Care Home: Bridge House

What the care home does well The premises are suitable for the care of residents. Residents are helped to lead an active life. Members of staff receive good training and support from the owner organisation to help them meet the support needs of residents. Care plan records reflect the needs of residents and their aspirations. These contain extensive information about how residents are progressing, aims of care identified by staff and agreed with residents, their health requirements and risks associated with their daily living and activities. The service provides a good structure for residents who are considering the next steps towards greater independence. Options are available within the group for realising this target. The owner organisation is implementing plans for enabling residents to move towards greater independence, for example, by obtaining different types of premises for this purpose. Each resident has a range of opportunities for progressing their education and leisure, employment and social skills. What has improved since the last inspection? The AQAA referred to attempts to use alternative formats (e.g. signs, symbols, pictures and simplified text) to assist residents with assess to some documents, for example, complaint`s procedure, accommodation agreement, household schedules and activity plans. It indicated that the content of such documents is so complex that this is an ongoing challenge and that it is an intention to provide residents with an audio version of key documents. The AQAA suggests that the staff group intends to continue to develop even more sophisticated ways of encouraging residents with communication difficulties to contribute more effectively. The AQAA outlined how staff awareness of lifestyle issues has been raised through training, staff meetings and coaching sessions. Changes have been made over the past six months to improve medication procedures, a revised medication system that has in the opinion of support workers reduced the likelihood of errors, more frequent medication audits and a tracking system for medicines taken out of the premises and for PRN. More accessible formats of the complaints procedure have been developed and residents are being re-coached in how to make a complaint or discuss their views. The service is in the process of delivering Adult Protection and Mental Capacity Act training to all members of the staff team. According to the team leader and a declaration in the AQAA, greater emphasis is being placed on the importance of formal staff supervisions and for the company to further develop a broader and more responsive training strategy. What the care home could do better: This report contains no requirements or recommendations. Key inspection report Care homes for adults (18-65 years) Name: Address: Bridge House 115 Grovehurst Road Kemsley Sittingbourne Kent ME10 2TA     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: Eamonn Kelly     Date: 0 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Bridge House 115 Grovehurst Road Kemsley Sittingbourne Kent ME10 2TA 01795478157 01795410877 care@cartrefhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cartref Homes UK Ltd care home 5 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 5. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The website www.cartrefhomes.co.uk defines the objective of the service as providing residential services for young adults with learning disabilities who may also present with challenging behaviours, mental health difficulties and other special needs but who aspire to more independent living. The website describes how the intention is to focus on transitional work - moving service users towards greater skill levels and competence in preparation for moves from residential care into more independent living models. Bridge House provides accommodation and personal support for up to 5 people with Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 Brief description of the care home learning disabilities with, as described above, emphasis on assisting them to move towards a more independent life style. The premises are situated close to shops, bus and train routes and other local amenities. Information about fees, services and facilities may be obtained from the manager or team leader and these are also described in a written guide to services. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 Star. This means that people who use the service experience good quality outcomes. The inspection took place on 4th June 2009. It comprised discussions with the team leader, support workers and five residents at the premises. Care practices were discussed and parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. The Commission received an annual quality assurance assessment (AQAA) from the manager. This provided good information about how residents are currently supported and how the service is being developed. The previous report from 2007 and the Commissions annual service review of 2008 were checked as part of this inspection. The evidence of the inspection visit and that Care Homes for Adults (18-65 years) Page 6 of 28 contained in the AQAA (annual quality assurance assessment) indicated that the published aims of the company are being met. This report contains no recommendations or requirements. Some suggestions for improvement are contained in this report. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: This report contains no requirements or recommendations. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives are given information in a variety of ways to help an informed choice to be made. Residents have their individual aspirations and needs assessed before they enter residential care. Evidence: The AQAA (annual quality assurance assessment) prepared by the manager to assess the current service to residents and to identify areas for improvement states that efforts are being made to encourage residents to move towards a more independent way of living. This is in line with the aims of the service as outlined in its website and statement of purpose. Advocates are able to obtain information about the service and other associated services provided by the group from a website. During the inspection, it was a little difficult to check the effectiveness of written pre-admission information as it was not readily available. The team leader was advised to make this more accessible to potential residents and advocates. The evidence from resident files seen during the inspection was that careful consideration is given during the time when an admission is being considered. This Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: includes carrying out a range of activities involving the potential resident, advocates, medical practitioners and care managers. Following this, a series of observations are carried out to enable staff to compile a care plan and up-to-date risk assessments. From the examples of records seen and individual profiles discussed, these are subject to constant amendment as the needs of the resident are assessed over time and the corresponding care plan and risk assessments are refined. Each resident is provided with a contract that outlines the main aspects of the responsibilities of both parties. An example was seen of a contract that used symbols and photographs to assist clients in understanding them. The AQAA refers to ongoing efforts to provide residents with an audio version of key documents. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are helped to make decisions and to express themselves as part of developing their confidence and quality of life. Evidence: Each resident has an individual care plan formed from original and subsequent assessments of their needs. They are encouraged to make their own decisions and choices. The team leader and another member of staff provided useful insights into how this is being achieved. Care plans outline the support needs of both residents and relate to all areas of their lives. The format is used in other residential homes owned by Cartref Homes Ltd. The team leader and another member of staff explained how the staff team have the skills and ability to support and encourage residents to be involved in the ongoing development of their plan. They use a variety of ways to help them communicate their aspirations and difficulties. New communication methods are being implemented to assist residents and staff. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: From the evidence of individual profiles discussed, it was clear that members of staff have a good knowledge of the types of support residents need and, from the evidence of the excellent support plans seen, the staff team are succeeding in helping residents exercise choice and make plans for the future. Some residents have begun to make realistic plans for the future and all have increasingly independent lifestyles with agreed levels of staff support. Residents are supported to take reasonable risks to allow them to participate in a range of activities. Risk assessments within care plans indicate how relevant risks are assessed and kept under review. Care plans are kept up-to-date and focus on how residents develop their skills and have their future aspirations recognised and addressed. The examples of risk assessments discussed address safety issues whilst aiming to maintain good qualities of life for residents. The AQAA suggests that the staff group intends to continue to develop other ways of encouraging residents with communication difficulties to contribute more effectively. These are consistent with the aims of the owner organisation to enable residents to live fulfilled lives and to develop the confidence and skills to move towards more independent living within other parts of the organisation. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines and activities developed with each resident give them opportunities to exercise preferences on a day-to-day basis. They are helped to take part in activities they enjoy and to be a part of community life. Evidence: The AQAA outlined the areas discussed during the inspection visit relating to how significant efforts have been made by the staff team to improve the lives of residents. It described how regular resident/staff meetings take place where, for example, activities are discussed and plans are made for additional ones. Each resident has an agreed weekly timetable of activities and efforts are made to enable these to be carried out. The AQAA referred to how members of staff work towards ensuring that suitable activities are accessible for each resident and reviewed so that they are in step with Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: changes agreed during residents meetings or progressive changes to routines agreed for their individual benefit. Current activities include visits on the bus to visit family members, trips to the local pub for a meal, music and activity sessions, 1-1 with staff support to go to the local town and places further away. Each resident has his bedroom maintained in a way they prefer and they receive differing levels of staff support in keeping their rooms safe and well maintained. Some residents have voluntary and paid employment. Records and charts maintained showed how residents are encouraged to complete daily and weekly tasks within their home, for example, cooking, cleaning and clothes washing. Care plan records indicate how residents have different plans relating to meals, meal times and preferences. Examples were discussed where relatives were involved in the preparation and review of care plans. There was evidence that daily routines are flexible to suit the different needs of residents and of how residents are helped in keeping touch with family and friends. Where a resident was settling in to a new environment at the time of the inspection visit, a trainee social worker enabled staff to gain additional insights into potential behavioural challenges that are likely to contribute