Care Home: Boundaries Road

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What the care home does well The staff team works hard to support people using the service within a friendly and family-like atmosphere. The atmosphere in Boundaries Road is very relaxed and staff are approachable. The home works closely with other agencies, especially the local community mental health team, to meet the specialized needs of people using the service. The home continues to develop a personcentered approach to support people, that builds on the residents` strengths and wishes, and encourages their independence as far as possible, including using advocates to safeguard and promote residents` best interests. The staff team works very well together and people using the service live in a relaxed, but professional environment. The home is decorated and furnished to high standards and a homely environment has been created together with and for people using the service. What has improved since the last inspection? This was Boundaries Road first key inspection, since registering with the Commission for Social Care Inspection (CSCI) in March 2009. What the care home could do better: We have made four requirements during this key inspection. We found some areas in the administration of medication requires more attention. Peoples allergies and the name of the prescriber is not documented on the Medication Administration Sheet (MARS). This is required to ensure legislation is met and people using the service are protected. All staff competent to administer medication, must sign a signatory sheet, this ensures people are only administered medication by trained and skilled staff. We found liquid medication bottles opened, but not dated. It is important that liquid medication bottles are dated once opened, to ensure the medication has not expired when administered to people using the service. Staff have a range of training, this however is not recorded on training and development plans, which is required. Key inspection report Care homes for adults (18-65 years) Name: Address: Boundaries Road 75 Boundaries Road Feltham Middx TW135DR 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: Andreas Schwarz Date: 2 1 0 7 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 30 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 30 Information about the care home Name of care home: Address: Boundaries Road 75 Boundaries Road Feltham Middx TW135DR Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Cascade Care Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 5 Number of places (if applicable): Under 65 Over 65 5 0 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: Five The registered person may provide the floowing category/ies of service only: Care home only - Code PC to service users of the following gender: Male whose primary care need on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Boundaries road is a registered care home located on the outskirts of Feltham. Feltham city centre can be accessed easily via bus or by foot. The home is in a quite cul de sac. The two storey building is registered for five people who have mental health problems. On the groundfloor of the building is a large lounge and seperate kitchen/diner. A large well maintained garden can be accessed through the lounge or kitchen. Bedrooms are located on the ground and first floor, all but one bedrooms have en-suite facilities. The home is managed by Cascade Care a mental health care provider based in North London. Boundaries Road is the first service of Cascade Care in West London. Prices and fees can be obtained from the manager or operation manager on request. Care Homes for Adults (18-65 years) Page 5 of 30 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 Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home This inspection is the first annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Younger Adults. The unannounced inspection consisted of two visits over nine hours. The manager and deputy manager were interviewed and assisted with the inspection. The manager showed us around the home. All three people using the service were in the home at the time of the inspection. We spoke to two people using the service and observed interaction between people using the service and staff. We also interviewed staff to get their views and comments on the home. We did not receive staff and service users surveys in time to include in this report. The home returned a detailed Annual Quality Assurance Assessment, information has been included in this report. The inspector would like to thank the residents, staff and management team at Boundaries Road for their assistance with the inspection. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well The staff team works hard to support people using the service within a friendly and family-like atmosphere. The atmosphere in Boundaries Road is very relaxed and staff are approachable. The home works closely with other agencies, especially the local community mental health team, to meet the specialized needs of people using the service. The home continues to develop a personcentered approach to support people, that builds on the residents strengths and wishes, and encourages their independence as far as possible, including using advocates to safeguard and promote residents best interests. The staff team works very well together and people using the service live in a relaxed, but professional environment. The home is decorated and furnished to high standards and a homely environment has been created together with and for people using the service. Care Homes for Adults (18-65 years) Page 8 of 30 What has got better from the last inspection What the care home could do better We have made four requirements during this key inspection. We found some areas in the administration of medication requires more attention. Peoples allergies and the name of the prescriber is not documented on the Medication Administration Sheet (MARS). This is required to ensure legislation is met and people using the service are protected. All staff competent to administer medication, must sign a signatory sheet, this ensures people are only administered medication by trained and skilled staff. We found liquid medication bottles opened, but not dated. It is important that liquid medication bottles are dated once opened, to ensure the medication has not expired when administered to people using the service. Staff have a range of training, this however is not recorded on training and development plans, which is required. Care Homes for Adults (18-65 years) Page 9 of 30 