Care Home: Eden Cottage

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What the care home does well People have free access to the garden so can get fresh air when they want to. Most of the staff are longstanding and know service users well. There is a day service held nearby so service users have opportunities to attend a range of events and activities. People have the support they need to access the community and stay in touch with family and friends. People have the support they need to remain healthy and well as staff work with health professionals. What has improved since the last inspection? Staff have worked with people to ensure that everyone has the opportunity to take part in activities. The AQAA says that some new activities have been introduced. People have support to develop skills like travelling independently and taking more control of their medication. There have been some improvements to the home including a new lounge carpet and new kitchen cupboard doors. The audit of the service by the company is more detailed and relates to the Minimum Standards. They plan to improve the information about the home so it is user friendly. What the care home could do better: There is a single bed in the service users lounge where staff sleep at night. This means that service users cannot use an area of the lounge and it does not look like an ordinary lounge, having a single bed at one end. Staff said in surveys that it means they have limited privacy when they sleep in. Staff said they find encroaching on service users communal space unacceptable. The manager must ensure that staff have a suitable place to sleep and store their belongings that does not take communal space from service users. The manager and staff agreed that there is opportunity for a sleep in room to be created upstairs. Some parts of the home need to improve to ensure that service users live in an attractive well kept home. For example the gardens to the front and rear have weeds between paving slabs making the ground uneven. The front driveway is uneven and the front garden is overgrown and has weeds growing over the paths under the windows. The fascias to the side of the house have flaky paint. All of this makes the home look shabby from the outside. Two doors have been cut horizontally to suit the needs of past residents. These doors should now be replaced so they look like ordinary domestic doors, meet fire safety requirements and suit current service users needs. The manager must check that the home complies with fire legislation to ensure that people are safe. For example, doors that need to be fire resistant are proper fire doors. Key inspection report Care homes for adults (18-65 years) Name: Address: Eden Cottage 6 The Oval Dymchurch Kent TN29 0LR     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: Kim Rogers     Date: 1 1 0 8 2 0 0 9 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 31 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 31 Information about the care home Name of care home: Address: Eden Cottage 6 The Oval Dymchurch Kent TN29 0LR 01303872686 01303875095 eden.cottage@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lothlorien Community Ltd care home 3 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 3. 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 Eden Cottage is registered to provide accommodation and personal care for up to three people who have a learning disability. The provider, Lothlorien Community Ltd is a subsidiary of Parkcare Homes Ltd (Craegmoor), a national provider. At the time of the inspection three people were in residence. Eden Cottage is a chalet style bungalow in a private cul-de-sac close to the centre of Dymchurch. The accommodation is provided on two floors. All of the service users have their own bedroom. Dymchurch has a selection of shops, cafes and entertainment particularly in the Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 3 Brief description of the care home summer months. Local transport facilities are close by as well as the sea with a large sandy beach. Paula Beshaw is the registered manager. The fee for this home is about £1200 a week. For more information about fees and services please contact the manager or the provider. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a Key inspection of the service which included an unannounced site visit. We assessed the Key Minimum Standards. The last Key inspection of this service was carried out on 8/08/06. We have carried out two Annual Service Reviews since this inspection on 18/02/08 and 16/10/08. Copies of these reports are available from the Provider or can be viewed on our website. During this inspection we spoke to the people who use the service. Two people showed us their rooms and we had a look around the home. We spoke to staff and the manager and sampled various records. We made observations. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about how the home has improved and how they intend to improve further. They returned the AQAA when we asked for it and it gave us the information we need. Care Homes for Adults (18-65 years) Page 6 of 31 We look at any notifications from the home about accidents and incidents. We sent surveys to the people who use the service and to other stakeholders. People told us what they think about the home. We sent three and received three surveys back from staff, two from service users and one from a relative. All of the surveys we received were positive. Comments from staff include, We work as a team I am very happy and contented in my working life The manager is really good and very understanding Service users said they feel safe, staff treat them well, the home is clean and fresh and they can choose how they spend their days. A service user said I like it here The staff are nice here A relative said very helpful staff, nice and kind. Eden Cottage looks after our relative to a very high standard. