Care Home: Dorandene

What the care home does well Care plans are personalised and work on developing person centred plans continues to progress.The information in the care plans is of good quality,kept up to date,reviewed and holistic. Service users can feel confident that they will receive the personal support that they need and that importance is given to addressing healthcare needs and changes and maintaining good health and nutrition. The home offers a growing selection of activities and supports service users to access local services and facilities.It is addressing the need for the availability of more transport. There is a good standard of cleanliness and hygiene throughout the home. There is low staff turnover, staff are well supported and have good training provided. Staff appear genuinely interested in the lives of the people they support and in enhancing them. The home actively encourages contact with relatives especially if relatives are unable to visit. The home demonstrates that it consults with service users and each person is supported to be involved in personal decision making and in decisions about the service. What has improved since the last inspection? This section is not applicable as this is the first inspection of the service. What the care home could do better: Pre admission assessment documentation needs to be held at the home as well as at head office so that staff can refer to it if they need to and it is available for inspection. As has been identified by the registered manager and care staff,the work on person centred planning needs to continue and to be refined so that each individual has a completed person centred and health action plan in place. The recording of service users personal expenditure always needs to relate to the specific item or activity purchased rather than state, as it has in some instances just "activities". Further work is needed to make the environment more homely especially in the lounge and dining room. A suitable and accessible quiet room would benefit service users who wish to spend time alone away from their bedrooms or to meet with visitors. Bathrooms need upgrading. More areas of the garden could be made accessible for service users to enjoy. The organisation should consider filling the three staff vacancies with permanent staff. Key inspection report Care homes for adults (18-65 years) Name: Address: Dorandene 42 Alma Road Reigate Surrey RH2 0DN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Sullivan     Date: 0 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Dorandene 42 Alma Road Reigate Surrey RH2 0DN 01737222009 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Mr Rengasamy Govinden Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Dorandene is located in Alma Road in Reigate.It provides care and accomodation for up to ten service users who have a learning disability,some may also have a physical disability.Accomodation is provided over two floors and all service users bedrooms are singles.The home has a large secure garden and is a short distance from the town and local facilities. Fees are individually costed by the organisation on request. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 10 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 unannounced key inspection of Dorandene took place over five hours. During the visit time was spent with service users,the manager and deputy manager and staff.Two staff members were involved in individual discussion. A range of records and documents were examined including a sample of care and health action plans,staff files,training information and medication information. A tour of the building took place which included the viewing of some service users bedrooms. Information that we received in surveys from relatives,health professionals and staff and in the AQAA(Annual Quality Assurance Assessment) document completed by the registered manager has also been used to inform this inspection.Some of the information in the AQAA and surveys is included in this report. 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 Care Homes for Adults (18-65 years) Page 6 of 28 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 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 8 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. Accessible information about the service is available for prospective service users and their representatives. There is a thorough assessment and admission process and service users are only admitted if their needs can be fully met. Evidence: Dorandene was registered under a new provider in October 2009,it had an existing statement of purpose and service users guide which are satisfactory and are in the process of being brought up to date to reflect the changes. The home had one vacancy at the time of the inspection and a new service user had been admitted in October shortly after the change of provider. The pre admission assessment information for the service user was held at head office but the manager discussed the process.The service user had been admitted due to the closure of their previous home,the manager had visited to undertaken a full assessment and the service user visited with their parents,was offered choice of bedroom,stayed for a Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: meal and then overnight.Records evidence the introductory work done and the service user has settled in well. The other service users have all lived at the home for some time and whilst some of their needs have changed due to health problems and ageing it continues to meet them satisfactorily. The manager emphasised that importance is given to making sure that new people admitted are compatible with others. With the change of provider each person has been issued with a new contract,those seen on care plans had been signed by representatives on behalf of the service user. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user has a care plan that reflects their individual needs,preferences and interests. Service users are given support with decision making and to contribute to the running of the home. Risks are assessed,documented and reviewed. Evidence: Work has been taking place to make service users care plans more person centred and holistic.Four care plans were examined,each was at a different stage of development and all showed that needs were clearly and comprehensively documented,reviewed,there had been consultation with service users where possible and up to date signed and dated risk assessments were in place.Examples of activities risk assessed were going out in the minibus,showering, and risk of choking when eating. Care plans also included pen pictures and personal histories,preferences for Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: personal care,eating and communication profiles,food likes and dislikes as well as information on activities and social needs and interests.Separate health action plan folders are being developed for each person.The information in the care and health action plans was clear and of good quality. Daily recording sheets are added to the care plans and give sufficient detail on a persons day,health ,activities and mood. There was evidence that service users are encouraged to actively participate in compiling the plans and the cover of one folder had been decorated by the service user with staff support. Information about service users and other personal records are kept confidentially and safely. The service users are mostly non verbal with the exception of one person who has limited verbal communication.Some pictorial information is used such as a picture board with photos of staff on duty and photos of food items.Picture recognition skills are also limited and as such staff rely on their awareness of service users gestures,moods and other non verbal communication to consult with them about choices and to help them make decisions. Service users are encouraged to participate in the running of the home,they contribute to menu planning and those more able are supported to make drinks and snacks and to keep their bedrooms clean and tidy. Care Homes for Adults (18-65 years) Page 12 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. Opportunities for activities at home and in the community are offered to service users and each person has an individual activities programme. Service users are supported to maintain contact with relatives. Meals are varied and healthy and there is choice available. Evidence: Service users have individually tailored activities programmes that incorporate activities at home and in the community. The amount of activities and opportunities to access the community have increased since the home has had a new provider.Some staff surveys that had been completed fairly soon after the changeover reflected the need for more activities,the evidence gained during the visit was that this was now Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: happening.There are more drivers on shifts and more funding for activities is available.Daily record sheets,individual activities books and discussion with the manager and staff showed that each person participates in regular activities and trips into the local community and further afield are provided as often as possible.A staff member said We take every opportunity to get people out and about. The home has a large minibus and a smaller vehicle shared with another service,a new smaller vehicle for the homes own use was on order. During the visit an activities provider called Us on a bus gave a morning and an afternoon session to some service users on an individual basis.One service user observed for a short while during their personal session was benefiting from it. Others were interacting with staff in the main lounge or spending time in their rooms.A shopping trip was offered to one person who declined.The manager said that due to the exceptionally cold weather no other trips out were scheduled for the day. Some service users attend a local day centre,they had no sessions there on the day of the visit and all were at home.The day centre programme was seen and is varied. Other activities provided at home are arts and crafts,music sessions,menu planning and aromatherapy.Trips out include the cinema,going out for meals and to places of interest,walks and accessing services such as the hairdresser. Each person has an annual holiday,the manager has obtained passports for some service users and a foreign holiday may take place this year. One staff member spoken with said there had been a great improvement in opportunities for activities and was encouraged by this. Religious and cultural needs are recorded and respected,two service users attend a local church regularly.Another service user is supported to attend a synagogue with relatives in another town every few weeks as there is not one locally and to observe Jewish festivals. The routines of the home aim to be flexible,service users get up and go to bed when they choose and have choice of meals. Service users who have relatives are actively supported to keep in contact with them via visits,phone calls and written information. One relative wrote in a survey that the home, Keeps me informed regarding events and happenings affecting my (relative),as I am not able to visit as often as I would like and another said that They always have helped my (relative) to keep in touch with relatives as much as possible.Records are kept of family visits on care plans. The manager discussed how one service user had been supported when their parent died and had been given the Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: opportunity to pay their last respects. The menu offers varied meals that are well balanced and appear healthy and nutritious. Service users contribute to menu planning on a rota basis two at a time each week so that each person can be consulted about preferences as fully as possible. Lunch was partially observed,choice was available and service users encouraged to eat without assistance if they were able to.Those who were given help with the meal were assisted appropriately. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of service users are well met and thoroughly recorded. The home refers promptly to health professionals if they need to and follow through on advice given. Medication policies and procedures are in place that protect service users. Evidence: Service users have individual health action plans that include detailed information on health needs. All medical appointments are documented,service users have routine health checks such as dental check ups and eye tests and a range of health professionals are involved depending upon individual need. The health needs of service users are very varied and as they are ageing their medical and health needs are becoming more age related.Some service users have very limited mobility and other specialist needs, the home involves professionals such as occupational therapists,physiotherapists,dietitians and district nurses and refer people promptly if they are concerned about them. Changes in health needs or behaviours are Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: recorded.One service user had been referred for a speech and language therapy,physiotherapy and occupational therapy assessment as they were having problems with eating and needed new seating,a new specialist chair has been provided which has benefited them. The manager had also recently referred another service user for assessment as it was suspected they were developing dementia and has also approached the care manager for some additional funding. The home has sought information from some relatives about the wishes of service users in the event of death. Three health care professionals returned surveys,one wrote that the home Refers to health professionals appropriately and takes on board advise another wrote The service is very good at contacting when health input is required and Has good communication skills when addressing service users who have limited/no verbal abilities. Personal care preferences are recorded on care plans and gender preferences in respect of the delivery of personal care are respected. Staff were observed to maintain the dignity of service users during the visit and in discussion showed were keen to increase their personal knowledge of the health care needs of those they support and to progress development of person centred care plans and health information. Medication is securely stored and all staff receive medication training.A recent report of an audit by the homes pharmacist was read,some minor actions to improve medication procedures were identified that the manager confirmed had been acted upon.Medication Record Sheets seen were correctly completed and there are guidelines in place for as required medication. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure and processes for managing complaints. Policies and procedures are in place for the protection of service users and staff have improved safeguarding training opportunities. Evidence: The home has a complaints procedure that is included in information about the home,it is available pictorially and displayed in the home.The manager said that the new provider has a designated complaints manager who would support the home in managing a complaint. Service users would need support to raise a concern or complaint,staff are aware of how they indicate that they are not happy.There is low staff turnover so the majority of carers are familiar with the ways in which unhappiness or distress is expressed.The AQAA says that the home intends to work on looking at ways in which service users can increase their opportunities for communication and is looking at involving advocacy for them. No complaints have been made about the service. Staff receive safeguarding vulnerable adults training the tracking of this and other training and timely provision of the course and regular updates is improving under the new organisation.Staff spoken with confirmed that had done the training. Recruitment procedures are thorough and the checks undertaken on applicants protect service users. The AQAA (annual Quality Assurance Assessment) tells us that there are Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: safeguarding procedures in place. No safeguarding alerts have been raised in relation to the home. Care Homes for Adults (18-65 years) Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe,clean and comfortable environment.Some communal areas need attention to make them more homely looking. Service users would benefit from having access to more areas of the garden and a more suitable quiet room. Bedrooms are well decorated,meet service users needs and are personalised. Evidence: The home is clean,hygienic,safe and well decorated.The dining room and other communal areas had been redecorated,the dining room would benefit from further attention to make it more homely feeling and to make good unfinished repairs and the lounge also needs to be made more homely.The lounge is large and the majority of service users spent some time there during the morning. The manager said that it was hoped that an area of the lounge could be made into a sensory area and costings were being considered for this. There is an upstairs and downstairs bathroom as well as a Parker bath downstairs.There are stairs and a shaft lift to the first floor. Some of the bedrooms were visited,all were well decorated and clean and there were personal items such as family photos pictures,sound systems,CDs,TVs and cuddly toys.One Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: person who was very keen on the sea has a display of model boats.The bedroom of the most recently admitted service user needed some redecoration the manager stated this was planned. There is a large,well maintained garden at the front and back of the house,the back garden is sloping and not very accessible to those with mobility difficulties or who use wheelchairs.The front garden is more accessible whilst service users would benefit from a path being added to improve access.There is a patio with patio furniture that is used in good weather and the manager said service users help with some gardening. The home has a quiet room which is small and a bit cluttered, a more suitable quiet room is needed for visits or time alone,the need for this was