Care Home: Eva`s Folly

What the care home does well Residents present as being relaxed and comfortable with staff indicating they feel safe and secure with them. Residents say they like the staff and that they are friendly. Staff members enjoy working at the home and have a commitment to the resident group. The home offers a clean and comfortable place in which to live. There is an open and friendly atmosphere. Robust recruitment processes are followed to help ensure the home employs only appropriate people. What has improved since the last inspection? Some parts of the home have been redecorated and refurbished. Since our last inspection the home has ensured that all bathroom and toilet locks are of a type that can be opened from the outside in the event of an emergency. A new boiler has been fitted and it is much more efficient at delivering hot water around the house than the old one had been. What the care home could do better: Five Requirements have been made as a result of this inspection. The home must develop its care plans to be more comprehensive and have more consistent recording of daily care. Risk assessments must also be more comprehensive and recorded in response to incidents and changes in service users` welfare. The home must ensure all records of medicines administered are made in accordance with good practice guidelines. The home must be able to show that there are always enough staff on duty at all times and they have the training, service specific and mandatory, so they have the skills and knowledge to meet resident`s needs. The Managers acknowledge they should have better recognised that, during the last year, they have been directing resources in meeting the increased care needs of two particular residents when alternatives should have been sought. The Managers are appointees for three residents. It is strongly recommended that the home continues its efforts to pass this responsibility to more appropriate parties to comply with Regulations and better safeguard residents` financial interests. Key inspection report Care homes for adults (18-65 years) Name: Address: Eva`s Folly 33 Parrock Road Gravesend Kent DA12 1QE     The quality rating for this care home is:   one star adequate 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: Gary Bartlett     Date: 0 3 0 3 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Eva`s Folly 33 Parrock Road Gravesend Kent DA12 1QE 01474320653 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Rosemary McGinty,Ms Kay Reeves Name of registered manager (if applicable) Ms Rosemary McGinty Ms Kay Reeves Type of registration: Number of places registered: care home 8 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 8. 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 The home provides care and accommodation for 8 people with learning disabilities and some mental health difficulties. The owners who both manage the home are registered nurses. There are staff on duty during the day to support service users with daily living tasks and the activities they wish to do. At night, there is a sleep in person with on call support. The people living in the home are assisted to help with the running of the Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 Brief description of the care home home and are supported to develop their skills. Each person has their own bedroom. There are comfortable facilities that include a kitchen, dining room, lounge, conservatory, garden and an external office. The home is 10-15 minutes walk from the town centre and there is easy access to public transport. There is a walled garden at the rear. The home has its own transport. The base fee for this service is £580 per week. Fees are calculated following the assessment of the persons need. Details can be obtained from the provider. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate 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 key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Evas Folly on Wednesday, 3rd March 2010, from 9:00 a.m. until 4.45 p.m. Judgements about quality of life and choices were taken from direct observation and by discussion with Ms. McGinty who is one of the Managers, some residents and staff. Some records and parts of the building and grounds were inspected. Account has been taken of information provided by the Managers subsequent to our visit. The Inspector would like to thank everyone involved for their contribution to the inspection. Care Homes for Adults (18-65 years) Page 6 of 30 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 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 Care Homes for Adults (18-65 years) Page 7 of 30 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 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. There are procedures for an accurate assessment of prospective residents needs before they move in to help ensure Evas Folly is the right home for them. Evidence: The home has an assessment and admission policy and procedure to help ensure admissions are undertaken in a planned way. These would be inclusive of relatives and health care professionals. If prospective residents are assessed to be suitable for the service, arrangements will be made for them to visit the home, where they can have a meal and attend social functions to enable them to get to know the staff and those who already live at the home. The people living at Evas Folly have been there for a number of years and there have not been any new admissions in recent times. The Manager explained that as the home is currently on the market, it is not intended to admit further residents. Care Homes for Adults (18-65 years) Page 10 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from improvements to their care plans and be better safeguarded by more comprehensive risk assessments. Evidence: Each resident