Care Home: Chant Square (15 &17)

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What the care home does well Individuals living in the home receive a good standard of care and support in this service. Their needs are appropriately identified through good person-centred care planning and reviewing of assessed needs. Individuals are respected and involved in decision making about matters affecting them. They are well supported to lead active lives and staff enable individuals to get involved in activities and leisure pursuits of their choice. The service is consistently well managed and organised. Individuals speak positvely about living in the home and feel well supported by staff, describing staff as helpful. What has improved since the last inspection? Requirements made at the previous inspection have been achieved. Monthly management monitoring visits are occurring and regular fire drills are taking place. What the care home could do better: Requirements have been given to ensure that medication recording and adminstration practises are safe and follow procedures that are considered to be good practise. A number of recommendations are also given in areas where practise could improve in line with minimum standards, including pre-admission assessments by the referring authority, health and safety issues and for the service to produce an annual development plan for the ongoing development and improvement of the service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chant Square (15 &17) 15 & 17 Chant Square Stratford London E15 4RT     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: Nurcan Culleton     Date: 0 6 0 5 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 28 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 28 Information about the care home Name of care home: Address: Chant Square (15 &17) 15 & 17 Chant Square Stratford London E15 4RT 02085190551 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) : sonia.sandhu@east-living.co.uk East Living Limited care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home only - Code 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 15-17 Chant Square is a registered care home for people with a learning disability. The home comprises of a seven- bedded unit (no.15) and a one bedded flat (no.1). The home is situated in Stratford, close to local shops, amenities and public transport facilities. The home occupies two ordinary domestic properties in a residential street. East Living manages 15-17 Chant Square, which is a local care provider and housing association. Care Homes for Adults (18-65 years) Page 4 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: We conducted this unannounced inspection on 6th May 2009 and were assisted by the Regisered Manager throughout. we spoke with staff and two individuals using the service and observed how staff related to people in the home and how individuals were being supported. We examined a sample of individual files and staff files and a range of documents and records, including policies and procedures, health and safety certificates and records. We also took into account the services own self-assessment called the Annual Quality Assurance Assessment (AQAA) and we toured the premises. Care Homes for Adults (18-65 years) Page 5 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 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 6 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 7 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. Individuals using the service have their needs identified prior to their admission and adequate information is given to them about the home. Good effort is put into ensuring individuals settle well into the home. Evidence: The Service Users Guide is available and in accessible form. It is recommended that the Statement of Purpose is also more accessible and user-friendly and that the new Care Quality Commission details are updated in these and all other relevant policies and documents held by the home. We discussed a resident who was the latest to be admitted into the home. There was evidence of the home conducting an assessment prior to the individual being admitted. This included the managers attendance at a series of transition meetings from the previous placement attended by a number of health and social care professionals. admitted last year has dementia. The individual also had a transition plan including a detailed diary of the individuals visits before they were admitted. It is recommended Care Homes for Adults (18-65 years) Page 8 of 28 Evidence: that local authority assessments and care plans are also obtained prior to an individuals admission. The home is able to demonstrate that it is effectively able to support individuals with their assessed needs and is successful in meeting its objectives as set out in the homes statement of Purpose. Individuals have contracts available in their files that include their individual fees. Care Homes for Adults (18-65 years) Page 9 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate plans are in place to meet individual identified needs. Individuals are involved in developing their support plans and plans are person-centred. Individuals are supported to make choices about their lives and their choices are respected. Evidence: Care plans are developed from a person centred perspective, including photographs of family and friends, written illustrations of things that are important to the individual, how the individual communicates, their activities, routines, religion and health. Person Centred Planning meetings occur every six months, looking at goals which are identified during the review meetings. These were seen in individual files along with monthly progress reports as written by the key workers. At the time of the inspection two individuals and two staff had been attending a multimedia advocacy course to help produce multimedia person centred plans. The Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: home have pushed for them to attend several times in order that they develop confidence in contributing to the development of their individual plans. However the manager informed that they would like to extend this participation to all the residents in the home. The manager explained how this would be most beneficial for people who are non-verbal in