Care Home: Cranleigh

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What the care home does well Anyone who wanted to move to Cranleigh was invited to come for a visit. This helped to make sure they liked the home and they got on with the other people who live there.The staff were good at helping people to make choices about their lives. One person told us, "I make all my own decisions."People told us they liked living at Cranleigh and they were happy with the staff. One person said, "My family say this is the happiest I have been."People living at Cranleigh could take part in lots of activities inside and outside the home.Staff helped people to look after their health. They saw the doctor or the nurse if they were not well. The home is clean and comfortable. People could choose what they wanted in their bedrooms. Everyone we spoke to said they liked their bedrooms.The manager makes sure that the home is safe. Everyone living and working in the home have training so that they would know what to do if there was a fire. What has improved since the last inspection? The manager had improved the training records which helped her to organise training courses. This made sure that the staff had the training they needed to help people living at the home.The manager sent out surveys to people living at the home to ask whether they think anything could be made better. She made sure that she acted upon anything that people told her. People using the service also have meetings to talk about what is happening in the home and what they would like to change. What the care home could do better: The care plans should have more information in them. This is so that staff understand exactly how the person using the service wants to be supported.There should be more risk assessments to make sure that people who use the service stay as safe as possible.The complaints procedure should be written in easier words so that everyone could understand it. This would help to make sure that everyone using the service would know what to do if they were not happy. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cranleigh 21 Vicarage Road Cromer Norfolk NR27 9DQ 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: Jane Craig Date: 0 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 34 Information about the care home Name of care home: Address: Cranleigh 21 Vicarage Road Cromer Norfolk NR27 9DQ 01263512478 01263512478 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) : Mrs Susan Fuller,Mr Simon Fuller care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: That the home be registered as a care home only. That the maximum number of service users accommodated should not exceed 8 (eight). That only persons with learning disabilities be accommodated at the home. That only person`s up to the age of 65 may be accommodated at the home. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Cranleigh provides care and accommodation for eight adults who have a learning disability. The service is owned by Mr Simon Fuller and Mrs Susan Fuller. Mrs Susan Fuller is the registered manager. The home is located in the coastal town of Cromer and is close to shops, public houses, beach and other community facilities. The house has three floors, with bedrooms and bathing facilities on each floor. All bedrooms are single rooms and three have en-suite facilities. The communal areas are of a homely nature and provide appropriate facilities for the service users. There are small garden areas at the front and rear and car parking is on the road. Anyone thinking of using the service can obtain information, including the latest inspection report, from the manager. At June 2009 the weekly fees were based on the assessed needs of the individual. Care Homes for Adults (18-65 years) Page 5 of 34 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 Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home We visited Cranleigh to do our inspection on 1st June 2009. The staff and people who live there did not know we were coming. We met everyone who lives at Cranleigh. We asked some people what they thought about the home. We looked at care plans. Care Homes for Adults (18-65 years) Page 7 of 34 We talked to the manager and the staff. We asked them how they helped the people who live at Cranleigh. We looked around the house. We looked at some of the policies and procedures in the office. Care Homes for Adults (18-65 years) Page 8 of 34 What the care home does well Anyone who wanted to move to Cranleigh was invited to come for a visit. This helped to make sure they liked the home and they got on with the other people who live there. The staff were good at helping people to make choices about their lives. One person told us, I make all my own decisions. Care Homes for Adults (18-65 years) Page 9 of 34 People told us they liked living at Cranleigh and they were happy with the staff. One person said, My family say this is the happiest I have been. People living at Cranleigh could take part in lots of activities inside and outside the home. Staff helped people to look after their health. They saw the doctor or the nurse if they were not well. The home is clean and comfortable. People could choose what they wanted in their bedrooms. Everyone we spoke to said they liked their bedrooms. Care Homes for Adults (18-65 years) Page 10 of 34 The manager makes sure that the home is safe. Everyone living and working in the home have training so that they would know what to do if there was a fire. What has got better from the last inspection The manager had improved the training records which helped her to organise training courses. This made sure that the staff had the training they needed to help people living at the home. Care Homes for Adults (18-65 years) Page 11 of 34 The manager sent out surveys to people living at the home to ask whether they think anything could be made better. She made sure that she acted upon anything that people told her. People using the service also have meetings to talk about what is happening in the home and what they would like to change. What the care home could do better The care plans should have more information in them. This is so that staff understand exactly how the person using the service