has a care plan. Four were inspected, three of these in detail. The home uses the Standex care plan system. Whilst this provides adequate facility for recording individuals personal and health care needs, there is little detailed care planning for social care support. The care plans seen include dates of recent reviews, but it is not evident the home or the placing authorities have been consistent in ensuring reviews were regularly undertaken in the past. It is strongly recommended that all recorded dates be made in pen rather pencil to provide a clear audit trail. Staff spoken with have a good understanding of individuals care needs and of the importance of promoting their choices but these are not always recorded. The care plans should include more information about the individuals aspirations and how they make choices in their life. Irregular daily recording makes it difficult for the home to Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: provide clear evidence of how peoples needs are being monitored and met or when specialist advice has been sought or implemented as necessary. In response to our comments, the Manager stated that daily records of care will be more closely monitored and all staff will be required to retake the Mullberry training course in report writing by 14th March 2010. The records we saw show that residents are supported in having access to health care services such as dentists, opticians and chiropodists. The Manager says she recognises the home is legally required to keep clear records and the importance of being able to provide staff with clear directives of residents needs and how they are to be met. This is especially important as there have been some changes to the staffing group in recent months. She explained that meeting the increasingly complex needs of some of the residents has diverted their attention from making the intended improvements to the care planning system. There are risk assessments for some activities but they are not consistently comprehensive. For example, one persons particular behaviour is risk assessed for when they are in the community but not when they are in the home. Another risk assessment describes an individuals challenging behaviour but there are not strategies for staff to follow. It is not evident the risk assessments are always reviewed in response to incidents or changes in peoples welfare. This must be addressed to better safeguard people. Some residents have communication difficulties. From observation, the staff members have a good understanding of how to communicate with each resident, although it is not evident in the care plans if more innovative or individual communication styles have been explored. From observation and discussion, it is evident that residents have confidence in the staff team and the interaction is warm and friendly. Care Homes for Adults (18-65 years) Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents enjoy a range of activities and are encouraged to be a part of their local community, they would benefit from more comprehensive social care planning. Residents enjoy a healthy diet with plenty of choice. Evidence: The home is close to the centre of the town where there are shops, pubs and restaurants and some records show that residents are encouraged and supported to use these local community facilities. From discussion with staff and the residents, it is evident they continue to have busy lives and are consulted about the activities they would like to do. As mentioned earlier in this report, the home uses a care planning system that provides adequate facility for recording individuals personal and health care needs but Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: there is little detailed care planning for social care support. Daily records for one resident show they have a girlfriend. A senior staff member stated staff members are aware of this; however there is nothing recorded in the care plan to give guidance in supporting this relationship. Some residents care plans show they have communication difficulties. Although staff members were seen to be able to communicate with each of them, it is not evident in the care plans that more innovative or individual communication styles have been explored. Accordingly, it is not always clear how residents are consulted about their choice of activity. Since our visit, the home has been able to show us they have commenced writing new social care plans for each resident. Residents are welcome to entertain visitors at the home. Most people attend day centres or colleges. Those spoken with say they enjoy their activities. Some people said they enjoy going to the theatre, dancing, cinema and bowling. The physical and mental frailties of some people previously living at Evas Folly had markedly increased and two had become predominantly confined to wheelchairs. The Manager acknowledges this had resulted in the home not having as many spontaneous outings as previously. It is recommended the home reviews the current staffing levels at weekends to ensure they are always adequate to support residents in individual activities they may wish to undertake. The Manager said there are not any residents who have expressed a desire to attend religious services or practices but they would be supported in doing so if they wanted to. People living at the home can receive visitors when they wish and have use of a mobile telephone to call family and friends. We recommended the non operative payphone be removed to avoid confusion. Residents tell us they like the food. We had sight of directives written by the Manager reminding staff of the necessity of offering residents choices at all meal times that meet their preferences. The Manager stated she ensures the meals offered provide a balanced and nutritious diet and take account of peoples cultural