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: There is a single bed in the service users lounge where staff sleep at night. This means that service users cannot use an area of the lounge and it does not look like an ordinary lounge, having a single bed at one end. Staff said in surveys that it means they have limited privacy when they sleep in. Staff said they find encroaching on service users communal space unacceptable. The manager must ensure that staff have a suitable place to sleep and store their belongings that does not take communal space from service users. The manager and staff agreed that there is opportunity for a sleep in room to be created upstairs. Some parts of the home need to improve to ensure that service users live in an attractive well kept home. For example the gardens to the front and rear have weeds between paving slabs making the ground uneven. The front driveway is uneven and the front garden is overgrown and has weeds growing over the paths under the windows. The fascias to the side of the house have flaky paint. All of this makes the home look shabby from the outside. Two doors have been cut horizontally to suit the needs of past residents. These doors should now be replaced so they look like ordinary domestic doors, meet fire safety requirements and suit current service users needs. Care Homes for Adults (18-65 years) Page 8 of 31 The manager must check that the home complies with fire legislation to ensure that people are safe. For example, doors that need to be fire resistant are proper fire doors. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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 needs are assessed before they move in. There is some information available about the home. Evidence: There is some written information about the home including a Statement of Purpose and Service User Guide. This information gives details of the facilities and services on offer. We found that each person has a copy of this information. This information is produced in text so it may not meaningful to everyone. The AQAA says they plan to make information more user friendly. The AQAA gives detail of the assessment and admission procedure. This could not be fully tested as there have been no new admissions to the home in recent years and there are currently no vacancies. We did see assessments in service user plans that have been carried out previously. These are needs lead assessments. This means that personal goals and aspirations are not assessed. We understand that the company is Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: reviewing the assessment tool to include aspirations and personal goals. The AQAA says that trial visits would be offered and a written service user agreement issued to anyone who moves in. The AQAA says they plan to improve the information about the home so it is more user friendly. Care Homes for Adults (18-65 years) Page 12 of 31 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 know that their needs and goals will be supported. People are supported to take reasonable risks. Communication needs are recorded. Evidence: We found that each person has a care plan that details the support they need. Peoples needs are recorded and the action that staff need to take to meet those needs. People or their representatives have been involved in developing the plans. In one plan sampled we found that a personal goal has been identified and is being supported. We found that plans are reviewed regularly. We found that important information that staff need is part of the care plan held in large heavy files. The care plan is with lots of other information that staff do not need on a daily basis including contracts of residency and information about the home. The manager may want to review these large files to ensure the important information staff need is more accessible and easier to use on a daily basis. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: We found that potential risks to people are identified and assessed. This means that staff know what to do to keep people safe without restricting them. We found that communication needs are recorded in individual plans. We observed staff communicating effectively with service users. We found that staff know service users well so this helps them support choice making. We found that environmentally things could be improved to support communication. For example, in the hallway is a board with the word staff but on both days of the inspection there were no photographs or names showing who is or who is going to be on duty. We found no system showing what the meal choices or activity choices are for the day or week. This means that service users cannot currently find things out for them selves so have to ask staff. The manager may wish to review how the environment supports communication. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the support they need to take part in a range of activities. People are involved in preparing meals and snacks and have a choice of food. Relationships are supported. Evidence: We found that people have the opportunity to take part in a range of activities. Each person has an activity planner showing what they are doing from day to day. People said they enjoy going to college and attending daily sessions at the local community centre including art and craft and music. The AQAA says they are planning to introduce new activities. People are supported to access the community and enjoy meals out and shopping trips. One person said they really enjoy going out for meals. Some people prefer to go Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: out on their own and this is supported. The surveys received from service users said that people can choose how they spend their day. Everyone has had support to plan and book their holidays this year. We found that relationships are supported. People have support to keep in touch with their family and friends. Visitors are welcome at reasonable times. On the first day of the visit some people were preparing to attend a barbeque at another company home where they have friends. We found that people have support to take part in planning and preparing meals. Nutrition and weight is monitored to ensure that people have a healthy diet. People are involved in the household tasks like vacuuming and the laundry. Care