Care Home: Beech Lodge

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What the care home does well The service provides a relaxed, homely and inclusive atmosphere. Staff were observed to be attentive and interacting with people throughout this visit. People living in the service stated that they were happy and the three most recently admitted into the home confirmed that they felt that the staff are nice and supported them well. Staff demonstrated a good knowledge of people`s needs and know them well. The home has a robust admissions process and there was evidence that the process was implemented prior to people moving into the home. The people who move into Beech Lodge are supported during the transition of moving into the home. People are supported to participate in a range of varied and appropriate activities, which meet their needs and preferences and they are encouraged to be independent. Staff were observed to offer choices to people and people asked their preferred choice of lunch. Staff are well trained and have received training, which meets the needs of people living in the service which was confirmed by staff. What has improved since the last inspection? The service completed all requirements and recommendations made during the previous inspection report. 1) Residents now all have detailed activity plans on file. 2) The complaints procedure has been redesigned and is now user friendly. 3) Unpleasant odours have been rectified. 4) Lounge furniture is now domestic in nature. 5) The general environment of the home has been upgraded. 6) Staff training has been updated. What the care home could do better: One requirements was made as a result of this inspection and one good practise recommendations were made. Staff files must be retained At Beech Lodge at all times and the views of other stakeholders in the community (i.e. care managers, community nurses, GPs etc.) should be as part of this process of quality assurance. Key inspection report Care homes for adults (18-65 years) Name: Address: Beech Lodge Beech Lodge 95 Thorkhill Road Thames Ditton Surrey KT7 0UW     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: Kenneth Dunn     Date: 0 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Beech Lodge Beech Lodge 95 Thorkhill Road Thames Ditton Surrey KT7 0UW 02083985584 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Y Jeetoo,Mrs Kathleen Jeetoo care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 9 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose care needs on admission to the home are within the following category : Learning disabilty(LD) Date of last inspection Brief description of the care home Beech Lodge is a detached property set in a residential road. There are three single bedrooms on the ground floor plus an open plan lounge/dining room, a kitchen, shower room, toilet and a laundry room. The property has been extended recently to provide a new room to the back of the building on the ground floor. It has not yet been decided how this room will be used. On the first floor there are six bedrooms, a staff sleep-in room and a small office. There are separate toilets for staff and residents, and a bathroom. The home provides care and accommodation to adults with learning disabilities. Support can be provided for personal care, daily living skills and activities. The fees vary from 812 to 953 pounds sterling per week depending on the needs of the person. Care Homes for Adults (18-65 years) Page 4 of 29 9 Over 65 0 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This visit was part of a key inspection, which took place over four and a half hours commencing at 09:30 am and finishing at 13:00pm. The last key inspection was carried out by the commission was on the 01st July 2008. Information was provided to us before this visit in the annual quality assurance assessment. (AQAA). This is an assessment that focuses on how well outcomes are being met for people living in the service, reference is made to the AQAA throughout this report. During this visit we had the opportunity to speak with four people who live in the service and we received two feedback surveys. Feedback was also received from members of staff and a social care professional. During this visit we looked around the home and some people invited us to see their Care Homes for Adults (18-65 years) Page 6 of 29 bedrooms. We looked at a random sample of some care plans, risk assessments, medication administration practises,staff recruitment and training records, health and safety and policies and procedures. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission procedures at the home ensure that service users needs and aspirations are fully assessed prior to admission to make sure that their needs can be effectively met. Evidence: Since the last inspection three new service users have moved into the home there admission followed the services admissions policy. The pre-admission policy and procedures in place are designed to ensure that prospective service users will not be invited to move to the home unless they are sure they can meet their needs. The three care plans of the most recent admissions were sampled, it was evidenced that the staff carry out regular needs assessment reviews to ensure that they are continuing to meet the needs of the people living at the home. In the AQAA, to demonstrate what the home does well, the manager stated that: we undertake regular reviews to ensure that our services constantly meets the demands of each service user as prescribed in the care package. The service users needs are Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: reassessed every 6 month and during the annual reviews or anytime if necessary. This statement is supported by the evidence seen at this inspection. Data provided in the homes AQAA provided details of the service users specific religious, racial or cultural needs. This was supported during the site visit from the evidence seen by the inspector and comments received from service users, the service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The site visit provided evidence that the needs of the residents are being assessed and met. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users individual plans are clear and comprehensive including details of needs and goals. They also incorporate known or indicated preferences. Service users are supported to take risks as part of an independent lifestyle. Evidence: Care plans for three service users were sampled, they were seen to be comprehensive, well set out and easy to follow. The care plans were person centred and included the service users personal preferences and also risk assessments for all activities, with clear guidelines for staff to follow to minimise any associated risks. There was evidence of regular reviews being undertaken in conjunction with the service users their families and other relevant individuals. Service users spoken with confirmed they were involved in drawing up their care plans and also knew where they were kept should they wish to see them. Staff write daily notes with each service user to evidence that their individual goals and needs are being worked towards and met. Ways that staff could relate their daily Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: notes more directly to specific care plans were discussed. In the AQAA, to demonstrate what the home does well, the manager stated that they: We ensure that all service users have an up to date, comprehensive individual support plan based on a multi-disciplinary needs and risk assessments with necessary changes incorporated in the support plan. Through key work sessions, we ensure that each service user has an insight and participate in all decisions regarding his/her care plan and in accordance with appropriate set out goals. The care plans sampled were designed to effectively meet the needs of the individual residents. Through service user meetings, we actively listen to the views of service users regarding effective running of the Home in accordance with their informed choices. We involve service users in striving to realise their potential through activities designed to provide knowledge of basic living skills as part of our aim to steer their progress towards independent living. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users have opportunities for personal development and to take part in appropriate activities. They are supported and enabled to maintain and develop appropriate personal and family relationships. Systems are in place to ensure that service users rights are respected. Meals are well balanced and varied Evidence: The daily routines at the home reflect the requirement to promote independence, individual choice and freedom of movement. Service users confirmed they could choose what to do, when they wanted. This was also confirmed by observations made by the inspector on the day of this visit. Each service user has a weekly activity schedule that is based on his or her known Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: interests and hobbies. The activity schedules sampled were seen to be varied and included activities both within and outside the home in the local community. In the AQAA, to demonstrate what the home does well, the manager stated that: The service users are introduced to and well coordinated with the local community through a variety of activities involving their families and embracing their sexual relationships. The Home has good links with the local community and the service users are involved in a range of external activities, including Gyms, local places of worship, libraries, shops, local shopping centres, day care placements, colleges etc. We nurture a culture in which the right of service users are fully embraced and their contributions are recognized and appreciated. The AQAA furthers states that the service engage and support service users in choosing their diet, and making changes whenever the need arise. We display before hand a weekly menu plan and involve service users in the preparation and serving of meals which are prepared according to individual choices or as recommended by medical professionals. One service user has a voluntary job in the library of a local infant school, the manager stated that this placement has been very successful and the service users has been offered the role as a paid employee. A further service users works on a part time assistant at a local supermarket. The service users take part in activities, hobbies and leisure interests according to their likes and dislikes which is often discussed in their monthly meeting. When asked one service users stated that the service provided support so I can to live the life I choose. However the service user did continue to raise concerns that even when the homes car was available, two service users had to use their own money to pay for taxies to take them the there club on Fridays. This was discussed and confirmed by the manager, who explained that this was due to an omission in the service users initial contract. The menu for the week of this visit was seen to be varied and well balanced, advice is sought from a local dietician, for individual service users, as and when needed. The inspector was advised that service users plan and prepare their evening meals. Lunch is informal with service users choosing what they want each day from the store of food at the home. Service users spoken with confirmed they had enjoyed their lunch and that they enjoy the meals at the home. The AQAA states that the service engage and support service users in choosing their diet, and making changes whenever the need arise. We display before hand a weekly Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: menu plan and involve service users in the preparation and serving of meals which are prepared according to individual choices or as recommended by medical professionals. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and health care support and assistance was seen to be provided, where needed, in a respectful and sensitive manner. Sound policies and practises are in place for the administration and management of medications. Evidence: During this visit three care plans were sampled and it was seen that all health care needs were incorporated into the care plans. Diary notes evidenced that staff take prompt action to deal with any new health problem that may occur and care plans were specific with information for staff to follow when supporting service users to manage any long-term conditions. The home has been proactive on seeking advice and following through with recommendations from appropriate health professionals. For example, two service users are being supported to try and reduce their weight and there is a close working relationship with a local dietitian and community nurses. Medication is provided mostly in the monitored dose system provided by the local Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: chemist. The administration of some medications was observed and the medication administration records (MAR), medication storage, policies and procedures were all sampled and found to be in good order. The manager and staff are supporting two service users to self medicate and have undertaken a series of risk assessments to maintain their safety. One service users stated that she is very happy with the arrangements that allow her to look after her own medication. In the AQAA, to demonstrate what the home does well, the manager stated that We have reviewed all risk assessments and prepared new care plans to meet the needs of individual service users. We have incorporated ADL (Activities for Daily Living) and Basic Skills training into the care plan to provide lead to wards our goal for independent living, designed for each service user. We have re trained our staff in administration of medication and the staff are able to do so according to protocol. We have improved on our personal care facilities to offer a better degree of personal safety and privacy. We have increased levels of staff support for service users personal care. the service users have regular health checks, and that the staff: record medication given/received/returned, weekly as needed (PRN) medication check, liaise with other services e.g. community nurse, occupational therapist, nutritionist and speech and language service about problems with swallowing. A review of protocol demonstrated that the service has reinforced its policies to protect the residents. During this inspection, all interactions observed between staff and service users were polite and respectful. Staff never entered service users private rooms without knocking and awaiting permission to enter. All personal care was carried out behind closed doors. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All required policies and procedures are in place to ensure that service users feel their views will be listened to. Policies and practises are in place to protect service users from abuse and neglect. Evidence: The home has a complaints procedure in place that is available to all service users. The complaints/compliments log was seen during this inspection and all concerns were seen to be clearly recorded with actions taken to resolve the concern. This meets with the requirement related to the recording of concerns made at the last inspection. The home has recorded one complaint since the previous inspection (1st of July 2008) and in compliance with the services policies and procedures. No complainant has contacted the Commission with information regarding any further complaint or allegation made since the previous inspection. There is a whistle blowing policy in place and the home have a copy of the latest Surrey County Councils Multi-agency Procedure for the Protection of Vulnerable Adults. At this inspection it was seen that all staff have signed to say they have seen the procedure and the training log demonstrated that all staff have received training and/or updates in the protection of vulnerable adults. The staff on duty confirmed that they have received training in safeguarding and felt assured that they understood their role in the process and what they must do to safeguard the residents. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Service users stated during the site visit all stated that they knew who to talk to if they were not happy and one care manager said that the home respond appropriately if a concern is raised. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The The The and location and internal layout of the home is suitable for its stated purpose. home is relatively well-maintained on the whole. home was found to be clean and hygienic and meets the service users individual collective needs in a comfortable and homely way. Evidence: The issues identified during the previous inspection (1st July 2008) have now all been addressed, however during the part tour of the service it is evident that the floor covering in the communal areas were still stained and have become rippled in areas. The provider must take appropriate action to assure these areas are are maintained to a good level to meet the needs of the residents. The service has three residents who are smokers who have to go into the garden to smoke. One residents stated that this is ok but when it get cold where will I go then. A recommendation has been made to seek an alternative area fore the smokers. The AQAA states that We provide a safe and homely environment of the service users ensuring the standards are maintained. We encourage service users to personalise their bedrooms and to promote their independence. We provide adaptations and equipment as the needs of the services users require. The visit confirmed that the environment was homely and met with the individual and group needs of the Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: residents. Two service users who recently moved into the service both stated that they were very happy with the home and love sitting in in the lounge watching TV with everyone. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Action must be taken to improve the staff recruitment procedures to ensure that the safety of service users is protected. The service has a staff training programme which is designed to ensure that service users are supported by competent and qualified staff team and that, as far as reasonably possible, they are protected from harm. Evidence: All requirements from the previous inspection (1st July 2009) had been fully actioned. At the time of this unannounced key inspection staff group comprises the manager; three full time senior support worker, three part time support workers and 2 further ancillary members of staff. The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the service users at the home. During this visit it was not possible to access the staff files as they are kept at the services head office therefore a requirement has been made requiring all staff files pertaining to Beech Lodge must be kept at the service at all times. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: The manager explained that all files contain proof of identity, two references and a completed application form and Criminal Record Bureau (CRB) certificates. The staff training records were sampled and it was seen that all staff were up to date with mandatory training and had received additional training related to the specific needs of the service users. Staff induction training was seen to cover the topics outlined in the new, mandatory Skills for Care common induction standards. In the AQAA, states that The Home has a consistent, stable, trained staff team and a good balance of culture and gender. The team works effectively with all staff knowing their roles and responsibilities. The AQAA provides further evidence that Staff receive good management support further. On the day of the site visit it was apparent that a greater emphasis has been placed on training. The review of staff files and the staff present during the visit confirmed that training has received more attention since the previous inspection visit by the commission. The supervision files provided evidence that staff are now in receipt of regular one-to-one supervision sessions with the manager. Two service users stated that the staff always listened and acted on what they said. One service user further told the inspector that she felt she was well looked after and confirmed that she felt staff knew how she liked things done. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users benefit from the management approach at the Beech Lodge providing an open, positive and inclusive atmosphere. The home has a quality assurance and monitoring system in place that is based on seeking the views of the service users. Policies and procedures are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of service users. Evidence: The service has a new manager in post, at the time of this key inspection the manager had not applied to the Commission for registration. The manager stated that he planned to start the process of registration and had made provisions to attend the commissions regional office for the purpose of submitting his documentation for his registration. It is essential that the registered provider ensure that the manager of the service is registered with the commission. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The manager has over 11 years experience working in the care profession and holds a BSc in Health Studies and Psychology. Service users views are sought on a regular basis. The service carry out a yearly survey which seeks the views of service users. The manager advised that the results of the surveys are correlated, actions for improvement are identified and then added to the managers continuous improvement plan for the home. A random sample of the most recent survey (January 2009) was seen and provided evidence of the overall satisfaction of the service by the service users. At present the views of other stakeholders in the community (i.e. care managers, community nurses, GPs etc.) are not sought as part of this process and a recommendation has been made for their inclusion to be considered in the future. All necessary health and safety checks are carried out by the staff at the home with documentary evidence inspected of routine fire practises and evacuations. Fire equipment checks, daily checks of fridge and freezer temperatures and a number of maintenance certificates were seen. All records were up to date and well maintained. However as was previously mentioned in this report the service does not retain staff files on site, therefore a requirement was made to ensure that the best interest of the service users are safeguarded by the service record keeping policies and procedures. Irrespective of the failure to retain staff files at Beech Lodge the health, safety and welfare of the service users are promoted and protected by the services policies and procedures and record keeping. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 Staff files must be retained At Beech Lodge at all times. To ensure that as far as reasonably possible service users, are protected from harm or abuse. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 24 39 The registered provider should review the arrangements for residents smoking at the home. At present the views of other stakeholders in the community (i.e. care managers, community nurses, GPs etc.) are not sought as part of this process therefore a recommendation has been made for their inclusion to be considered in the future. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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