Care Home: Chandos House

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What the care home does well The `Have your say` survey comments from people at the home show that there is a comprehensive admission procedure where introductory visits take place. People said that they received detailed information supporting them to make decisions about their admission to the home. Surveys asked people about making decisions and the comments received indicate that their day is structured around group work and recreational activities are on Fridays and weekends when there is a more relaxed atmosphere. Other comments received confirm that people know who to approach with complaints and staff have the skills to meet their needs. Comments from individuals included ` The staff have always got time for everyone and you can book 1:1 sessions,` `I made the right choice to come here` and `I know the house offers the practical help that I need to treat my underlying addictive behaviour.` What has improved since the last inspection? People wishing to use the service have clear detailed information provided to them so they make an informed decision about whether the treatment centre can meet their individual care needs. The service provider continues to make repairs to the property ensuring that people stay in a homely environment. What the care home could do better: There are five requirements arising from this inspection and relate to care planning and associated risk assessment, and training for staff. Written care plans about the way the home meets the individuals needs must be formulated and must show that people have input into planning their care. This will confirm that there is a personalised and consistent approach to meeting needs. Risk assessments for activities that involve and element of risk must be devised and must include the options available for each element with an action plan on the way the risk is to be lowered. Policies and procedures that demonstrate the home`s commitment to safeguarding people must be reviewed to inform staff about the implications for not reporting poor practise. Staff at the home must attend safeguarding adults training to ensure they know the factors of abuse that the actions they must take when reporting alleged abuse. Application forms must seek from candidates any criminal convictions to further assess their character and integrity. This will ensure that the people employed are suitable to work with vulnerable adults Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chandos House 36 Chandos Road Redland Bristol BS6 6PF     The quality rating for this care home is:   two star good service 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: Sandra Jones     Date: 0 1 0 7 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 30 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Chandos House 36 Chandos Road Redland Bristol BS6 6PF 01179243071 01179243071 info@chandoshouse.org 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) : Ms Joyce M Dickinson care home 10 Number of places (if applicable): Under 65 Over 65 0 0 past or present alcohol dependence past or present drug dependence Additional conditions: 10 10 The maximum number of service users who can be accommodated is 10 The registered person may provide the following category of service only: Care home only - Code PC to male service users whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D Past or present alcohol dependence - Code A Date of last inspection Brief description of the care home Mrs J Dickinson is registered with us as the owner of Chandos House which provides secondary care residential treatment for up to ten males, aged 18 - 65 years who are recovering from drug and alcohol dependency. The service is committed to the twelve-step programme provided in a holistic environment which uses counselling and a range of other therapies. Residents are expected to participate in the activities programme to assist them in regaining structure and a sense of wellbeing in their lives. This includes group and individual therapy sessions, as well as focusing on life skills. Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home Chandos House is not intended to be a home for life and an average stay lasts no longer than six months. The service is not staffed during the evening or at the weekends. However arrangements are in place to give support in the event of an emergency. The home is a large Victorian house which has four floors. There is no lift facility and but some adjustments have been made to assist wheelchair users. The home is in a residential area, close to local amenities and major transport routes. Fees are currently in the range of £450-£780 a week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was conducted unannounced over two days in June/July 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection. This information was used to plan the inspection visit. Have your say surveys were sent to the people using the service and five were returned by the people accommodated at the home. Care Homes for Adults (18-65 years) Page 6 of 30 The three individuals accommodated at the time of the inspection were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings. The views of the people living at the home and staff were gathered through face-toface discussions. 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 Care Homes for Adults (18-65 years) Page 8 of 30 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by information and visits to make decisions about going to the home for a period of rehabilitation treatment. The information provided is detailed and would enable people to make decisions about staying at Chandos House Evidence: Chandos House is a second stage treatment centre for people recovering from drug and alcohol addiction. It has a holistic philosophy where psychological, physical and spiritual approaches to change and recovery is used. The age range along with the criteria for admission is listed within the Statement of Purpose. It was reported that part of the admission process is face to face assessments based on motivation, commitment and willingness to remain drug and alcohol free. Information is detailed and any person wishing to use the service can make decisions about receiving treatment. Information about the assessments conducted would benefit from more detail. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The manager said that pre-admission assessments are done by senior staff to determine the suitability of the person for admission. Admissions are generally through Local Authority referrals and needs assessments are provided by them in advance of any admission. In-house assessments are done by the staff and include risk assessments that seeks the individuals past and present history of addiction, behaviours that challenge, criminal history and mental health care needs. Additional information about health and medication is also sought during this period. Contracts and house rules are signed and dated by the person during the assessments. Care records show that placements are based on information received through documentation provided by the organisation making the referral and on a 24 hour assessments conducted in the home. People using the service have input into each potential admission, significant events forms are used to express their views about the person seeking admission to the home. People accommodated at the home were consulted about the admission process followed by the home. They told us that Chandos house was recommended by previous residents who have remained free of addiction. People said that they liked a male only environment because they would be more likely to focus on their recovery and not on developing relationships. We were told that informal introductory visits take place and the information provided ensures that they are able to make decisions about programme offered by the home. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Chandos House are able to make decisions about all of aspects of their lives. Care plans must be crucial to providing consistency and monitoring the progress of the treatment programme. Risk assessments must contain action plans on the way the level of risk is to be reduced. Evidence: The manager said that the care planning process is a group approach process because of the secrecy characteristics of people with addiction. It was explained that there are 8 treatment aims which is achieved through group therapy, 1:1, complimentary therapies, workshops and written assignments. Group therapies occur three times per week, 1:1s are weekly for the first four weeks. We were told that application forms are completed by the person and during their 1:1 assessment social, medical and psychiatric needs are sought along with drug and alcohol history. However, assessments forms were not compiled for the people Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: currently staying at the home. We were also told that people at the home must engage on the 12 step programme to stay at Chandos House which is complimented by group work and external support groups such as AA/NA. Weekly groups are held, where individual goals are set and significant events forms are completed each day by the person about how they are feeling. The records of the people currently using the service were examined and care plans do not currently reflect the structure described or the work undertaken with the staff to achieve the programme. Records must show the programme plans followed for each person so that progress can be monitored and where appropriate make amendments to the plan of care. While progress notes from the group work and weekly treatment plan goals are set, the action plans must be devised to draw together the programme plan. People at the home have the capacity to make decisions and the manager told us that it is essential for people wishing to use the service, to be able to make informed choices about the treatment programme offered. There are ground rules which impose restrictions and the manager must ensure that people using the service are clear about them so that they can make decisions about the treatment programme. A risk assessment check list is completed during the assessments about criminal past, history of addiction, behaviours that challenge and mental health care needs. Where a need is identified, a more detailed risk assessments must be completed. The level of risk and the options available to lower the risk with an action plan must be devised. Feedback was sought from people at the home about the care planning arrangements of the home. Two individuals explained that there was an expectation that people work through the 12 step programme, there is group work which provides coping strategies and goal setting operates as a reviewing mechanism. We were also told that there is care file and they have access to it. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for the people at the home to shape the lives they live. People are able to learn new skills and are as respected as individuals . People have a good diet. Evidence: The manager said that complimentary therapies are daily and used as a means of relaxation which include Yoga and Shiatsu. There are weekly recreational activities are usually on Fridays, weekly community meetings; career guidance with after care support forming part of the treatment programme. Recreations, education and occupation is not currently part of the care planning process at the home and must form part of the care planning process. This will show that people have input into shaping their lives also underpinning the aims Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: and objectives of the home. A welcome group is held each Tuesday for people on 24 hour assessment, people using the service and people on after care. Its a secure forum where people have an opportunity to express their feelings and anxieties about the programme; share information, closing with positive affirmations about the person. There is a 7 day boundary where people recently admitted are accompanied and outside of this structure people are free to leave the property. People must return by 11:00 pm during the week and at weekends the regime is more relaxed. Where people do not return at the specified times the missing person procedure is put into effect. The manager told us