Care Home: Edward House

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What the care home does well The service provides good quality care and support to people who have an autistic spectrum disorder and who also may present challenging behaviors. The service provides good training to staff and also leadership and guidance on how this should be delivered. The current staff team are motivated towards providing good outcomes for people and there is evidence of good team working and support. The environment has been adapted imaginatively to better meet needs, with the creation of more private accommodation and adaptations were necessary. There are good systems in place to ensure that people are protected from potential harm or abuse. The home has good assessments process and procedures in place to ensure that transitions to the home are managed professionally and sensitively. What has improved since the last inspection? Improved systems for auditing medication administration have been put into place. Various improvements and adaptations have been made to the environment. Staffing arrangements rarely involve the use of agency staff. There has been an increase in the amount of community based activities that are being supported by staff. There has been a decrease in the number of challenging behaviors that have occurred and that have to be responded to be the staff team. What the care home could do better: There is a need for some PRN medication protocols to be reviewed and updated. Staff could receive more regular formal recorded supervision. There is a need for some activities to be more clearly risk assessed. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Edward House Matson Lane Matson Gloucester Glos GL4 6ED     The quality rating for this care home is:   three star excellent 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: Simon Massey     Date: 0 9 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Edward House Matson Lane Matson Gloucester Glos GL4 6ED 01452307069 01452311742 iainsteel@selwyncare.com 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) : Selwyn Care Limited care home 10 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home 10 10 Edward House is part of the care provision offered by Selwyn Care Limited. The home is situated on the outskirts of Gloucester in the Matson area. The organisation provides residential and day care services to adults with Autistic Spectrum disorders and associated behaviours. The home shares the site with the organisational office, and another two care homes and the day care facility. There are spacious grounds around the home, with a lake, garden, fields and a large car park. All communal and individual accommodation are on the ground floor. There are seven single bedrooms all with full en-suite facilities and three individual flats and one seperate bungelow. There are two spacious communal lounges, one incorporating a dining/activities area, as well as an additional dining room accessed via the kitchen. Just outside the main building there is a laundry area and an additional room, which is used for art and craft activities by the residents. The laundry and the art room have stepped access. The home has a Statement of Purpose and Service User Guide from which prospective Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home service users can gain information about the service provided. The current fee range begins at 1725 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 inspection took place on 8/07/09 and 9/07/09. The Inspector met with the manager, who has applied for registration, several members of the staff team and also the Director of Care of the organization. People using the service were not communicated with directly, but were observed at various times receiving care and support. Records relating to care planning, health and safety, staff recruitment and training and medication administration were examined. An inspection of the environment was also carried out. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough and detailed assessment process and the provision of transition plans ensures that the service has the capacity to meet the needs and aspirations of people moving into the home. Evidence: The service has recently successfully changed in registration to increase its numbers and reviewed and updated its Statement of Purpose, and a copy was supplied to the Commission. The service has admitted three new people in the last twelve months and the admission process and care planning for two of these people was examined as part of this inspection. This showed that comprehensive pre admission assessments were completed and information collected that ensured that the service had the capacity and potential to meet their needs. Where appropriate pre admission visits are arranged. Transition plans were prepared and the care staff were provided with good information in order to begin meeting the needs and develop the professional relationships and understanding of the complex needs that were to be met. Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: There was evidence that people moving into the home are closely monitored and supported by care staff, who are being supported by the management team who carried out the assessments and prepared the transition plans. Further case tracking of individuals showed how plans of care were developed from these initial assessments. Staff spoken with demonstrated a good understanding of the need for lengthy settling in periods for people with an autistic spectrum disorder 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. Detailed care plans ensure that the needs of the people living in the home are documented and guidance is available to staff. The home takes action to encourage people to make choices and supports them to take appropriate risks. The risk assessing of certain activities may improve opportunities and ensure people are better protected from potential risks. Evidence: The service has developed a person centered care planning system that is appropriate to the needs of people who use the service. People using the service can present challenging behaviors, have complex needs and may also have an autistic spectrum disorder. The plans were comprehensive in the areas they covered and provided guidance on issues including managing behaviors, personal care, levels of staff support required and communication. Through observation and interview staff demonstrated a good