Care Home: Budge Lane (31)

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What the care home does well The outcomes for people who use the service are good. The staff team are well supported and trained to ensure that they meet the needs of people who live in the home. People who use the service are offered choice at a range of levels, this includes what they want for breakfast or where they want to go on holiday. People who use the service all looked well groomed with a range of appropriate clothes available to choose from. People`s activity plan is tailored to their needs, preferences and wishes. There are a range of activities on offer that all take place in the community, this includes sports, going to the cinema, meals out or attending the local church. What has improved since the last inspection? There have been two main areas of improvement within this home that have had a significant impact on the people who use the service. Firstly, there has been a permanent manager in post since the summer of 2009; Ms. Rix is also in the process of becoming registered with the Commission. This has resulted in the home having a direction and a strategic overview which it has lacked for some considerable time. As a consequence, supervision is now being undertaken regularly, staff are being trained, all documentation has been reviewed and updated, and there have been significant changes to the fabric of the home. The manager should be commended for these improvements. Secondly, the manager has been able to appoint a number of permanent staff and has been able to retain them. This will have had a significant improvement on the care of the people who use the service, and ensured that issues of dignity are maintained. What the care home could do better: There are areas that this home needs to focus on. Firstly, three out of the six people who use the service are on special diets to increase thier weight. It is therefore vital that thier weight is monitored on a regular basis to ensure health and welfare. Secondly, all staff need to be reminded of the administration of medication to ensure that errors are minimised and that the safety of people who use the service is maintained. Key inspection report Care homes for adults (18-65 years) Name: Address: Budge Lane (31) 31 Budge Lane Mitcham Surrey CR4 4AN     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: Rin Saimbi     Date: 2 4 0 2 2 0 1 0 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: Budge Lane (31) 31 Budge Lane Mitcham Surrey CR4 4AN 02086405206 F/P02086405206 budgelane31@walsingham.com www.walsingham.com Walsingham care home 6 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (CRH - 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 - Code LD Date of last inspection Brief description of the care home 31, Budge Lane, otherwise known as Wandle View, is a residential care home for up to six adults with learning difficulties, who also have physical disabilities. The accommodation compromises of a single storey bungalow, which is specifically adapted to meet the needs of people who use the service. Each person has their own bedroom, two of which, meet the size requirements for people who use wheelchairs to mobilise. There is a large communal lounge to the rear of the building and a secondary smaller lounge. In addition, there is a separate dining room, kitchen, laundry, staff sleeping-in room, and office. There is a large enclosed, lawned garden to the rear, and a smaller garden at the front of the building. The bungalow is on a small estate, which is made up of private, and housing association property. The nearest Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 0 1 0 5 2 0 0 9 Brief description of the care home shops are some 15 minutes walking distance away. The bungalow is sited between Morden and Mitcham. Public transport links are limited, although the home itself owns two specifically adapted vehicles. The bungalow is owned and managed by Walsingham, who are a registered charity who have a Christian ethos. Placing authorities are advised to contact the home directly regarding the costs of the placement which are tailored specifically to an individuals needs. 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: This was an unannounced visit that started at 9.40 am and finished six hours later. The inspection took the form of meeting with the majority of people who use the service, and as many do not have any verbal communication there could be no direct discussions about the service and what they thought of it. Instead we observed people who use the service and their interaction with staff. We also received five completed staff questionnaires about the service and the management. In general, staff felt that they were supported and that they were able to meet the needs of people who use the service. Comments included we meeting and protecting the service users and they do strive to safeguard the service users interests and rights. There was a tour of the buildings communal areas and some of the bedrooms, which Care Homes for Adults (18-65 years) Page 6 of 28 was only undertaken with permission of people who use the service. We looked through documentation, which related to people who use the service to make sure that they were relevant, accurate and up to date. This case tracking ensured that all documentation relating to two people was checked thoroughly. We also checked documentation coming into the Commission, so that this report reflects the home over the year, rather than a snapshot of findings on the day of inspection. We would like to thank the people who use the service and staff for their time and cooperation during the inspection process. 