Care Home: Brighton Lodge

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Brighton Lodge 40 New Brighton Road Emsworth Hampshire PO10 7QR two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Laurie Stride Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Brighton Lodge 40 New Brighton Road Emsworth Hampshire PO10 7QR 01243373539 F/P01243373539 declarke@ormsbylodge.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr David Ernest Clarke, Mrs Ninfa Clarke care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: 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). The maximum number of service users to be accommodated is 12. Date of last inspection 1 5 0 4 2 0 0 8 A bit about the care home Twelve people live at the home. The home is near to the town and they can use the bus to get there. They all have their own bedroom. Fees range from 104.00 pounds to 164.00 pounds per day. 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 How we did our inspection: This is what the inspector did when they were at the care home We (the commission) visited the home and did not tell them we were coming. We looked at how well the home was doing and checked that they were doing what we had asked at the previous inspection on 15/04/08. We were in the home for seven hours. We met some of the people who use the service and spoke briefly with three of them. We also talked with one of the service providers, the manager and two staff members. We went to a team meeting. The home gave us information about what they were doing in their annual quality assurance assessment (AQAA). We sent survey questionnaires to people who use the service, staff and other people who have contact with the service. We received responses from a health professional and three service users. Staff helped two people to complete the form. What the care home does well The home works at providing care and support for each person in the home to make sure their health and personal care needs are met. Staff know how each person likes to be supported. A range of activities are available for relaxation, mental stimulation and learning life skills. Visitors are made welcome. People can keep in touch with their friends and relatives and the home helps them to do this. Meals at the home are varied. People can choose what they want to eat. The home offers a clean, wellmaintained and comfortable place to live. There is a reliable staff team who have training to make sure that they can meet the needs of everyone who lives in the home. What has got better from the last inspection Peoples goals and wishes are written down in a better way. People who live in the home have had more holidays. The home writes down more information about complaints that are made. This shows that the home listens to people who use the service. It is easier to see what checks are made before staff start working in the home. This shows that the home protects people who use the service. What the care home could do better The information that people receive before they go to live at the home should include the full cost of services not covered by fees, in order to protect the rights of people who live in the home. A place to store particular medication that people living in the home should be provided, in line with changes in the law. The manager should apply to be registered so the home continues to develop. The current manager has been registered with us previously and said she will be applying to register. 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 Laurie Stride Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 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 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service have their individual needs and aspirations assessed. The written statement of terms and conditions that each individual has needs to be updated and include the full cost of services not covered by fees, in order to protect the rights of people who live in the home. Evidence: The home has an admissions policy and procedure and the manager reported there have been no new admissions since the last inspection. One person had moved to another placement following a change in their individual needs. During our visit we saw that individuals needs are re-assessed and care plans had been regularly reviewed and updated. Each person who uses the service has a contract stating the terms and conditions of residence and copies of these are kept in their individual files. We looked at a sample of one of these, which stated what the fees include, for example care and accommodation, and what are additional costs such as the purchase of clothing and personal effects. The contract does not inform people that there are additional costs in relation to using the homes transport (see the section on Lifestyle) and a requirement has been made for this to be included. 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 home has made improvements in the way that individuals goals and aspirations are recorded. People who use the service are supported to make decisions about their lives and to take risks in order to promote their independence. Evidence: During this visit we looked at care and support plans in relation to 3 individuals. The records included person centred plans including the use of communication tools and also risk assessments and support strategies for each individual. We saw that the home has made improvements in the way that individuals goals and aspirations are recorded. The AQAA identified that the monitoring and evaluation of outcomes could be further improved. The care plans and support strategies we saw were in individual formats, reflecting the different personalities and wishes of the people they related to. This is good practice. For example one person had stated they did not wish to have a care plan, but agreed to keep a photo album that also contained information about them. More detailed support strategies relating to the individual are kept in another file so that this information is available to staff. At the beginning of our visit we observed a staff team meeting taking place, during which the guidelines in relation to an individuals specific behaviours were discussed. The guidelines were clear and detailed and were being revisited following an incident when staff had observed the behaviour re-occuring. This demonstrated a co-ordinated response to the individuals changing needs. People who use the service indicated in our survey that they always or usually make decisions about what they do each day. They also