understanding of the needs of the people they were supporting, and the commitment to provide a low arousal and calm approach. Staff have a good Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: understanding of the care plans and the guidance and were also observed seeking further advice and input from senior staff. The plans are being reviewed at appropriate intervals and some issues are reviewed on an ongoing basis. It would be possible for some goals and objectives to be better documented, and also contain information about the person responsible and the planned completion date. There is also scope to improve the care staffs understanding of how they can use the care planning system to identify goals and implement changes for the people they are key working. Whilst choice is promoted and encouraged the importance of routine and adherence to planned timings for some people who live the home was understood by the staff interviewed and observed. There was also good evidence of recording being completed on the completion of activities to provide feedback and information to the rest of the staff team. The needs of the people using the service are carefully considered when staffing is organized and arranged, with the majority of the people having designated one to one staffing for considerable periods of the day. One person for example only has staff support from people who have known them for at least six months. The staffing arrangements for another person were also changed during the shift, as it was felt a better response might be affected by a change of worker. There was some inconsistency in the quality of recording, with some descriptions of behaviors not providing sufficient detail about the context of the behaviors and also some descriptions which appeared to dramatize the behaviors that had been presented. It is important that the level of aggression or agitation displayed in an incident is accurately and objectively described. It was evidenced from the recording and interviews with staff that the occurrence of challenging behaviors, resulting in the necessity to complete incident reports, had decreased steadily and consistently over the past six months. The manager and staff spoken with thought this was as result of improved staff knowledge of the new service users, increased confidence of staff and also the better organizing and implementing of daily activities and routines. It was evident that staff had identified a clearer understanding of the likes and dislikes of some people and the possible triggers for incidents that could then could be avoided. A sample of incident forms and response recordings were examined and these were found to be accurate and were correctly cross referenced to other paperwork that may have been required, such as body charts and the administering of PRN medication. The service has changed to a different format for completing risk assessments with a generic individual risk assessment for each person in place. Whilst this is good practice in certain ways the Inspector felt that there was a need for some activities to be specifically risk assessed and guidance provided to the staff. There is also a need for risk assessments around staffing levels required to support people in the community to Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: be completed and updated when required. One person for example had varying levels of staff support provided, depending on the staff who were working and how the individuals day had been going. This information needs to be more clearly recorded. There is also a need for clear risk assessments in relation to traveling in vehicles. This is in terms of combinations of people going out, and also the procedure to be followed for each person when being transported into the community. Any limitations or restrictions placed upon people were clearly recorded and documented. Care Homes for Adults (18-65 years) Page 13 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 excellent 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 are given opportunities to take part in a variety of activities in the community and in the home, with variety and choice being provided. People benefit from a structured and realistic approach towards the development of independence skills. Evidence: Improvements have been made to the variety and frequency of activities undertaken in the community. The staff office has a weekly activity planning board that documents the weekly routine and trips which, due to the complexity of the arrangements, need to be well planned and coordinated. Staff were positive about the increase in trips out, which they considered had contributed to the general decrease in challenging behaviors that had been present over the past twelve months. The organizing of activities has also been helped with the provision of a daily tasks and activity planner Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: and also a board in the staff office which reminds staff of any incidents that may have occurred. Staff then read the detailed notes relating to these before activities are undertaken. Improved communication between staff, and between staff and management has also been a contributing factor in the improvement of outcomes for service users, and further reference is made to this under the staffing standards. The service has access to the facilities of the day centre, that is situated on the same site, on the weekends. This has provided more opportunities for activities in familiar surroundings for some people. There was evidence that efforts are made to manage autistic behaviors in a sympathetic manner when supporting change to people lives. One person who was recently admitted to the home is having the change to their weekend arrangements done in an structured and planned manner in order to minimize the stress this may cause. The staff were working with the family to ensure a consistent approach. One person has had an advocate involved and has also had involvement from the local Connexions service. This is in response to an identified need. One person has been provided with a form of work experience for a couple of hours a week, which is completed with staff support. People were observing enjoying their food and being involved in the kitchen, though some people have limited interest in this. Staff interviewed thought that the food was of good quality and that a healthy diet was encouraged and choice respected. Staff stated that there was always sufficient quantities of fresh and packaged food available to meet the needs of the people living in the home. 