wants to be supported. Care Homes for Adults (18-65 years) Page 12 of 34 There should be more risk assessments to make sure that people who use the service stay as safe as possible. The complaints procedure should be written in easier words so that everyone could understand it. This would help to make sure that everyone using the service would know what to do if they were not happy. Care Homes for Adults (18-65 years) Page 13 of 34 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jane Craig Cambridge Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 14 of 34 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 15 of 34 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 were not admitted to Cranleigh unless their needs could be met and they were accepted by people already living in the home. Evidence: The manager gave out a service users guide to anyone thinking of moving into the home. Although some parts of the guide were written in plain English and large font, most of the document would not be accessible to people thinking of using this service. The manager had plans to review the information about the home. There was a thorough admission process. The manager carried out an assessment with anyone thinking of moving in, which helped her to decide whether or not their needs could be met at Cranleigh. The pre-admission assessment we looked at had been partially completed by the persons family and further developed after the person moved in. It provided a a good picture of the persons abilities as well as their needs. People thinking of moving in were invited to spend time with people currently using the service, and the staff team. The manager described how a recent weekend stay had resulted in the person not being offered a place because the other people using Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: the service had not been comfortable with them. Care Homes for Adults (18-65 years) Page 17 of 34 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 . People were supported to maximise their independence by making decisions and choices but minor shortfalls in documentation could result in inconsitencies in support. Evidence: Everyone using the service had a care plan. Some of the information about the persons goals and directions for staff support were brief and did not give a clear enough picture about how the person preferred to be supported. However, most of the information could be found in other documents. There were also good systems of verbal communication and the staff we spoke to were clear about the personal, health and social needs of each person and their preferences for support. One of the plans we looked at included a good description of challenging behaviour, the potential reasons for this and how it could be reduced. There was not enough written information about how staff should react if the person became aggressive but the staff we spoke to were able to describe the interventions they used. It was apparent that the person was receiving consistent support and staff minimised any risk of harm to others. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: The goal setting plans were drawn up with the person using the service and were reviewed annually. Review meetings took place with the full involvement of the person using the service, staff and care managers. It was the persons choice whether or not they invited family. Everyone currently using the service was able to make choices and decisions about their daily life. Staff were available to provide information and support if they needed it. People told us they chose what to do with their time. One said, I make all my own decisions, and I am allowed to go out, I just have to let them know when I am going to be back. One person managed their own money and the others had varying degrees of support to access their accounts or to budget. We checked three records of money given to staff for safekeeping and found them to be correct. People using the service had risk assessments and risk management strategies on file to assist them to take responsible risks as part of everyday living. For example, enabling people to go out, or to be more independent in carrying out personal care or domestic tasks. Some of these were brief and needed further development to ensure that the risks were fully controlled, or to provide an adequate rationale for placing any limitations on the persons freedom of movement. Care Homes for Adults (18-65 years) Page 19 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People received the support they needed to live their chosen lifestyles. Evidence: Everyone we spoke to said they enjoyed living at Cranleigh and were happy with their lifestyle. One person told us, My family say this is the happiest I have been. Another said, Its nice living here, it feels like a family. People were assisted to work out a weekly programme that suited their interests and abilities. One person told us they liked to play football and staff had found them a team to play with. Everyone had a full programme and went out most days. One person told us, Its good, I am always on the move. Some people attended educational courses run by local colleges. Two people had been to a drama class on the day of the visit and one person said they attended a weekly photography group. Others attended educational groups organised by About with Friends, a local charity, of which a service user and a member of staff were trustees. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The group also arranged for people to have occasional employment with a catering group if they wished. Two people had recently been on holiday to Turkey. Some others were attending French lessons in preparation for a trip to France. One person told us they did not like going on aeroplanes or boats so staff had arranged for them to have a holiday in this country. People who were not able to go out alone were supported by staff to access community facilities. On the day of our visit a small group decided they wanted to go into the town and were accompanied by staff. The manager told us that they tried to match staff to the needs and interests of the people using the service, for example the young men preferred to be accompanied by male staff of a similar age. There was open visiting at the home but people could choose whom they wished to see and when. People who use the service were also supported to keep in contact with their family and visit them where possible. Staff had helped one person to establish a plan for using public transport to visit their family unescorted. People were supported to make and maintain friendships. We were told that people could bring their friends home for a meal and some accompanied the group on planned trips. Some of the people using the service had long term personal relationships. The AQAA told us that most people had attended educational groups about establishing relationships, and staff talked about how they supported a couple who were engaged to be married. Routines were generally flexible. We were told that people were expected to be in bed by 11pm during the week but everyone we spoke to said they were quite happy with this. One person told us, I dont mind that, sometimes I go earlier. Peoples rights to privacy were understood and upheld by staff. One person using the service said, If Im in my room and they need me they knock on the door and if not they leave me alone. There was a planned menu but this was very flexible to fit in with peoples requests and activities. People generally made their own breakfast and the main meal was served at lunchtime. Dependent on their abilities, one of the people using the service helped with the preparation or cooking. All of the people we spoke to said they were happy to do this. There was a set meal and the cook told us that they knew what people liked and disliked and would ask if anyone wanted an alternative. There was a picture of the days main meal displayed in the kitchen. One person said, If there is something I dont like they do me something else. Everyone told us they enjoyed the meals. Care Homes for Adults (18-65 years) Page 21 of 34 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 . Peoples health and personal care needs were met in the way they preferred. Evidence: Most of the people using the service only needed prompting or supervision to assist them to meet their personal care needs. This was made clear in their plans, which helped people to maintain their independence. Staff assisted people to buy clothing and, on the day we visited, everyone using the service was dressed in keeping with their age and personal preferences. Several of the women using the service had regular sessions with a beautician. One person said they loved having their nails done. As recommended following the last inspection, health books had been introduced. The staff had helped people to complete these as far as possible but were waiting for further information and instruction from the learning disability service. Staff showed understanding of physical health care needs of people using the service. The AQAA told us that staff had recently attended training to understand more about diabetes to help one of the residents. People had information about their ongoing physical and mental health care needs on their plans. These were not always detailed but staff were able to consistently describe Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: the care they needed. There was evidence that new health care needs were identified quickly and referrals were made to the appropriate professionals, for example, dentists, psychologist, opticians and consultant psychiatrists. Records showed that the manager followed up appointments and ensured that people received the health care they needed. Staff supported people to attend health promotion sessions. None of the people using the service managed all their own medication. One person told us that staff checked to make sure she was giving herself the right dose of insulin. Staff who had responsibility for managing medication had received the appropriate training. Medication was stored securely. There were accurate records of medicines received, administered and returned, which provided a complete audit trail and enabled staff to carry out checks. Following a previous recommendation everyone had instructions for medication that was prescribed when required. This helped to reduce the risk of people receiving too much or too little medication. Variable dose medicines were recorded so that staff could calculate when the next dose could be given and also evaluate the effectiveness of the medicine. There were no controlled drugs at the home. Care Homes for Adults (18-65 years) Page 23 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were protected by the complaints and safeguarding procedures. Evidence: Everyone received a copy of the complaints procedure and there was one on display in the home. The procedure explained the process for investigating and responding to complaints, including the timescales involved. However, some people with a learning disability may have difficulty using the procedure because it was not in an easy to read format. People we asked said they had not had to make a complaint but named the manager or assistant manager as people they could speak to if they were not happy about something. As recommended after the last inspection, the manager had introduced a document for recording minor grumbles but this had only been used once. We were told that most people talked about things as they arose or in the service users meeting and they were generally addressed straight away. The service had not received any complaints in the last year and one person we spoke to said, I feel safer here than I ever did. Staff received training in safeguarding during their induction and NVQ training. There had been some refresher courses but not recently. Written guidance was also available to staff, helping them to recognise and report any suspected or actual abuse. However, the homes own policy was not completely clear about reporting abuse without the service users consent. Staff said they would report any incidents to the manager. They were also aware of who to report to outside the home if necessary. There had been no safeguarding referrals. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: The service had a policy of no restraint and staff received regular training to manage aggressive incidents in a non-abusive way. The manager had some awareness of the Mental Capacity Act 2005 and implications for the people using the service. She was seeking training for the staff. Care Homes for Adults (18-65 years) Page 25 of 34 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 using the service had a safe, clean and comfortable place to live. Evidence: Safety measures were in place. For example, all the radiators were guarded and there were restrictors on the upper windows. Communal areas were decorated and furnished in a style that suited the people living there. There were plenty of books, DVDs, jigsaws and games for people to help themselves to. The combined lounge / dining room gave people enough space. There was a pleasant garden area for people to sit out, which staff and people using the service looked after together. Some rooms had en-suite facilities and there were communal bath or shower rooms on each floor. A new shower had been installed on the ground floor. One person told us that they had asked for a shower to be fitted in their en-suite to give more privacy and this work was being carried out when we visited. Everyone furnished and decorated their rooms to their own taste. Those we saw were highly individualised and reflected the occupants interests. Everyone we spoke to said they were happy with their bedrooms. With staff help, people kept their own rooms clean and most did small domestic tasks towards the upkeep of the rest of the house. At the time of the visit the house was clean. There was a separate laundry that was tidy and organised. Some staff had a Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: recent update of infection control training and as a consequence had changed how people dealt with their dirty laundry. Care Homes for Adults (18-65 years) Page 27 of 34 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 . Recruitment practices provided safeguards and people using the service were supported by a consistent and competent staff team. Evidence: Staffing levels were completely flexible to support people to be involved in the activities of their choice. We were told that no-one was ever prevented from doing anything or going anywhere because there were not enough staff. People we spoke to said that they liked the staff. One person told us, staff are nice, they take me out. Another said, The staff look after you and they are kind. There was a low turnover of staff and most had been there for a number of years, which helped people to build up relationships and assisted with continuity of care. We looked at two staff files. Both contained evidence of a thorough recruitment process. Pre-employment checks had been carried out before they started work at the home, which helped to protect the people living there. The AQAA told us that all new staff completed an induction training programme that met the standards of the national training organisation. We saw evidence of this on both the files we looked at. As we required at the last inspection, the manager kept a central record of training, which helped to identify when mandatory training was due. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: Most staff had completed refresher courses in health and safety and other topics relevant to their role. Further training sessions were planned. Most of the staff held an NVQ at level 2 or above. Care Homes for Adults (18-65 years) Page 29 of 34 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 . People using the service and staff benefited from a safe and well managed home. Evidence: One of the owners managed the home on a day to day basis. She is a learning disability nurse and also holds the required management qualification. She has many years experience in managing care services. The manager keeps up to date with new legislation and good practice guidance and ensures that it is put into place. The manager is supported in her role by an assistant manager, who has also completed the Registered Managers Award. The previous requirement to provide a system for monitoring the quality of the service, had been partially met. Although there was no formal procedure, it was evident that there were quality monitoring practices in place. There were monthly meetings, which people using the service arranged, chaired and recorded themselves. Staff were invited to put items on the agenda which helped to keep people up to date with any new developments in the home. Staff told us they were on hand for support if needed but they were not part of the meeting. People using the service had been invited to complete a survey which asked for their views on all aspects of the home and the Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: support they received. The information had not been collated and published but the manager told us there were no outstanding issues. Information in the AQAA showed that the manager had a clear understanding of the strengths of the service and what could be improved. The business plan provided information about the goals for future development. Information in the AQAA showed that the servicing and maintenance of installations and equipment was up to date. There had been a recent fire inspection and the recommended work was almost complete. All staff and people using the service had attended fire safety training. Care Homes for Adults (18-65 years) Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 6 Goal setting and action plans should be more detailed to ensure that staff are clear about the persons needs and how they wish to be supported to meet their goals. Risk assessments and risk management strategies should be further developed to ensure that people are supported to take risks as part of an independent lifestyle and the reasons are recorded for any limitations or restrictions. The complaints procedure should be revised to make it more understandable and user friendly for the people living at the home. The systems for monitoring the quality of the service should be formalised and results of surveys should be collated and published. 2 9 3 22 4 39 Care Homes for Adults (18-65 years) Page 33 of 34 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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