that planned visits are welcome during specified times and must occur in shared space. People staying at the home must give 7 days notice for home visits and during group work people must negotiate and make arrangements for these visits. It was also stated that because visits are planned whenever objections arise, people can negotiate and 1:1 space may be provided. There is an expectation that people undertake household chores which is undertaken each day. This we were told is for people to assume responsibility and personal accountability in a structured way, developing respect for their surroundings. The manager was asked about the way people are treated as individuals and the expectations of the people living at the home. It was stated that on Thursdays there is a menu planning meeting where household duties are set in terms of allocating tasks for the shared areas. People are treated as individuals by the provision of 1:1s, heath care visits are in private and mail is handed unopened. We asked people at the home about opportunities available to shape the lives they live. One person explained that activities occur twice weekly and Fridays is a designated relaxing day away from the home. Visitors are welcome but not overnight and they can arrange for visits from their children. At the weekly community meetings people at the home make decisions about household chores and menu planning. There is an allocated budget that is controlled by one individual accommodated at the home with responsibility for food shopping. Another person said that there are complimentary therapies , there is an expectation that people undertake household chores, they said if you live here you have to keepit clean. It was explained that a housekeeper is appointed and in charge of the money for shopping, there is a rota for cooking and cleaning. This individual also confirmed that there are house rules and these were explained. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: The menus are planned daily and food served is recorded along with fridge and freezer temperatures. However, a record of cooked meat is not currently maintained. A record of all cooked meat must be maintained. The home caters for special diets including vegan. Comments from people at the home together with the records of food provided confirm that a varied and health diet is served. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at the home are independent with personal care and are able to make individual arrangements to see health care professionals. Evidence: The people at the home are able to undertake their own personal hygiene and it is not necessary for personal needs to be part of the care planning process. The Code of Conduct says that people receiving a service must discuss their health care needs and medication with the staff at the home. The manager told us that when people arrive they register with the local GP practise, the staff direct people to request a check-up and where appropriate review of medication. The people currently accommodated confirmed that they are registered with a GP and are able to make individual arrangements to visit the GP. We were told that generally medications are administered by the staff during trial periods and once the period has lapsed they are given more control of their medications. People are then given a small supply and medication records are signed Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: by the person receiving the medication and staff handing the medication. Homely remedies are not currently administered from a stock supply by the staff . The manager told us that consideration is being given to having homely remedies mainly painkillers for people when required. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns and complaints raised by the people using the service are taken seriously, acted upon and safeguarded from abuse. Evidence: The homes Complaints procedure describes the process and stages of the procedure. In the first instance the staff will aim to resolve complaints and for more formal complaints a written report must be submitted. The manager will be including a statement supporting that complaints are valued as a form of feedback. The procedure confirms that complainants will be informed of the outcome and listed are the external bodies including CQC that can be for unresolved complaints. The Whistle Blowing policy reassures staff that they will be protected from reprisals. While the essence of the procedure is to make staff people feel safe to report poor practise, the implication for not reporting are not specified if they then do not report poor practise. The procedure must specify the consequences for staff that witness poor practise and do not report it. The Safeguarding Adults procedure currently in place requires updating, the manager must make clear the actions to be taken for reporting poor practise. People accommodated were asked about who they would approach with complaints Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: and The people consulted said that a complaints procedure was available and feedback is sought during house meetings. Another person said that there are two types of complaints, informal where staff make every effort to resolve complaints at a local level and most commonly used by the people at the home. Formal complaints are recorded and are dealt with at a much higher level. People at the home were also asked about protection and they said that they felt safe at the home. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is homely and decorated to an adequate standard. Where potential risks are identified action must be undertaken to lower the level of risk. Evidence: Chanos House is a large period property in the centre of Bristol close to shops and bus routes. It is arranged over three floors with communal space in the basement and bedrooms on the ground and upper floors. There are four double and two single bedrooms providing accommodation for up to 10 people. It is evident that the service providers undertakes repairs of the property to provide a homely environment to the people accommodated. However, further remedial action is required. The windows in the upper floor are not fitted with window restrictors and can be opened fully. The manager must ensure that window restrictors are fitted to prevent people from falling. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment process must be more robust to ensure that the staff are suitable to work with vulnerable adults. Training must be improved to ensure the staff know the actions to be taken to protect people from abuse and to maintain their levels of expertise. Evidence: The personnel records of the staff were examined to establish the recruitment process followed at the home. Completed application forms that require a full employment history and the names of two referees were found in place for the staff currently employed. However, staff are not required to disclose any criminal history through the application forms. Application forms must require that candidates disclose any criminal convictions so that their integrity and character can be assessed. Criminal Records Bureau (CRB) checks obtained and two written references confirms that every step is taken to recruit staff who are suitable to work with vulnerable adults. There are three core staff employed at the home and comprise of a Director of Therapy, Business Development Manager and Councillor. The home is staffed during normal working hours and outside these hours there is an on-call system in operation. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Since the last inspection the manager has undertaken Health & Safety, First Aid, Diversity & Equalities and Medication training. However, Safeguarding Adults training and specific training that maintains the level of expertise has not been provided for the staff working at the home. The people at the home were asked about the staff and we were told that the staff were OK and that they understood what the people in the programme were going through. One member of staff was asked about their role at the home, we were told that part of the role is to empower people to make decisions. There is a 12 step programme, goal setting and during the settling-in period 1:1 with the person is structured and planned. Workshops, 1;1 counselling and group therapies are provided to assist people to recover from addiction. This member of staff explained their qualifications for the role and acknowledged that more training could be useful. Supervision, we were told occurs with the Director of Therapy and is used to discuss issues and performance. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at the home receive a reliable service because the records were kept up to date and they are reassured that standards are subject to ongoing monitoring. Evidence: The manager was consulted about the direction the home will be taking. We were told that providing a valid service for men while enhancing practise and developing networks with outside agencies were ways in which the aims and objectives of the home will be achieved. Complimentary therapies and boundaries ensure success of the programme, clarity and inclusively which provide clear direction and maintain consistent standards. A member of staff on duty was asked about the management of the home. We were told that the roles change depending on the issues, its like a dance. It was then stated that Chandos House has a unique place where staff can move in and out with people so they can accept pain, boundaries and spirituality. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: There is a Quality Assurance system in operation in the home and comprise of feedback from people using the service. People complete questionnaires after the first week of admission based on accommodations, Health & Safety, complaints and cleanliness. People also have opportunities to make suggestions through house meetings. It was also stated that the AQAA will be combined with the feedback received to ensure the standards of care can be measured so people can benefit from ongoing monitoring. Fire risk assessments were recently reviewed for the purpose of assessing the potential of a an outbreak of fire in the premises with an action plan to reduce the level of risk are in place. These fire risk assessments could benefit from further development to make clear preventative measures such as checks and practises. Contractors are used to ensure the environment is safe for people living at the home and the staff that work there. Health and Safety, gas boiler safety checks and portable equipment tests are done annually to ensure compliance with associated legislation. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation 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 6 15 The registered provider must prepare a plan on how the individuals needs are to be met. Written plans about the way each person is to meet the programme offered at the home must be developed with a clear input from the person. 25/09/2009 2 9 13 Risk assessments for any 25/09/2009 activity involving an element of risk must be devised. Risk assessments must be developed for each identified risk. The options available to reduce the potential risk with an action plan on the way the level of risk will be reduce 3 23 13 The registered person must ensure that steps are taken to protect people from abuse. The manager must ensure 30/09/2009 Care Homes for Adults (18-65 years) Page 28 of 30 that staff are clear about the actions that must be taken when reporting alleged abuse. The Whistle blowing policy must inform staff of the consequences for not reporting poor 4 34 19 The manager must ensure that details of criminal offences are sought for staff wishing to work at the home. Application forms must request from candidates details of criminal convictions. 5 35 13 The manager must make arrangements by training or other measures that people are protected from abuse. The manager muse ensure that the staff at the home attend Safeguarding Adults training to ensure that every step is taken to protect people from abuse 30/12/2009 03/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose would benefit from additional information about the admission procedure. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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