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. Clear guidance and recording supports service users to receive their personal care in a way that promotes their privacy and dignity. Satisfactory arrangements are in place for the handling of medication and the training of staff but there is a need to ensure that all protocols are appropriately reviewed within the correct timescales. Evidence: The care plans contain good detail about the personal care that is required and how this is to be delivered The service has completed person centered Health Action Plans for everyone and these documents contain all the required information about health needs and appointments. Clear records are kept of all health related appointments. There are also records of input from outside health professionals. The medication storage and administration were examined and found to be largely satisfactory. The home have put in closer monitoring and auditing of the systems to Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: try and eradicate errors. Staff must complete training before undertaking medication administration and also have a competency assessment completed by a senior member of staff. There is a need for some PRN medication protocols to be reviewed and updated. Also clearer guidance needs to be in place for one PRN medication where there appeared to be some confusion over pre epileptic behavior and general agitated behaviors. It is also recommended that all PRN medication is recorded with a double signature. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training and competence, staffing levels and good monitoring from management help to promote a safe environment in which people are protected from potential abuse. Good systems exist for staff, outside professional and relatives to raise concerns, issues or make a complaint, helping to further ensure people living in the home are protected. Evidence: The service has a complaints process and copies of this have been supplied to relatives of the people living in the home. It would be difficult for the majority of people living in the home to raise concerns or make a complaint, but there was evidence throughout the inspection of staff trying to communicate effectively with people and respond appropriately. There was feedback from the quality assurance surveys that the majority of relatives consider that the staff team communicate well with the families and keep them informed of any issues or concerns. Staff undertake training in protection issues during their induction and also undertake further training in this provided by the local authority Adult Protection Team, though this training has recently been provided by local college. Staff also explained how this area had been covered on their NVQ training. All staff must also complete training in the managing of challenging behaviors which promotes deescalation and low arousal practice. The home has a policy of no restraint and staff spoken with were confident Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: that this practice was understood and observed by the staff team. Many of the people living in the home have complex needs and can present challenging behaviors but it was observed by the Inspector thats there appeared to be a relatively relaxed atmosphere in the home and people appeared comfortable and generally relaxed within the home. Staff were observed managing peoples behaviors in a sympathetic and confident manner, promoting peoples dignity. High staffing levels are also maintained, which helps ensure that staff and service users are protected. The service has responded quickly and appropriately to concerns raised by relatives and also taken action to address practice issues when they have arisen. Good levels of informal supervision and staff training help ensure the staff have the necessary skills to manage the behaviors and ensure that people are protected from unnecessary physical intervention. All staff are provided with radio intercoms to ensure that assistance can be provided in an emergency. It was observed by the Inspector during this visit that these were being used more judiciously by all staff, which contributed to the promotion of a more homely and normal environment. These radios are only now used in an emergency. Other workers on the site now use a different frequency to the care staff, which has also decreased the intrusion that sometimes can occur when radios are constantly in use. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home that is well maintained and decorated throughout and provides a comfortable homely environment. People are supported and encouraged to personalize their living space and are provided with accommodation appropriate to there needs.. Evidence: The environment is being maintained to an excellent standard and potential damage to the property, as the result of some behaviors, is managed creatively by the Provider. There have been various adaptations to the building to provide more individual accommodation and promote personal space. The service and staff have maintained a homely and comfortable environment and people were observed relaxing in the two separate lounges, either on their own or with staff. The outside area has been made more attractive and is a safe and secure place for people to spend time. This has been provided with seating and plants. There is also access at the rear of the property to a large garden area and pond which the home shares with other services on the same site. These are all run by the same Provider and the people living in the home are familiar with these other services users and staff. All bedrooms are individually organized and decorated according to needs and Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: interests and where some restrictions are in place over fixtures or furniture, these issues are correctly recorded. Adaptations have been made to make the environment safe, with the provision of a ramp for one person and also protective padding arranged to avoid injuries where possible. The home was clean and hygienic throughout. 