helping to communicate their plans to them. It was evident on the day of inspection that people in the home are consulted for their views and preferences on the way they wish to be supported. One to one recorded consultations occur with each individual about any significant decsions that are made, for example, how they wish to celebrate birthdays and who with. The manager informed that all individuals have voting cards two people were supported to vote last year. Risk assessments are in place. Adequate risk assessments are in place and are reviewed annually. Care Homes for Adults (18-65 years) Page 11 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. Individuals are offered good support to participate in local activities and join in with community life. Individuals are enabled to access good leisure opportunities of their choice. The food service is very good. Evidence: Individuals are supported to engage in activities of their own choice and ability. This did not include paid or unpaid jobs or college at the time of the inspection. The manager explained that this was given the age range, lack of interest, skills and physical disabilities of the individuals resident in the home. However individuals engaged in activities including attendance at the East Ham Leisure Centre and Newham Leisure centre for exercise and hydrotherapy; a group for rug making and a resource centre. It was evident that individuals had good interactions with the local community, attending the shopping centre at Statford for tea or taking walks in the Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: local park. We were informed of a number of activities taking place in the home also and activities charts were available for each person, including sensory activities and relaxation to music, pampering, reminiscence and exercise. Individuals in the home also enjoyed groups of actors from Tickled Pink Productions putting on shows in the home and four more were planned this year. Many of the residents went to Blackpool last year and some to Wales. These were successful holidays that were much enjoyed by the residents. This year however a holiday had not yet been planned, due to the staffing situation resulting from the recent staff reorganisation necessitating the use of agency staff. The manager explained that more experienced staff were needed who were familiar with the residents before being able to go on longer holidays. However staff will be discussing their views on day trips with individuals, such as going to the sea. The home have use of the community transport in Newham to enable them to take trips out. It was evident through records kept in individual files and the visitors book that individuals maintain links with their family and friends. Individuals are supported to have relationships if this is their choice. The meals provided in the home were healthy and varied and alternative foods are written on the weekly menu. These are planned in consultation with individuals on Wednesdays and include meals suitable to individual ethnic and cultural tastes. Fresh fruit was available on the day of inspection. Care Homes for Adults (18-65 years) Page 13 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported well with their personal, emotional and health care needs, however the administration and recording of medication and the auditing of medication needs to improve to ensure that practises are safe and in line with good medication procedures. Evidence: We observed during the inspection that staff engaged postively with individuals in the home who were treated with dignity and respect. Individual health records are in place, though some of the My Health Matters documents were not fully completed as the manager explained that they are long documents and involve timeconsuming research. Each individual has separate health monitoring folders. These are for any visits to health professionals, recording the reason for the interaction, the outcome and any action required. On the whole, individuals health needs appear to be well met including good liaison with relevant health professions. However we observed one anomoly in one persons file where they had attended attended a clinic and were prescribed shampoo to be used twice weekly, Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: not once daily as was being given by staff. We observed a My Diabetes Information and Resource Pack in one individuals room. We noted however that there was a lack of clear guidance to staff in their health pack as to what was considered to be safe blood sugar levels for the individual and what actions staff should take if their blood sugar levels were high. Some of this information was is in the guidance sheet but not in their individual file. The manager stated that before the individual was admitted to the home staff were trained by the diabetic nurse who had visited the home and spoke to staff. However it is recommended that this guidance should be in the persons individual file. Lockable medication cabinets were available in each room. The Boots Monitored Dosage system is used for administering medicines. Only bank staff have had medication training, not the agency staff who we were informed do not administer medication. The Medication Administration Record (MAR) charts were examined for three individuals. We found two unexplained gaps in one persons MAR chart. There was also prescribed Epaderm emolient for one individual in their room which had not been recorded on their MAR chart. We were told this was no longer being given. In the medication cabinet there were two boxes of Paracetomol precribed in 2008 which was no longer prescribed and needed to be returned. The cabinet also contained a full bottle of shampoo precribed in Feb 2009. The current MAR chart identified this shampoo but stated this at none was supplied. We also found, as stated in the section above, the following: 1. The shampoo entry in the MAR chart seen stated use twice weekly, but was actually been given once daily with no explanation for the change in administration or authorisation for this change from the GP. 2.The MAR chart showed no signature for the shampoo from week beginning 23/03/09, but no record as to why it had stopped being given. Additionally, one individual was taking a herbal rememdy for their health condition. The manager informed