told us that staff listen and act on Evidence: what people who use the service say. We observed staff interacting with people who live in the home in a friendly and respectful manner. One of the staff talked to us about risk assessments and how risk is part of normal life. The staff member spoke of never dismissing what people want to do, but looking at what steps are necessary to achieve these things. An example given was about one individual wanting to climb a mountain, which presented too much of a risk. The persons key worker arranged a visit to a hill that gave good views from the top and which the individual was able to achieve. This had been recorded for the person to look back on and remember. We had been informed by the home that one person who lives there has a buzzer/alarm outside their bedroom door, which alerts staff if the person leaves their room at night. The service provider had written to Adult Services to get confirmation of agreement about the arrangement. We spoke with the manager who told us that the individual is aware of the buzzer and why it is there. A health professional has identified further planned work to be undertaken with the individual through a male staff member. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are supported to make choices and to develop their life skills. The home ensures that a range of social activities, community access and support with maintaining relationships are available to people. Evidence: The AQAA stated that individuals are supported to attend educational establishments, social and recreational activities. During the day of our visit some of the people who use the service were at the day service. Others were out taking part in various activities of their choice including work experience, shopping and sporting activities. We looked at records of activities and spoke with the manager, senior support worker and another staff member about the opportunities available for people who live in the home. People who use the service indicated in our survey that they can do the things that they want to do during the day, in the evening and at weekends. The AQAA had informed us that one persons day care facilities had been relocated to the home in order to minimise risk. During our visit we saw that the individual was now using the day service again, in line with their wishes and following a review involving external professionals in planning to meet this persons changing needs. During the time the person was not attending the day service, staff had been supporting them to access places and activities of interest, for example using the computer at the local library and at a community centre. We also heard how the individual had become involved in visiting local businesses to report on access for people with disabilities, linked with a local community website. Evidence: Another person who lives at the home does 3 work placements, including a youth centre, a boatyard and gardening. We later heard this person talking to staff about a recent fishing trip they had gone on. A staff member showed us the photographs of another persons holidays and trips to places that they wanted to go, including a cathedral, public gardens and art galleries. Another individual was being supported in their personal development through working on expressing their emotions positively. After taking part in a survey evaluating peoples life experiences (see the section on Conduct and Management of the Home), the manager said that the home is supporting people to use public transport more. One person travels by coach to visit their familiy twice a year. The manager told us that 5 of the people using the service are going on holidays this year and another 2 will be staying with relatives. One of the people living in the home had been seeing family more often in the last year and had a photo record of this. We briefly met a visiting relative who spoke positively about the staff and manager. The manager told us that the home had made the relevant placing authorities aware during reviews that service users pay for the use of the minibus. Those who use the minibus contribute towards an overall cost plus mileage. We advised that this arrangement needs to be stated in the contract of residence. We saw a record of an agreement between the home, a care manager and the individual concerned in relation to the person paying for one-to-one staff support and transport to visit a relative. One of the results of the homes annual service user questionnaire was that people indicated that they would like to try new music and food. Since January the home has held a number of evenings with a different cultural theme and we saw photographs of these and a newsletter describing the evenings. These events and the homes questionnaire promote peoples awareness of diversity. We saw that people who use the service participate in menu planning, which is done during house meetings. As well as menu planning, the agenda for house meetings includes activity plans and individual responsibilities. Photographs and pictures are used to support people making choices and we saw previous menus were kept on file. The manager said they try to provide variety and not to repeat the same menu over each 28 day period. We observed the evening meal taking place in a relaxed atmosphere with staff members providing one-to-one support to individuals as required. 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 . The personal and healthcare support people recieve is based on their individual needs. The procedures for managing medication protect the people who use the service. Evidence: Individualised support is provided for people using the service and support for personal care is recorded in care plans. The sample of care plans we saw included sections about individuals health needs and how these were being met. For example, strategies were in place for supporting one person in relation to drinking fluids and for another person in dealing with their emotions. We saw evidence of recorded key worker sessions, using a comunication tool recommended in a psychologists report. A monthly assessment is undertaken of each individuals daily records, giving a summary of any health issues and appointments, general feedback, activities and relationships. Review notes indicated the involvement of external social and healthcare professionals in planning the care and support provided to people who use the service. A General Practitioner who completed our survey questionnaire told us that individuals health care needs