recorded in the AQAA and on one staff survey. Care Homes for Adults (18-65 years) Page 21 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. The needs of service users are met by a well supported and well trained staff team. Staff are dedicated and the team would be enhanced by recruitment to fill the staff vacancies. Evidence: The home was sufficiently staffed for the number of service users,four care staff including the deputy manager were on duty as well as the full time housekeeper.There is very little staff turnover and no new staff had been recruited since Leonard Cheshire Disability became the provider.There were three staff vacancies,gaps in the rota are mainly filled by bank staff who know the service users well including some who work permanently at the home,there is also some use of agency staff who are used to working at the home.One staff member commented on a survey that the home would be improved by the recruitment of more permanent staff.The staff group is diverse and there were male and female staff on duty. Three staff files were sampled,there is a recruitment process and although all recruitment records predated the new provider they were in order.The manager said that staff will be having their CRBs renewed. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Regular supervision meetings take place and the two staff members spoken with individually said they had good management support.Team meetings take place and there are new arrangements for the tracking of mandatory training.The organisations training manager had provided the manager with details of core training scheduled where updates were needed. Specialist training relating to the needs of service users is also provided including dementia,palliative care,sensory impairment and epilepsy. The majority of care staff have gained a National Vocational Qualification at level two or above,the deputy manager has a management qualification and NVQ 3. Staff who were on duty were observed to treat service users respectfully and to have a good rapport with them,their comments on surveys and in discussion demonstrated that they are genuinely interested in the lives of the people they support and have considered ways in which to enhance them. Nine members of staff returned surveys,they told us that they feel well supported,that they receive training that is relevant to their role and the majority said there were always enough staff on duty. Examples of comments from members of staff included on surveys are , I do enjoy working at Dorandene.I have learnt the importance through training on how to value and give independence to individuals by respecting their choices and dignity and I feel I am part of a good team and have enjoyed getting to know the service users. Care Homes for Adults (18-65 years) Page 23 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 home has a friendly atmosphere and is run in the best interests of service users and staff. People who live at the home are protected by the use of safe working practises. Evidence: Dorandene is a existing home that was registered under new provider,Leonard Cheshire Disability in October 2009. The existing registered manager remains in post and the deputy manager transferred from another service run by the previous provider around the time of the new registration to fill a vacant post. The registered manager is well qualified and experienced,he is working towards the NVQ 4 in management,and holds a Bsc in community care for people with a learning disability. The general view gained from staff spoken with was that they felt most positive about the new provider and that in the short time since transfer there had been noticeable improvements,for example more funding for activities and outings,easier access to funds for items that needed to be purchased,better training support and structure ,more drivers on shifts and better maintenance. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Further improvements are planned including more work on the environment,continuing to offer more activities and refining person centred planning. The atmosphere in the home is friendly one member of staff commented in a survey that I enjoy working at Dorandene especially as there is always a good atmosphere and I have always felt welcomed and a health professional wroteGenerally Dorandene provides a safe,clean and happy environment in which to live.Staff are friendly and knowledgeable about service users in their care. The home is well maintained and the organisation has addressed the need for some repairs whilst others are due.During the visit there was a problem with the boiler causing the heating to be inefficient,a member of the maintenance team had tried to resolve the problem but an engineer needed to be called.In the interim as it was a very cold day, staff purchased additional heating.Dust from the new heaters set off the fire alarm, and an efficient fire evacuation took place before the fire service arrived and declared the building safe and clarified the cause. All staff acted promptly and as a team and were clearly familiar with fire procedures,The AQAA tells us that regular fire practises are held. The manager was contacted the following day and confirmed the engineer had called and the boiler was working properly again. The AQAA was submitted within the timescale we had given and the information in it is clear and comprehensive. Internal quality assurance is taking place,monthly visits by a representative of the organisation take place and reports are written about the visit.Three such visits since registration are so far recorded and reports show that action is taken to address any issues. The manager said a survey form is to be reviewed and will be circulated to stakeholders. The views of service users are sought individually and the home tries hard to establish their wishes and views. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 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 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 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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