towards better anticipation of events. A visit by a psychologist was also taking place to help with early diagnosis of conditions and advice for staff on next steps for supporting the resident. The AQAA outlined how staff awareness of lifestyle issues has been raised through training, staff meetings and coaching sessions. It also indicated that there are weekly menu meetings for residents to ensure they have contributed effectively. Examples discussed a part of case tracking showed how communication and observation methods are leading to realistic changes in how some residents see their future within supported living frameworks. There is a varied menu and examples of how residents are included in meal preparation and planning were witnessed during the inspection. The AQAA stated that there is emphasis on providing balanced meals that reflect individual taste and preference as well as healthy eating. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good physical, emotional and personal support. They are protected by procedures for administering medication. Evidence: The evidence from care plan records and discussion of individual profiles of two residents indicated that they receive good healthcare support. This includes access to GPs and NHS healthcare facilities. The home arranges for health professionals to visit residents at home when necessary. There is good quality planning and support for residents. The care plans seen during the inspection had relevant information for carers in the event of having to deal with episodes of various conditions associated with individual residents. Support workers have a high level of awareness of residents emotional needs and they explained how they help them to retain individual identity. Medication is stored in a locked cupboard and MAR sheets are updated when medicines are administered. Procedures have been reviewed and the team leader was Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: confident that current procedures are effective. A resident keeps his own medicines: the procedure is that residents must be seen to be able to do so competently and follow specific rules including co-operating with regular safety reviews by staff. Residents individual plans record their personal and healthcare needs and outline how these are being met. Members of staff ensure that personal support is flexible, is consistent and able to meet the changing needs of residents. They provided examples of how they know and respect residents preferences. There was evidence that the staff team reviewed all aspects of residents personal and healthcare needs over the past six months. This was evidenced through discussion of residents profiles and how they are moving towards better realisation of their preferences and expectations. The AQAA refers to how risk assessments have been updated and to how they form part of individual care plans. Information is outlined on how staff training in health matters and individual health action plans are now seen to be giving residents more control over their own health with the support they need. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home know that they can complain or comment about the support they receive and that their complaints and comments will be taken seriously. They are protected from abuse by procedures practiced by staff and policies within the company. Evidence: The service has a complaints procedure and residents are encouraged to express themselves in ways that members of staff understand. No complaints have been received since the previous inspection visit. The team leader said they welcome comments from residents and their supporters about how care and support is provided. The AQAA stated that residents are receiving coaching in how to comment about how they feel they are being supported. Policies and procedures for safeguarding adults are available to all members of staff and give specific guidance to those using them. Staff working at the service said they know when incidents need external input and who to refer the incident to for guidance. The team leader said that support workers are aware of local authority procedures for Safeguarding Adults. The Commission is notified of relevant incidents that occurred and reflection on these is reportedly used as part of quality assurance measures for the protection of Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: residents. The recruitment procedure contains the checks (including CRB checks) necessary to help contribute to the protection of residents and all members of staff receive training for their responsibilities under current POVA arrangements. The team leader was aware of how current ISA (independent safeguarding authority) arrangements affect staff in the care sector and of the responsibilities in this regard for people registered with the Commission. The AQAA stated that all members of staff are aware of the rights of residents and of how their interests must be identified and promoted. It outlines how the companys quality assurance system focuses on issues consistent with current care standards with emphasis on making residents quality of life progressively better. It also highlighted the fact that current stable management conditions have had a positive effect on residents and on the staff team. Reference was also made to staff guidance on relevant aspects of the Mental Capacity Act and how procedures might be affected in the future by aspects of this legislation. Care Homes for Adults (18-65 years) Page 20 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for the support of residents. Evidence: The AQAA stated that essential refurbishment is carried out routinely. Bedrooms are suitable for the needs of residents. Each person has their own bedroom that is well decorated and personalised with their own belongings. Bedroom doors are lockable; people can have their own keys and are able to invite others to visit their room when they wish. Residents routinely use the garden, for example, for bike storage/repair and growing plants. The premises were clean throughout. Residents use the laundry facilities as part of agreed household tasks and to give them the skills they need where they might be able to aim towards moving to more independent living. A declaration is made in the AQAA that all necessary checks are carried out and that the necessary safety certificates are in place. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are in the care of members of staff that are supported by the owner organisation through personal development and recruitment procedures for the purpose of meeting their support needs. Evidence: Staff files for all staff in the group are kept at the companys office in Sittingbourne and the range of checks carried out during recruitment was checked during a more recent inspection. The Commission is satisfied that residents are protected in a number of ways including via the required recruitment procedures. The manager of each service is involved in these procedures. Managers, for example, ensure that CRB checks are taken up in every case according to the records seen. The team leader was aware of how current ISA (independent safeguarding authority) arrangements affect staff in the care sector and of the responsibilities in this regard for people registered with the Commission. All new members of staff have induction and foundation training based on standards recommended by Skills for Care, according to the team leader. According to the AQAA, most support workers are trained to NVQ Level 2 or above and others are completing NVQ training. The team leader is a qualified and experienced chef, has now achieved an NVQ in Care and is progressing towards NVQ 3/4 in Care and Management. The Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: manager achieved the registered managers award. There was evidence on this occasion that a stable management system is in place and that the staff team is addressing the needs of residents. It was evident that the manager and team leader undertakes formal supervision in a planned way with all members of staff. The stated purpose is to identify practice standards relevant to the needs of residents and staff and to progress the objectives of the staff team and aims of the group. The AQAA included an analysis of the effectiveness of recruitment and staff development procedures. From the documents seen at a previous inspection, it is possible to conclude that all relevant checks are carried out, there is a process for involving some residents in the recruitment process and support workers receive guidance and on-going support. The AQAA, for example, stated that in addition to the statutory training provided for every member of staff specific training to meet the needs of each resident is given. Examples of the knowledge and skill levels needed by staff were discussed during the inspection and it was clear that all staff receive specialist training as needed according to the changing needs of residents. The AQAA referred to the initiative of the owner organisation in developing a broader and more responsive training strategy to meet the needs of clients. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in an environment that is well managed. Residents and members of staff are benefiting from improvements in the way the service is conducted. Evidence: The AQAA stated that policies are gradually all being updated with more accessible formats being introduced. Quality assurance questionnaires have been developed and are completed by residents, their families and health/social care professionals with an annual report compiled from the results. The team leader said that managers in branches of the organisation and the registered responsible person for the overall service make assessments of this feedback and use it to progress the quality of the service. Other procedures include reviews of care plans, staff meetings and regular 1-1 supervision. The service has a development plan and environmental risk assessments are regularly conducted to ensure the safety of service users. Risk assessments for individuals form a key part of support in place for residents. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The team leader referred to how key workers take a special interest in, for example, keeping care plans updated and individual residents involved in this. The medication system has been reviewed by the manager and improvements made for the safety of residents and benefit of staff. This includes how residents are enabled to keep their medication, the rules they must follow, how procedures are followed to ensure that essential medication is taken and how medication is handled when residents are off the premises. The team leader explained how consideration is given to carrying out health and safety procedures affecting the safety of premises and individuals. All members of staff are working to improve services and to provide an ever-improving quality of life for residents and is aware of current developments both nationally and by CQC. Care plan and healthcare records seen indicated that there are procedures for meeting the needs of respective residents. Declarations are included in the AQAA about the required checks to premises and associated procedures and safety certificates. The manager has the experience and qualifications to run the care home in line with current legislation and standards. The AQAA outlined how this experience is being deployed for the benefit of residents. From evidence seen during the inspection and from references in the AQAA, the use of a person centred approach is improving the lives of residents and giving support workers an effective framework to carry out their work professionally. The provision of the service by the manager and staff team is complemented, according to the team leader, by the support received from other parts of the company and from the registered responsible person for the wider service Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!