are always met by the service and that staff members respect individuals privacy and dignity. The home has policies and procedures for the management and administration of peoples medication, which the manager told us were last reviewed on 29/02/2008. A staff member described the procedures for checking and giving out medication. Two members of staff take part to make sure that the correct medication is given to the right person. The manager showed us the storage arrangements and told us that there is never more than a 28 day stock of medication held on the premises. There were no controlled drugs being held on the premises at the time of our visit. We informed the manager of the requirement for care homes to provide suitable storage for any controlled drugs that may be prescribed, in line with changes to the legislation. The Evidence: manager said she would ask the pharmacist to visit the home and review the medication storage arrangements. We saw records stating that individual staff members receive medication training and a staff member we spoke with confirmed this. 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 who use the service are supported to express any concerns they may have and are protected from abuse and self-harm by the homes procedures and staff training. Record keeping in relation to complaints and staff recruitment checks has improved. Evidence: We saw that the home has a system for recording any concerns or complaints and action taken. The record showed a concern that had been raised within the home on 21/05/08 and gave details of the action taken by the service to address the matter. This meets a requirement made at the last inspection. The manager and a member of staff told us that, in addition to the complaints procedure, there are regular house meetings that give people who use the service an opportunity to express any concerns that they may have. People who use the service indicated in our survey that they would speak to staff if they were not happy and wanted to make a complaint. The homes records showed that staff training in safeguarding and protecting people from abuse had taken place on 25/02/09. We spoke with one of the staff members, who demonstrated their awareness of the whistle blowing policy and of various types of potential abuse and procedures for reporting. The manager told us that supervision is used to ensure that each staff member keeps up to date with safeguarding and other relevant policies. The AQAA stated there had been 13 safeguarding referrals by the home and 3 meetings. The manager showed us a record she keeps of when and who to any safeguarding concerns are reported. For example during September 2008 a resident was reported as missing and subsequently returned to the home. A risk assessment had been put in place and a procedure activated to alert staff when the person left the property. The situation had subsequently been reviewed and the procedure removed. We had also received notification of reportable incidents. We saw letters from the local authority to the home in relation to re-arranging dates for safeguarding planning meetings. The support strategies for the two individuals involved had been reviewed with the involvement of the community team and placing authorities. Evidence: During this visit we found that staff recruitment records had improved, showing that people who use the service are being protected in this way. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service continue to benefit from a clean, well-maintained and comfortable home environment. Evidence: The home is very spacious and there is a large well maintained garden. Since the last inspection, a wet room and new hoist equipment has been installed in one individuals rooms in order to meet the persons changing needs. The manager told us that new flooring is now on order for the individuals bedroom and new carpet for another persons room. We saw evidence throughout the building of recent redecoration, for example five of the bedrooms including a spare room. The premises were clean and tidy and there were no visible risks to peoples safety. The handrails have been extended on the ramped access to the house via the patio. The AQAA told us that infection control procedures are in place and that a new sink had been fitted in the laundry room. People who use the service indicated in our survey that the home is kept fresh and clean. One person commented that the housekeepers do a good job. 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 . Improvements in the homes staff recruitment procedures mean people who use the service are now better protected. Staff receive training to ensure that they can meet the individual needs of people who live in the home. Evidence: The previous inspection report identified a requirement in relation to staff preemployment checks and supervision. During this visit we looked at personnel records in relation to two staff members who had been employed since the last inspection. Each individuals record contained a completed application form, two written references, Criminal Records Bureau (CRB) and evidence of PoVA First (Protection of Vulnerable Adults) checks. One staff member had commenced work following the PoVA check and prior to completion of the full CRB check. We saw that the home has devised a pro-forma on which the risk assessment and supervision arrangements are recorded in such instances, which is in line with the regulations and meets the previous requirement. The manager told us that, since the beginning of this month, staff members are now randomly selected and asked to sign statements confirming that their CRB status has not changed. This is particularly relevant to long-term employees and is another way in which people who use the service are protected. During this visit we saw the record of the training undertaken by staff and individual certificates were held on file. Training provided in the last year included First Aid, Fire Safety, the Mental Capacity Act, Assertiveness, Valuing People, Positive Approach to Managing Mental Health, Safeguarding Adults. Staff also received specific training in managing challenging behaviour and refresher courses from the service provider between April and November last year. The service documentation indicated that the service provider undertook the relevant Instructor re-certification course in June 2008. Food Hygiene training certificates are kept in a separate file for environmental health inspections. Team meetings are also used as training events and for discussing