Homes for Adults (18-65 years) Page 16 of 31 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. People have the support they need with personal and health care. Medication practice is safe protecting service users. Evidence: We found that detail about peoples personal care needs is recorded in individual service user plans. There is detail about how people prefer to be supported. This means that people get the support they need in the way they prefer. People said that staff give them the support they need with personal care. One bedroom has an en suite shower room and there is a WC and bathroom close to other rooms. Every room has a wash hand basin. We found that the support people need to remain healthy is recorded in individual plans. Staff work closely with health professionals and support people to attend health appointments. We found that specific health needs are recorded including what staff need to do to ensure people are safe. Outcomes from health appointments are recorded and changes made to support plans when necessary. Everyone is registered with a GP and people see dentists and Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: opticians when they need to. We looked at the storage of medication and found that this is safe. Records are kept showing the receipt and administration of medication. Staff have training before they can administer medication to people. One person is having support to take more control of their medication. Care Homes for Adults (18-65 years) Page 18 of 31 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 know their complaints will be listened to and acted on. People feel safe and are protected from harm and abuse. Evidence: We found that there is a complaints procedure. This has large text, symbols and pictures to help make it more user friendly. The AQAA says there have been no complaints in the last year. Surveys showed that service users know who to talk to if they had a complaint. Staff said they know service users well so can identify when they are not happy about something. We found that staff have training in how to recognize and respond to abuse. Staff know what abuse is and how to report any suspected abuse. There is a safeguarding adults and whistle blowing policy. People said in surveys that they feel safe living at Eden Cottage. Staff are checked before they work at the home to make sure they are safe to work with vulnerable adults. The AQAA does not say how they safeguard people from harm and abuse and how they intend to improve in this area. Without plans to improve, outcomes for service Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: users may not improve. Care Homes for Adults (18-65 years) Page 20 of 31 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 is clean and internally well maintained. Improvements are needed to the exterior and garden to make it safe and a nice place to spend time. The staff sleep in bed should be removed from the lounge to give service users more space and staff more privacy. Evidence: We had a look around the home with the manager and staff. All three service users showed us their bedrooms. Bedrooms are all single and have a wash hand basin. One bedroom has an en suite shower room. Rooms are personalised with photographs and pictures so people can make it feel like home. People said that they are happy with their rooms. The manager said they plan to fit more suitable locking devices to bedrooms so that people can have privacy if they wish to. We found that the home is clean and smells fresh. Surveys from service users said the home is always clean. People said they have support to take part in keeping the home clean and doing household tasks like the laundry. This means that people can increase their skills and be involved. There is a lounge, separate dining room and kitchen. We found that staff are sleeping in a single bed at one end of the lounge. This means that service users cannot use Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: part of their lounge. Staff said they have limited privacy sleeping at the end of the lounge rather than having a separate room. Two staff surveys said they are not happy about the lack of staff sleep in facilities. We found that there is potential for the staff bed to be moved to the first floor. This will give service users back the space in the lounge and give staff more privacy. We found that during the night one person has to come out of their room, cross the landing and go through the staff office to use the WC. The alternative is to come downstairs and cross the hall to the other WC. There is potential for this person to move bedrooms so they have an en suite WC in their room. The manager agreed to talk to the person about this option. We found that internally the home has been well maintained. One person said they are looking forward to having their bedroom decorated. Externally some improvements are needed to make it safe and more attractive. For example at the front of the home the driveway is uneven, there is a pile of paving slabs, weeds are growing over the paths. This means that the front of the home looks untidy and is a hazard for service users with mobility needs. To the rear of the home is a garden with seating and flower beds. To make the area safe and a nice place to spend time some improvements are needed. The patio area has weeds growing between slabs making it uneven. The fascia boards to the side of the home have flakey paint and look in need of repair and repainting. Care Homes for Adults (18-65 years) Page 22 of 31 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. There are enough trained staff to meet service users needs. Recruitment checks are robust protecting service users. Evidence: We found that there are usually two staff on duty during the day and one staff at night. Extra staff can be called on when necessary. Staff said in the surveys they returned that they feel they have enough staff. There are no staff vacancies. The company organises mandatory training courses for staff including first aid and food safety. The manager said that all staff are up to date with mandatory training. Most of the staff