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Andreas Schwarz 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 02072390330 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 10 of 30 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 11 of 30 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. We looked at National Minimum Standards 1 and 2 during this key inspection. Detailed information about the home is available so that people using the service and families know what they can expect from Boundaries Road, the Statement of Purpose and the Service User Guide is up to date. People moving into the home can be confident that their needs and wishes will be fully assessed and an appropriate plan for meeting these needs will be drawn up. As a result their needs are met Evidence: We looked at the homes statement of purpose and service users guide, both documents are very detailed and provide prospective people using the service with information about the assessment process, the Aims and Objectives of the home, layout of the home and staffing structure. People using the service informed us that they have received the statement of purpose. The manager told us, that he is planning to review the statement of purpose and is planning in changing the Aims and Objectives to be more specific to the service provided by Boundaries Road. The documents are currently available in written format, this is suitable for the current service users group living in the home. We have viewed two very detailed assessments. Needs assessments are undertaken by Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: the manager or operation manager. People using they service have been involved in the assessment process and information obtained during the assessment is included in peoples care plans. The manager has informed us, that the home is basing their admission on the assessment process and the home has previously refused admission due to not being able in meeting prospective service users needs. People using the service told us that they have been assessed in their previous placement and confirmed that they had trial visits to test drive the home. Care Homes for Adults (18-65 years) Page 13 of 30 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. We looked at National Minimum Standards 6, 7 and 9 during this key inspection. Care plans provided detailed information so that the needs of residents are met. The staff team at Boundaries Road is good at finding ways for people using the service to make as many decisions for themselves as possible. People using the service are protected by risk assessments that are comprehensive and indicate clearly how risks to the safety of residents are reduced, whilst still promoting independence. Evidence: We looked at two care plan folders in detail. All people using the service have a key worker, who is responsible for regular meetings with the person and reviews of the care plan. Key workers meet monthly with people using the service to discuss progress and action plans which have been set out in the care plan. Care plans viewed are detailed and needs such as daily structures, medication, mental and physical healths are discussed during key working meetings. New people using the service have an initial meeting with their allocated key worker and roles and responsibilities are set out in a contact, which is signed by the person and the key worker. After one months living in the home, the home Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: is reviewing their stay together with the person. The manager told us that care plans will be reviewed if needs change or within the year. People using the service told us that they know about their care plan and have met with their key worker formally or informally to discuss their stay and the care plan objectives. People using the service told us, they look after me very well. During both days of this inspection, we have seen people using the service, to do shopping, meet friends, or go for a walk. People using the service can access all areas in the home and have been observed to be very relaxed around staff and their environment. The home is supporting one person in the management of his finances, records assessed have been of good standard and clear recording is in place. Due to issues with one of the people living at the home, keys have not been issued. The manager told us that the person has now moved out of Boundaries Road. People using the service told us that they would like to have a front door key, we recommend that all people are issued with a front door key if it is safe to do so. People using the service told us that they can go out whenever they want and choose what they want to do. The home has a wide range of very detailed risk management plans in place. These are reviewed if needs are changing or on a monthly basis as part of they regular key working meetings. Risk assessments are signed by people using the service, one person told us that he is aware of his risk assessments and has been involved in risk assessment meetings with his key worker. Care Homes for Adults (18-65 years) Page 15 of 30 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. We looked at National Minimum Standards 12, 13, 15, 16 and 17 during this inspection. The home is good at enabling residents to get out and about so that they lead as ordinary a life as possible. Residents are getting a better quality of life because of the good links with the local community and the range of leisure activities available. Staff supports residents to keep in close contact with friends and family, as well as respecting their rights and encouraging them to act responsibly. Residents enjoy their meals and benefit from being offered a healthy diet. Evidence: We spoke to two people using the service, both told us that they are currently not interested to access day centers or colleges. The manager told us that one of the people showed interest in voluntary work, which is currently explored together with the person. Information of local drop in centers and activities is displayed on the notice board in the hallway. The home has a small room, which is used by one of the people for painting and artwork, which has been shown to us. People using the service can access the gym, the Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: home is paying for a membership in a local gym. We viewed activity plans, which have been discussed and agreed by people using the service. People using the service told us that they can access the Open Door Project, which is run by a local mental health charity. The project offers drop in sessions, access to complimentary