support strategies for individuals living at the home. We observed part of such a meeting Evidence: taking place at the beginning of our visit. A General Practitioner who completed our survey questionnaire indicated that the care staff always have the right skills and experience to support individuals social and health care needs. We spoke with a member of staff who confirmed they had received training in Moving and Positioning, First Aid, Fire Safety, Food Hygiene, Infection Control, and Medication (handling and administration). They also mentioned Autism, Mental Capacity Act, Managing Challenging Behaviour, Active Listening and Hoist training and told us they were currently completing the NVQ level 3 (National Vocational Qualification). The AQAA stated that all but one of the staff team have either completed or are working to achieve NVQ3. The staff member said that the training programme is very good and is tailored to meet the needs of individuals who use the service. They told us that they have formal supervision with the manager once a month. People who use the service indicated in our survey that the staff always treat them well. 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 . Improvements have been made to ensure that procedures are adhered to and all relevant records are kept in the home, to demonstrate that the home listens to and protects people who use the service. The service still needs a registered manager in post to ensure that this legal requirement is met and service development is sustained and ongoing. Evidence: We met one of the service providers and the manager and asked them for an update on plans to register a manager, as the home has been without one for two years. We were shown emails dated between September 2008 and February this year indicating that advertisements for a registered manager had been made - locally at first and later through a national publication. We were informed that interviews of two applicants had taken place in March but that neither person had been suitable for the role. The manager has been registered with the commission previously and told us that she will be applying for registration. The service provider confirmed this and told us that the manager is enrolling to do the NVQ level 4 Registered Manager Award. The home has a senior support worker who has an NVQ level 4 in care qualification. During this visit we found that two outstanding requirements had been met. Two requirements were made as a result of this inspection, in relation to the homes statement of terms and conditions and upgrading the medication storage facility. The homes AQAA had lacked detail in terms of plans for further improvement and the manager agreed that more information could be included in the relevant sections. The homes own documentation stated there is a development plan that was last reviewed and updated in December 2008. We saw a sample of the homes annual service user questionnaire, completed between December 2008 and February this year. The Evidence: questionnaire is in a user friendly format and included an explanation of the methods used to communicate with and support the individual to complete it, for example specific sign language and picture cards. Action plans had been developed as a result of the survey and some of these were recorded as having been completed. For example a holiday had been booked, new bedroom items purchased and a gardening project started. We were also shown examples of a survey looking at peoples life experiences, developed by the British Institute for Learning Disability (BILD), which the home took part in last year. The survey provides a measurement of how aspects of the lives of people using the service compare with general social trends, for example how frequently public transport is used. We were told that as a result of the findings the home is supporting individuals who wish to use public transport more to do so. Also that there has been an increase in the number of holidays individuals have. The home last conducted a relatives questionnaire in 2005 and the manager said that this had been discussed at a management meeting and the home is planning to restart these. We saw letters that had been sent to relatives, asking them if they would like to be involved in reviewing the homes policies. We saw there had been a positive response to this and we were told that the date for the first meeting in May had now been decided and the relatives would be informed by letter. The relatives of people who use the service are also invited to attend and provide feedback at care reviews. The AQAA stated that quality questionnaires have twice been circulated to the sponsoring authorities and are also handed out at care reviews but that no responses have been recieved. The AQAA also told us that the views expressed about the service by family and professionals are always very positive. During our visit we spoke with a visiting relative who told us that the manager and staff team are very welcoming. Asked what does the service do well, a General Practitioner who completed our survey questionnaire said: I have no concerns and find the service to be excellent. We saw that the records of fire alarm and related systems tests were up to date. Since the last inspection the fire risk assessment had been updated using a template obtained from the fire and rescue service. A risk assessment had also been carried out in relation to the garden pond. Records of gas appliance servicing and portable electrical appliance tests were also on file. 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 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 5 5 Individual contracts must 08/07/2009 include details of the cost of services not covered by fees, such as the costs for using the homes transport . This is to ensure that the rights of each person using the service are protected. 2 20 13 The home must make sure that a suitable storage facility is available for any controlled drugs that individuals may be prescribed, in line with changes to the legislation about peoples medication. 08/07/2009 This is to ensure that the proper and legal safeguards are in place when care workers give controlled drugs to people who use the service. 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 Helpline: Telephone: 03000 616161 or Textphone : 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) Commission for Social Care Inspection (CSCI). 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. 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