that the individual had gone to the home with this herbal rememdy from their previous home and that the GP was aware of it. It is Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: recommended that authorisation is sought from the GP by the home for any herbal medicine and that this authorisation is recorded close to or on the Mar Chart. We discussed the auditing of medication. The manager said that the previous manager was responsible for checking medication on a monthly basis and had left a couple of months ago. The last check seen was completed in March 2009. It is recommended that daily medication monitoring checks take place and that staff are clear about safe medication administration and recording procedures. We further noted five boxes and one bottle of Lorazepam, a medicine given as and when required to assist in the behavious management of one individual. The home must ensure it follows good procedures in the stock control of medicines to ensure that it does not have a surplus in medicines. There were however guidelines available to staff explaining the circumstances in which it was appropriate to give this medicine. Care Homes for Adults (18-65 years) Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are satisfied with their service and their views and concerns are listened to to minimise complaints. There is an appropriate complaints procedure in place that is accessible to people using the service. Evidence: There have been no complaints since the last inspection. The last recorded complaint was in 2006 when a formal complaint was made. This was appropriately investigated and reported. A compliments book was available. This included compliments ranging from a cook to asocial worker, a district nurse and various relatives. One relative said, It is a lovely home with a lovely environment. A review social worker and family psychologist stated The family and professionals felt that the service provided was at a very high standard. All the staff were very caring. There is an approprite complaints and adult protection procedure in place. The complaints procedure is also available in an accessible format. The service needs to ensure the procedures are updated with the contact details of the new Care Quality Commission. Care Homes for Adults (18-65 years) Page 17 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. Residents are provided with a comfortable and pleasant home. Evidence: The envionment is bright, clean, homely and decorated to individual preferences in pastel shades. The home is cleaned by staff and a cleaner comes in once weekly to clean the communal areas. Notice boards in the hallway displayed picture menus of foods selected by residents. In-house and external activities were also shown. Some damage had occurred to the doors due to the impact of the wheelchair and behaviour of one individual which had escalated recently. It is recommended doors are painted and measures are taken to preserve the doors from the impact of any wheelchair damage. Walls had already been preserved by plastic wall coverings. Recommend fire doors are repainted and protected. The Kitchen was clean and foods in the kitchen of the main unit were labelled. However fridge temperatures consistently ranged between 9-10 degrees and went up to 12 degrees. This is against safe temperature limits and it is recommended that the fridge is replaced under health and safety issues in the section under Conduct and Management of the Home. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: On touring the premises we observed that laminated notices were displayed on kitchen cabinets identifying individuals who had difficult swallowing and suggestions of alternative foods to be given to them. The manager who gave her view that the notices were displayed due to the safety issues presented by the lack of permanent staffing at the time and that the notices would be taken down when permanent staff are employed, acknowledging the issues of confidentiality and dignity associated with public displays of personal information. We also observed a number of toiletries displayed on the shelves in the ensuite bathroom of one individual who has dementia. We recommend that these toiletries are put into a cabinet in their room for the safety of the individual, given their dementia. Residents benefit from a large garden that is well maintained by external gardeners. Care Homes for Adults (18-65 years) Page 19 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. Individuals benefit from receiving a service from staff who are safely recruited, appropriately trained and regularly supervised. Evidence: At the time of inspection there was a proportionately high number of agency staff due to an organisational restructure where staff had to apply for their jobs. Some staff had taken redunancy, others transferred to alternative homes within East Living. The staffing structure has also changed. There were eight vacancies which were being filled by using agency and bank staff and the home were in the process of recruiting permanent staff. However the manager informed that for the sake of maintaining consistency in staffing they had used only one agency who had been sending the same staff to the home. The home were also using two consistent bank workers. Bank and agency staff had received previous experience of social care in a residential environment. Only the permanent staff were key workers to the individuals in the home. Four staff files examined contained all relevant documents, including Criminal Record Bureau checks, identification, references and health clearance. They also showed that staff have annual appraisals and monthly or six weekly supervision, exceeding National Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Minimum Standards of six supervision sessions a year. Relevant training certificates were seen in staff files. Permanent staff follow the Skills for Care common standards for induction and most staff have have received the Learning Disability Awards Framework (LDAF) training. Most staff have received the NVQ Level 2 or 3 qualifications and have undertaken statutory training. The manager informed how the organisation has a learning and development calender. A support worker we spoke with confirmed she received monthly supervision and monthly team meetings. In her view this was a good home