therapy sessions, arts and crafts, etc. People using the service told us that they can go out whenever they want, which was observed on both days of this inspection. The home had a complaint from a neighbour, which has been investigated by the manager and has been resolved. Staff reflect the cultural background of people using the services. Staff support people using the service to maintain relationships, with siblings, family members and people in the local community. The manager told us that this is depending on peoples choices. The home has a visitor policy, which enables people to invite and meet people at the home, provided it is safe to do so. People using the service can move freely around the home and can access all areas. We observed mail handed to people unopened. People using the service told us that staff is very understanding and listens to service users if they choose to be alone. One comment made by a resident, If I want to be on my own I can go to my room. The home has rules on smoking, alcohol and drugs in place, which is clearly documented in the statement of purpose. People with a history of drug abuse, have to agree to random drug testing, which is done every two weeks. Staff prepare meals together with people using the service daily. We observed people using the service helping themselves to snacks and drinks during this inspection. The home has a menu in place, which is not necessarily followed. We recommend to record the food eaten by people using the service separately. People using the service told us that they like the food and are happy with the food available in the home. Care Homes for Adults (18-65 years) Page 17 of 30 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. We looked at National Minimum Standards 18, 19 and 20 during this inspection. Staff is good at meeting the physical and emotional health needs of residents. As a result residents feel more at home and relaxed at Boundaries Road. The residents are protected by effective arrangements regarding medication in the home, further work is required to improve the outcomes for people. Evidence: People currently using the service in Boundaries Road are fully independent in managing their personal care. Staff told us that they will remind people using the service if they forgot to have a shower. Assistance around eating and manual handling is not required. People using the service told us that they can get up or go to bed when they choose. The home can access the local mental health team for clinical support and all people using the service have an allocated clinical psychiatrist and Community Psychiatry Nurse (CPN). All people using the service have an allocated key worker, whom they meet regularly to discuss progress. People using the service are encouraged to register with a local General Practitioner (GP). Access to dentist, optician and chiropody is facilitated, as stated in the statement of purpose. Visits to and from health care professionals is recorded in peoples care plans. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: People using the service told us that they are happy with the health care support provided by the home. The home is storing medication safely in the office. Staff have recently received medication training and a medication procedure is in place. Staff told us that two carers are required to administer medication. One of the people using the service told us told that the home supported him to self administer, but following his request returned to administer medication. The service user said that this suits him better and he feels safer. We observed staff administering medication for one person, to take with him so he is able to go out. This has been risk assessed and appropriate systems are in place to monitor if the person has taken his medication. A signatory list of staff competent in the medication administration was not in place, which is required. The medication administration sheet (MARS) had no omissions. The name of the prescriber and information about peoples allergies was not recorded on the MARS, which is required. One of the people living at Boundaries Road is using liquid medication, we could not establish the date when the bottle was opened. This could lead that people using the service are administered medication, which has been expired. Care Homes for Adults (18-65 years) Page 19 of 30 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. We looked at National Minimum Standards 22 and 23 during this inspection. People using the service and relatives can be confident in the complaints procedures in the home that make sure their concerns are responded to. The residents benefit from a safeguarding adults procedures that make sure that they are safe and secure whilst at Boundaries Road. Evidence: People using the service told us that they are confident complaints are dealt with satisfactory. One comment made I would talk to the manager, who will deal with my complaint. The home has a complaints policy, people using the service receive the complaints policy as part of their induction to the home. Since registering with the Care Quality Commission (CQC) in March 2009, the home has received one complaint. This complaint has been dealt with by the manager and the issue has been resolved. Staff receive adult protection training as part of their induction. Since registering with the CQC no adult protection referral has been made. The manager told us that the home has no mental capacity or deprivation of liberty issues. The home has a generic adult protection procedure, which is based on local guidelines. Not all people using the service are funded by London borough of Hounslow and it is recommended to obtain adult protection guidelines from all purchasing authorities. Care Homes for Adults (18-65 years) Page 20 of 30 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. We looked at National Minimum Standard 24 and 30 during this inspection. People using the service life in a comfortable and clean home. Evidence: The manager showed us around the home. Boundaries Road has been registered in March 2009, the building has been completely refurbished and all rooms, with the exception of one are en-suite. Furnishing and fittings are new and of good standard. On the ground floor is a spacious lounge, large kitchen and diner, office, activity room and one room for people using the service. A large garden can be accessed through the lounge or kitchen. The manager told us that he is planning to build some vegetable plots for people using the service to use. On the first floor are rooms for people using the service, bathroom and a separate