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: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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. There was evidence that the home goes through an appropriate process before admitting any new person into the service. Information is gathered from a variety of sources and consideration is given to people already living within the home. This should ensure that any new person does not feel that they are just being slotted into a vacancy, but that it is the right place for them. The staff team have a range of skills and experiences, and are able in general, to communicate effectively with people who use the service and therefore meet their needs. Evidence: The home last admitted a new person into the service in January 2007. Records of this introduction were seen at previous inspections. The process was that after the home was identified as a possible placement, information was gathered from a number of professionals and then an introductory process was started. The introductory process consisted of meal visits and overnight visits before a meeting Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: was held to decide if the placement was suitable. The home also completes its own paperwork in preparation for someone moving into the home. This assessment is a comprehensive document which outlines every aspect of someones life, including thier likes, dislikes, family and friends. We also looked at information which is in the Statement of Purpose and Service Users guide, both these documents tell people who use the service what they can expect if they were to move in. Both these documents were written in a way that would be understandable to people who use the service. The existing staff team within the home have a range of experiences and skills, and come from a variety of minority ethnic groups. In addition, the home has been successful in appointing one male member of staff. People who use the service have a variety of communication methods, including some speech, Makaton and gestures; all are able to make their wishes known. Staff were generally aware of how people communicated, and were able to respond appropriately. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider has an ethos of involving people who use their service so that they can take control of their own lives as much as possible. Risks are taken in an informed way. Plans are drawn up between the home and people who use the service which outlines needs and goals, these are reviewed on a regular basis, and services to the individuals are delivered on this basis. Evidence: We looked at all the information relating to two people who use the service, and then we spent time with them; this is known as case tracking. Both individuals had a document known as a whole life risk assessment completed within the last year. This document was subdivided into categories, for example the home environment, eating and drinking and vulnerability to abuse. It was a well thought out, comprehensive and up to date document. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: In addition, both people had a care plan; this plan describes how the person would like to be supported in every aspect of their life including transport, mobility, what they like to do when they are woken up and how they like their food prepared. Each category stated whether the person had the mental capacity to make these decisions. This document is reviewed on a regular basis. The home has introduced Person Centered Plans (PCPs), at this stage everyone who uses the service has a basic plan which highlights their hopes, dreams and aspirations. The lack of trained facilities has hampered the extension of PCPs, although the manager did state that staff will soon be undergoing training in this area. People who we had case tracked had had their Social Services reviews, within the timescales, however, there was an issue regarding minutes of these meetings which the home has not yet received. Information that relates to people who use the service is kept within the main office; individuals can access their own files if they wish, although in reality this tends not to happen. In discussions with staff, there was an understanding and awareness of confidentiality and how to put it into practice. People who use the service are encouraged to participate in the day- to- day running of the home. This includes attending the staff meetings if they wish; one person has completed training regarding being on interview panels; there are two people who are part of Walsingham against cotton wool group which is facilitated independently of the home, and is to encourage involvement and participation of people within the service. Care Homes for Adults (18-65 years) Page 13 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 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 offered the personal support they need to live ordinary and meaningful lives. They are able to be a part of the community and participate in leisure activities. The daily routine within the home respects the rights of people ensuring individuality, dignity and promoting a sense of well being and independence. Evidence: We looked at the weekly activity sheets for people who use the service and found that their commitments are all different dependent upon what they like doing. One person enjoyed going out and therefore they had sports, shopping, meals out and going to church. Whilst another person who was in their 70s was choosing to slow down and tended to be home based with the occasional outing to tea dancing or a meal out. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: We looked at the daily log for everyone in the service which confirmed the levels of activities undertaken. In general, all staff are completing the log in a meaningful way and that the information is up to date. It is planned that everyone in the service will go on holiday over the summer months. Last year for the first ever a number of people who use the service went abroad or on a plane. The manager stated that those who did not get the opportunity last year to go abroad will be able to this year, depending upon thier individual finances. Everyone has a room key available to them for their bedrooms, although none are able to effectively use them themselves. Staff were observed to knock on bedroom doors before entering. A number of polling card were viewed, this was evidence that people who use the service were registered to vote. Family and friends are welcome to visit at any time, the home attempts to maintain family links and relationships where possible. In reality, three people who use the service do not have any meaningful family contact. The home does use an advocate for one of these individuals, but the advocate only has limited contact. Decisions about meals are made on a weekly basis, we were told that no one is really able to make an active choice about what they eat, despite the home using various techniques to gauge responses. Instead, decisions about food are made on a trial and error basis. All evening meals are made from scratch, although the home does have take-aways from time to time. There are three people within the home who are on special diets; a dietitian is involved to monitor thier progress. Care Homes for Adults (18-65 years) Page 15 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. In general, the home provides people who use the service with the support that they need regarding health care, these needs are often very complex. The support provided by staff is undertaken in a way that should enhance peoples privacy, dignity and independence. Evidence: Medication comes into the home from the Pharmacist in blister packs for ease of identification and monitoring. None of the people who use the service are able to self administer. Medication is stored in a locked metal cabinet secured to the wall, within a further cupboard, which is also locked. Boots the Chemist audit medication on a regular basis, the last audit was in May 2009 which found no major concerning issues. The storage and records for medication were checked and no omissions were found. We were informed that there is a practice within the home, that a trained member of Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: staff gives medication, and then a second member of staff checks at a later stage that medication has been given. It was observed on the day of the inspection, that the second member of staff supposedly checked that the medication was given whilst sitting in the lounge some three hours after it had been administered. This practice is not appropriate and does not ensure the safety and well being of the people who use the service. A requirement is therefore being made that medication is only administered within the remit prescribed by the Royal Pharmaceutical Society. Staff were asked questions about how they would maintain privacy and dignity; they were able to give appropriate examples, and their practice was observed in the inspection process, which confirmed what they did. Key workers take people who use the service out, in order to purchase clothes and personal toiletries; it was evident from the contents of individual wardrobes that each person had very personal choices about their likes and dislikes. With regards to health care, people who use the service are supported with their health appointments, these include to the dentist, opticians and chiropodist. Outcomes from these appointments were generally recorded. As two of the people who use the service have a significant visual impairments, a recommendation was made at the last inspection that the home seeks advice from the local authoritys sensory impairment team regarding technical equipment available. This has been undertaken by the home. There is an expectation that people who use the service have their weight monitored on a monthly basis. This is a way of ensuring peoples well being is maintained, particularly if they are unable to make their needs clearly known. This is particularly important as three out of the six people who use the service are on special diets to maintain their weight. This had been addressed at the last inspection, however it was noted that for one person their weight was checked in November and then not again until February. A requirement is therefore being made that for those people where weight is a concern that it must be monitored on a monthly basis at least, to ensure their welfare. Care Homes for Adults (18-65 years) Page 17 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. There is a policy available to people who use the service, their friends and familys allowing for them to make complaints. This should ensure that people who use the service feel that their views are heard and taken seriously. Evidence: The home has a clear complaints policy, which includes the response time if a complaint is made. The home has in addition, its own complaints policy, which is written specifically for the people who use the service in plain English and using symbols. We saw evidence that these complaints forms are used by people who use the service. The home has a general policy and procedure for adult protection and whistle blowing. The home also has a copy of Suttons policy and procedure for protecting vulnerable adults. During staff interviews, there was an awareness and understanding of the issues relating to vulnerable adults. A requirement made at the last inspection that staff needed to have refresher courses regrading adult protection has been met, this was evidenced by attendance certificates and during discussions with staff. Care Homes for Adults (18-65 years) Page 18 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. People who use the service are able to express their individuality within their environment. In addition, there are adaptations to the home and equipment provided that enables the people who use the service to be as independent as possible. The home is generally well maintained, providing a comfortable, clean and homely environment. Evidence: The home is located on a small estate, and in general, is in keeping with the local surroundings. We had a tour of the building, and for some of it we were accompanied by one of the people who use the service. The interior of the building is much improved from the previous inspection, thus ensuring that people who use the service live in a homely, clean and comfortable home. The refurbished bathroom has now been installed with a new bath that can be accessed by people who use the service; The home has acquired a new dining room table and chairs and the garden has been re-fenced. The manager stated that on closure of two other homes nearby, they will acquire newer furniture. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: The building itself has level access throughout with the inclusion of ramps and handrails for those with decreased mobility. There are various adaptations and aides present including, overhead tracking in two of the bedrooms and in the bathrooms; within the kitchen, work surfaces accessible for those in wheelchairs power sockets and light switches in places that are easily accessible. All the bedrooms were personalised with photographs of the people who use the service, friends and family. The rooms all reflected each persons interests and likes. We noted that in one of the bedrooms, a drawer front had fallen off, and that one of the taps at the sink was loose. The manager stated that both these issues were being dealt with; a different wardrobe was going to be supplied and that a plumber had already been called. Care Homes for Adults (18-65 years) Page 20 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. Staff receive support via training and supervision, giving them the skills that they need to undertake thier work; they are knowledge and experienced. Evidence: We looked at several sets of staff rotas which showed that in general, there was an adequate level of staff working at the home at any given time. This ranged from three to five staff on duty during the day depending upon the activities that were being undertaken. At night there are two members of staff on duty; a waking night and someone sleeping in. In the past, this home has had issues retaining permanent managers and staff. At the time of the last inspection, it was not unusual to find that there was only one member of permanent staff on duty with two agency staff covering a shift. The situation has improved significantly, four new members of staff have been appointed including a male member of staff. Agency staff are still used, but tend to be one of two people covering two or three shifts per week. There is a vacancy of a deputy manager in the home, but this is post is being held open pending the closure of two other nearby homes. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: With regard to training of staff, we checked three files and found that staff had completed between six and eight days training in the previous year, this included safeguarding training. This is much improved from the previous inspection when no training had been undertaken by staff. The level of National Vocational Qualifications (NVQ) is rising significantly within this home, with nine permanent staff now having completed thier NVQs. We looked at the levels of staff supervision, in general sessions are taking place on a monthly basis, the sessions are recorded and signed by both parties. Staff were also able to confirm this during discussions and via completed survey forms that we received. Recruitment records of staff are kept centrally by the provider, this has been agreed by the Commission. The Commission on a regular basis audits these records Care Homes for Adults (18-65 years) Page 22 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. The calibre of the manager is critical to the quality of care that is provided to people who use the service. The appointment of a new manager has had a significant positive impact on the outcomes for the people who live in this home. Evidence: Ms Hailey Rix became the permanent manager of this home in July 2009, she is in the process of becoming the registered manager with the Commission. Ms. Rix has considerable experience of working with the people who live in this home, having worked there since October 2005. Ms. Rix is being supported in her role by the regional manager and by another manager of a service that is located nearby. Ms. Rix is the first permanent manager that has stayed in post for a considerable number of years. This absence of a manager has had an impact on the home in that it has lacked a strategic overview and direction. However, Ms. Rix has already undertaken many significant changes within the home which has ultimately improved the outcomes for people who use the service. Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: We checked the documentation relating to safe working practices and in general these were up to date. There was exception, in that the Legionella test was out of date, and that although the Landlords gas certificate had been completed there was no actual certificate to verify this information. Whilst touring the building it was noted that the Control of Substances Hazardous to Health (COSHH) cupboard was unlocked. The manager was aware of this and was awaiting a visit from maintains to repair the lock. With regard to quality assurance, the home employ an independent person to undertake Regulation 26 visits. The records for this year were available for inspection purposes and were up to date. Care Homes for Adults (18-65 years) Page 24 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 25 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 1 19 12 The registered provider must ensure that for people were weight is a concern, that it is monitored on a regular basis. This is to ensure the health and welfare of people who use the service 25/03/2010 2 20 13 The registered provider 25/03/2010 must ensure that medication is administered in line with Royal Pharmaceutical guidelines This is to ensure the health and welfare of people who use the service 3 42 12 The registered provider must maintain up to date Legionella testing This is to ensure the welfare of the people who use the service 25/03/2010 Care Homes for Adults (18-65 years) Page 26 of 28 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 42 The registered provider needs to ensure that the COSHH cupboard is locked at all times. 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. 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