with good agency staff who worked well together at the current time. Care Homes for Adults (18-65 years) Page 21 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 service is consistently well managed and organised, effectively meeting its aims and objectives. The manager is skilled and competent and adequately supports staff to carry out their tasks. Some health and safety matters need attending to and the service would benefit from an improved quality assurance system. Evidence: The registered manager has 15 years experience of working in the field of learning disabilities, both as a support worker and as a manager. She has a range of qualifications including an an NVQ Level 4 Registered Managers Award, RMA and a Certificate in Management Studies. The manager is currently undertaking a Level 4 higher diploma in the Learning Disabilities Award Framework.The manager demonstrated an open, posiitve and enabling style of leadership and was observed to be able to support her staff well when they approached her on the day of inspection. The manager showed that she was knowledgeable, skilled and effective in her management of the service. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: We spoke with a support worker who had worked in the home for several years. In their view the manager was experienced, very good, understanding and supportive. We spoke with the manager about how the home formally seeks the views of people using the service and their level of satisfaction with it. We were shown a survey completed with most of the verbal residents on 7th April 2009 about cleaning and repairs. They were satisfied with the service except for an ongoing problem of leaks in the ceiling which is being addressed. A more independent survey was completed a couple of years ago by another manager. The views of people using the service are sought on a regular basis. Currently two individuals have advocates from Mencap. One to one consultation with individuals occurs as group meetings may be difficult for some. However we recommend an annual development plan based on a report about the quality of the service that includes the views of people who use the service, their relatives and professionals through any consultation exercises that seek their views, including surveys, if thought appropriate. The policies and procedures folder contained a range of relevant policies reviewed between 2005 and 2009. It is recommended that policies are reviewed on an annual basis. We further recommend that the home develops a policy and procedure on the Mental Capacity Act 2005 relating to persons who lack capacity. Management monitoring visits are broadly occuring on a monthly basis, meeting a requirement made at the last inspection. Health and safety records were available and generally satisfactory, such as records of fire drills and certificates of gas and water safety, Portable Appliance Test and electrical wiring, all of which were in date. The home had been given a Three Star Good rating for food safety and hygiene. A building and fire risk assessment were available and the maintenance and repair book was regularly completed. The accident and incident forms were appropriately completed. Records of alarms and fire door checks were seen. An external contractor checks emergency lights and other health and safety checks. Water temperatures are taken by staff. Water temperatures were high on occasions, up to 46 degrees on one occasion in the shower room. As referred to above under Environment, fridge temperatures in the kitchen consistently ranged between 9-10 degrees and up tO 12 degrees. This is against safe temperature limits and it is recommended that the fridge is replaced. It is recommended that water temperatures do not exceed safe temperature limits as according to advise from the Health and Safety Executive. Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: We visited the flat where one person is resident and noted that openend foods in their fridge had not been labelled. The public liability insurance was in-date. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R 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 1 41 26 The Registered Person must 30/06/2007 ensure that the unannounced monthly monitoring visits are undertaken every month and a report is issued to the service. This is a repeated requirement. The Registered Manager must ensure that fire drills are conducted at least four times per year. 30/06/2007 2 42 13 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 20 13 Discontinued or unused medicines must be returned for safe disposal. In accordance with safe medication practises. 10/07/2009 2 20 13 The registered provider 08/07/2009 must ensure good stock control of medicines and avoid the build up of surplus medicines. In accordance with safe medication practises. 3 20 13 The registered person must ensure that there are no gaps in records of medication administration. This is in accordance with safe medication practises. 08/07/2009 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 Care Homes for Adults (18-65 years) Page 26 of 28 1 1 It is recommended that the Statement of Purpose is produced in a more accessible format and that the Care Quality Commission contact details are updated in both the Service Users Guide and Statement of Purpose. It is recommended that local authority assessments and care plans are also obtained prior to an individuals admission. It is recommended that daily medication audits are undertaken to ensure adherence to safe medication procedures and to maintain good standards. It is recommended that any herbal medicine is recorded on or close to the MAR Chart with a recording of authorisation by the doctor. The service needs to ensure the complaints procedures are updated with the contact details of the new Care Quality Commission. It is recommended that policies are reviewed on an annual basis. It is recommended that measures are taken to ensure the fridge maintains safe temperatures or is replaced if faulty. It is recommended that water temperatures do not exceed safe temperature limits as according to advise from the Health and Safety Executive. 2 2 3 20 4 20 5 22 6 7 8 40 42 42 Care Homes for Adults (18-65 years) Page 27 of 28 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). 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