listened to and acted on the wishes of people who live at the home. Some people have not been happy with the key worker allocated to them and management has not responded in a timely manner. There were photographs of activities that has taken place, relatives present also confirmed that their relative has been away and came back showing that they had enjoyed themselves. Minutes of a resident meeting showed pictures of the discussions that took place. People at the home who we spoke with were able to say that they had holidays planned and on the day of inspection different people who live at each bungalow were out in the community doing different activities as shown on the activities board. (Out at Doctors appointment and day centre with pictures of the person on the activity). Care Homes for Adults (18-65 years) Page 28 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be placed at risk if the staff fail to respond to matters of health and safety. Evidence: The management at this home remains stable. The current certificates were seen for the Care Quality Commission and for the Employers Liability insurance. AQAA states:The area services manager completes a monthly quality review visit at the service to ensure standards are maintained. There is an audit that takes place by the organisation known as the service review. The manager completes a monthly compliance form within the service. All health and safety and fire checks are carried out weekly to ensure the safety of the service. Servicing of fire equipment carried out annually by the fire authority. On water temperatures it said Water temperatures are recorded in a water temperature book. At this inspection aspects of health and safety was found to have been compromised Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: when staff recorded high water temperatures in a bed room and failed to report and respond to the findings. At inspection the deputy manager re-checked the water temperature in question and it was found to be within normal limits. There was evidence of fire safety drills and checks being carried out at the service and people that live at the bungalows were also involved in the evacuation procedures. However prior to this inspection the Fire officer had visited. It took 15 days for the home to start responding to the these essential requirements. The system for addressing health and safety issues is not apparent. There have been some issues of concern raised through safeguarding and complaints that have not been adressed and as a result are continuing. Water temperatures have not been reported by staff when incorrect. Staff have said that they would like training on the use and play back facilities of the cameras to help Police with their enquiries when called to assist at the home. Since inspection the deputy manager has contacted the inspector to confirm that all actions under health and safety have been carried out and that people at the home are safe. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 22 13 19/11/2009 The registered person shall make arrangements by training or by other measures to prevent service users being harmed or suffering abuse or by being put at risk of harm or abuse. The role of the key worker should ensure that the service user can raise any issues with them so that they can readily be resolved. 2 23 15 They registered person shall keep the service users care plan under review, consult and revise it with them. 19/11/2009 Service users should be encouraged to select someone from the staff that they prefer. In this way person centred planning will be become a reality. Care Homes for Adults (18-65 years) Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 3 39 13 The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from avoidable hazards. This is important so that the risks of scalding can be avoided. 25/09/2009 4 41 23 The registered provider after 25/09/2009 consultation with the fire officer should take adequate precautions against the risk of fire and for the maintenance of all fire equipment. Fire safety is very important and delays in actioning this could be very dangerous for everyone. 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 33 of 34 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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