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. Service users are supported by a staff team that relates well to them and has a positive approach to their care and support. People living in the home benefit from a staff team that has good access to training and development and a good understanding of the needs of people with an autistic spectrum disorder. Improved formal supervision and appraisals of staff could produce improved outcomes for people living in the home. A good recruitment and selection framework helps to safeguard the people living in the home. Evidence: On the day of the inspection there were 8 staff on duty plus management and all the required one to one staffing arrangements were all in place. The home have changed its staffing rotas to provide two waking night staff and no sleeping in staff in the main building. There is an additional person sleeping in the separate flat which accommodates one person away from the main building. The whole site incorporates three registered services run by the same Provider and at night there are a total of six waking night staff and two people sleeping in. The rotas confirmed that these levels are maintained and that agency staff have not been used within this service since March 2009. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Staff spoke with were positive about the training provided and thought it was appropriate to the roles they performed. The service has replaced its behavior management training with a course it has developed itself. They have applied to have this accredited but are still waiting for this process to be completed. Staff explained how the training placed greater emphasis on deescalation and breakaway techniques rather than physical intervention and people were positive about its effectiveness. The majority of staff have completed NVQ training and all were up to date with the required statutory training, with refresher training being booked and planned in advance. The service has recently won an employment partnerships award for developing skills in care workers. A selection of staff files were examined and found to contain all the required information and the evidence that all required background checks had been completed. Staff are required to complete an induction process that involves monitoring and mentoring and after an initial six month period will lead onto NVQ training The home has had regular staff meetings and the minutes showed that a variety of issues are discussed, including practice and team working processes. Staff interviewed said that team working had improved over the past twelve months and that people were generally supportive of one another. Staff stated they had received good levels of informal supervision and support but formal supervision for some staff has been infrequent, with some people only receiving one formal recorded session over the past eight months. Also some of the recording around supervision was not very detailed. It was explained that the changes in the management arrangements had impacted upon the ability to deliver regular supervision and there were plans to address these issues once the management team had been fully recruited. Staff were observed interacting in a positive and professional manner with people living in the home throughout this inspection, and staff demonstrated a good understanding of the care plans and the approaches being implemented by the management team. Staff were also observed using various different approaches to communicate with people and staff commented that the approach to providing care and support was generally much more consistent with improved understanding of low arousal theories. Staff also commented that it had taken time for some relationships to be built up with people. 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. Service users benefit from a home that is well managed and organized and committed to providing high quality care and support. Systems are in place that help to monitor and improve the quality of the service. There are a range of measures in operation that help to protect service users health and safety. Evidence: The home currently does not have a registered manager but the person currently in post has submitted an application to the Commission. The manager has previous experience of working with people with an autistic spectrum disorder, and who also may present challenging behaviors. During the initial period of employment the manager has concentrated on developing the approaches to the meeting of needs, particularly for the new people admitted to the service, all of whom have complex needs. The manager has provided hands on guidance and been involved in developing the routines required to meet peoples needs. This has included developing the care plans. They have provided leadership and direction to the staff team. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Staff stated that they thought the management team were approachable and that generally there was a transparency about the issues being progressed and the direction that the service was heading. Some staff commented that they thought the management of the service had a commitment to a high quality of care and that this was communicated well to the staff team. Staff also commented upon the good level of support they had received from the human resources staff of the organization. The Director of Care of the organization has completed regulation 26 inspections of the home and provided detailed reports and feedback to the manager. These have also been undertaken at different times of the day, and also during the night. Views on the running of the service have been sought from staff and the information and findings fed back to the team. Surveys have also been circulated to relatives and outside professionals. A selection of health and safety recording was examined and found to be up to date and clearly recorded. The home has the services of a maintenance team that works on all the services run by the Provider. Staff said that emergency repairs which were required as a result of health and safety concerns were addressed quickly. 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 1 20 13 The home must ensure that all PRN medication and protocols are regularly reviewed All protocols for PRN medication should be regularly reviewed to ensure they are relevant to current needs 20/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The home should risk assess some individual activities and also provide assessments when people have variable staffing levels whilst in the community The home should ensure that administering of PRN medication is accompanied by two signatures 2 20 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!