WC. We observed people using the service relaxing in the lounge and appear very comfortable in their environment. One comment made by a person spoken to, look at it, its very nice here. The home has a separate utility room, people using the service have allocated laundry days. Cleaning materials are safely stored away. Staff have attended Health and Safety training, infection control training, etc. to meet and understand legislation. Monthly Health and Safety checks are undertaken by the home, this ensures that safety of appliances and the environment is regularly monitored, ensuring people using the service Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: live in a safe home. Care Homes for Adults (18-65 years) Page 22 of 30 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. We looked at National Minimum Standards 32, 34, 35 and 36 during this inspection. The committed, competent and experienced team of staff work hard to meet the needs of residents. People using the service are protected by the homes rigorous recruitment procedures for new staff. Residents have an improved quality of life because staff have the training and support they need to provide a good standard of care. Staff do have the benefit of formal supervision meetings at the required frequency. Evidence: We viewed staffing rotas, which told us that two staff work during the morning, two during the afternoon and one during the night. People using the service told us, that the home has sufficient staff, which is available if support is required. Staff have different skills and backgrounds. One member of staff is a qualified mental health nurse, one member of staff is currently completing his psychology degree. We looked at three staffing files, all files had evidence of carers having qualifications in Health and Social Care. The home informed us in the Annual Quality Assurance Assessment that six staff hold National Vocational Qualification in Health and Social Care. The manager informed us that the organisation is committed to enable all staff to obtain similar qualifications within the next year. All staffing folder viewed showed us that the required documentation, such as Criminal Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Records Bureau (CRB) check, two references, proof of identity, etc. are in place. We found the folder very unorganised and recommend to re-organise the folders for easier access. Staff spoken to informed us of having attended a number of training since starting at the home. Certificates of training attended with Cascade Care and in previous unemployment are in the staffing folders. We observed staff interacting very relaxed with people using the service. One staff member commented, the best at Boundaries Road is the staff team, we work very well together, which helps to improve the live of people using the service. We were unable to obtain up to date training records, documenting training attended and planned for each individual member of staff, which is required. Staff told us that they have receive regular supervisions. The staff group meets monthly to discuss issues with the home, support and problems with individual people. Staff told us that the manager and deputy manager is always available for support and help if it is needed. Care Homes for Adults (18-65 years) Page 24 of 30 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. We looked at National Minimum Standards 37, 39 and 42 during this inspection. People using the service benefit from being well supported at Boundaries Road. Residents benefit from living in a home where there are procedures in place to get the views of all key parties about how the home is running. The home has good procedures in place in relation to health and safety that help to ensure residents are protected at all times. Evidence: The manager is experienced and has been working in health care and mental health setting for a number of years. He has experience of forensic mental health services and has managed a similar home to Boundaries Road previously. He has partially completed his Registered Managers Award (RMA) and National Vocational Qualifications in Care Level 4. The staff team and deputy manager spoke very positive about the support provided from the manager. We observed the manager working with staff, which is nonhierarchical, but it was clear staff value his knowledge and opinion. The home has regular team meetings and a team development day is planned for the future to improve relationships between team members. People using the service told us Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: that they meet regularly to discuss the menu, activities and any other issues relating to the home. The senior management team visits regularly to monitor the quality of care provided and a business development plan is in place. All health and safety certificates such as Portable Appliance Test (PAT), gas safety certificate, etc. are in place and up to date. The fire risk assessment is of good standard and fire records are up to date. People using the service told us, I feel safe here. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 20 13 The responsible person must 01/09/2009 ensure liquid medication is dated once opened. This ensures people using the service are protected from expired medication being administered. 2 20 13 The responsible person must 01/09/2009 ensure that the name of prescriber and known allergies are recorded on the medication administration sheet. This ensures people using the service are supported safely in the administration of medication. 3 20 13 The responsible person must 01/09/2009 provide a list with signatures and initials of staff being competent in the administration of medication. Page 28 of 30 Care Homes for Adults (18-65 years) 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 This ensures people using the service are supported in the medication administration by competent staff. 4 35 18 The responsible person must 01/09/2009 record training planned and taken part by staff. This ensures people using the service are provided with up to date training information. 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 3 4 7 17 23 34 We recommend that all people using the service are issued with their own front door key, provided it is safe to do so. The home should record meals eaten by people using the service. It is recommend to obtain adult protection guidelines from all purchasing authorities. The home should re-organise and tidy the staffing files, to allow easier access. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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