have a National Vocational Qualification in care. Some staff said they have attended training relating to service users needs including epilepsy awareness and alternative communication. Staff said they feel they have the training they need to do a good job. Staff said they have the opportunity to attend regular staff meetings and one to one meetings with the manager. This means they have the opportunity to talk about their role and have some coaching and mentoring. We found that recruitment checks are carried out before someone starts working at Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: the home. Staff confirmed this in the surveys they returned. This protects service users. Staff said they had a thorough induction so they got to know service users and how the service operates. Most of the staff are long standing and know service users well. We observed staff supporting people respectfully and positively. Staff spoke with understanding and knowledge of service users needs. All three surveys returned by service users said that staff treat them well. Staff said we work as a team, I am very happy and contented in my working life, the manager is really good and very understanding, we have a good staff team who communicate and work together well. A relative said that staff are very helpful, nice and kind. Two out of three surveys returned said that staff need a proper sleep in room as sleeping in the service users lounge encroaches on their space and does not give staff privacy. Care Homes for Adults (18-65 years) Page 24 of 31 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 is well managed and is run in service users best interests. Peoples health and safety is protected. There are systems in place to monitor practice. The manager should check the home complies with fire regulations. Evidence: There is a new manager since the last key inspection. The manager has been at the home for about two years and is registered with us. This means that she has passed the fit person process. The manager was at the home on the first day of the inspection and she was on leave on the second day, so we talked to staff. The manager has now completed the work and evidence for the qualification required by the Minimum Standards. The manager said her work now needs to be internally and externally verified before she is awarded the qualification. The manager has attended one day courses in subjects relating to peoples needs although does not have an accredited qualification in learning disabilities. The manager works shifts with staff including sleep in shifts and weekends. This Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: means that the manager can supervise the staff team at all times of the week and work with different staff. Staff said the manager gives them support and is understanding. Staff said the manager is a really good manager. The manager completed the Annual Quality Assurance Assessments that homes are required to complete yearly. This gives us information about service users and staff and tells us what could be better, what has improved and how they intend to improve the service further. The AQAA shows that issues relating to equality and diversity are understood and supported. The manager has identified a barrier to improvement and has ideas of how to overcome this so the service continues to improve. We found that they seek peoples views about the service by holding monthly service user meetings and monthly company forum meetings called Your Voice. One person from Eden Cottage attends these monthly meetings. This means that service users have the opportunity to talk about the service provided. We found that surveys are sent to relatives and other stakeholders giving them an opportunity to air their views. Changes have been made based on peoples views. People are more involved in writing and reviewing their care plans and are increasing their skills. An area manager continues to make regular visits to the home to monitor practice. The company also carries out audits to make sure practice is safe. The manager said they have had a recent financial audit. The AQAA shows they plan to develop more self audits. We found that staff have training in areas related to health and safety including infection control, fire awareness and food safety. Staff said they held a fire drill recently. The manager told us there are systems in place to regulate and check the temperature of the hot water. This protects service users. We found that two doors have been cut horizontally and this may affect their resistance to fire. The doors do not look like ordinary doors and staff said they were cut to meet previous residents needs. To make sure the doors meet fire safety requirements the manager should seek advice from the local fire safety officer. To make them look like ordinary doors they should be replaced. We found that a care plan says if people cannot be evacuated in the event of a fire, Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: they should be left in their bedroom with the door closed and await the fire brigade. We found that bedroom doors may not be fire doors so to make sure people are safe we made a requirement for the manager to check this. The AQAA shows that checks of the premises and equipment are made. This protects service users. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 24 23 The front and rear gardens must be safe and well kept. The exterior paintwork needs attention. So that service users can enjoy the outside space safely. 31/12/2009 2 24 23 Suitable facilities must be provided for staff for changing, storage and sleeping accommodation. To ensure that staff have privacy and to ensure that service users space is not used. 31/12/2009 3 42 23 The manager must check that the home, including the doors, complies with fire safety regulations. To ensure that service users are safe and protected in the event of a fire. 30/09/2009 Care Homes for Adults (18-65 years) Page 29 of 31 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 30 of 31 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). 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