needs as well as any medical conditions. This is confirmed by the records kept. Care Homes for Adults (18-65 years) Page 14 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved recording will better show how residents are supported with their personal and health care. Evidence: The staff members we spoke with have a good understanding of the individual requirements of each resident. Through discussion with the residents and staff and assessing various records, it is evident that residents have access to health care support. Improved and regularly reviewed care plans will better show that staff members are made aware as to the type and nature of the support required for individuals personal and intimate care needs and how these needs are being met. The daily records that we looked at for three residents have some periods of times when no entries have been made. As a result, it is difficult for the home to provide evidence as to how it is monitoring residents welfare. The Manager undertook to ensure records of care are more consistently kept. At our last inspection, the Manager had said she was about to review the facilities for the storage of medicines to ensure they fully complied with the latest guidelines from the Royal Pharmaceutical Society. This had not been done by the date of this visit, but Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: the home tells us this has now been initiated with the medications being kept in a lockable room that has hand washing facilities. The temperature of the room is being monitored to ensure medicines are stored at an appropriate temperature. The Manager is aware the medicines should be stored in a fixed metal cupboard and is intending to arrange this. It is recommended this be done as soon as is practicable. We inspected the Medication Record Administration Record (MAR) sheets completed for four residents during February 2010. Some of those seen had a few gaps without explanation. Consequently, we could not be sure that medicines had always been administered as prescribed. Medications are only administered by staff authorised to do so. The list of authorised signatories still includes staff members who have left the home. It is recommended the list be amended as soon as possible. No residents staying at Evas Folly currently manage their own medicines. The Manager said that if a resident wished to do so, the home would look at the possibility of providing support through a risk assessed framework. Care Homes for Adults (18-65 years) Page 16 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures to protect residents from abuse. There is a clear written complaints procedure. Some residents would benefit from this being available in formats they may find easier to understand. Evidence: Residents say they feel confident they are listened to and any necessary action in response to any concerns or complaints is taken. The Manager said no complaints have been received by the home since the last inspection. The Commission has not directly received any information regarding complaints about the home in that time. The Manager described how the home keeps a record of all complaints received by them, the result of the investigation and how the complaint has been resolved. At the time of our visit, the complaints procedure could not be located. It has since been explained that this was because it was being updated, a copy of which has since been forwarded to us. Whilst written in a user friendly way, it is recommended the home explores the possibility of making the procedure in formats more easily understood by some residents. One option that could be considered is an audio version. The Manager stated it is intended to undertake Capacity Assessments of the residents with cognitive difficulties such as dementia as part of the review of their care plans. This will help the home ensure peoples best interests are being promoted. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: The Managers are appointees for three residents. They have kept us informed of their efforts to pass this responsibility to more appropriate parties to comply with Regulations and better safeguard residents financial interests. It is strongly recommended that the home makes a further approach to the local authority in regard to this. We inspected the records of financial transactions made in support of three residents. These were detailed and the appropriate receipts were in place. It is recommended that all transactions are recorded separately for easier auditing purposes. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The staff members spoken with have a sound understanding of safeguarding vulnerable adults procedures and of the need to be mindful of individuals needs. There has been one safeguarding alert since our last inspection and this is currently ongoing. Care Homes for Adults (18-65 years) Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable and clean home. Evidence: Evas Folly is a Victorian listed building. This restricts the changes and adaptations that can be made to the environment. Some changes had been made to accommodate the needs of residents who had become more physically frail. People currently living at the home are ambulant and say they can easily access the parts of the home they want to. Evas Folly offers a homely and comfortable environment for people to live in. There is an ongoing programme of redecoration and refurbishment. A part time Housekeeper is employed and those parts of the home seen are commendably clean and free from offensive odours. Residents say they find the bedrooms comfortable and the bathroom and toilet facilities are adequate for their purposes. Since our last inspection the home has ensured that all bathroom and toilet locks are of a type that can be opened from the outside in the event of an emergency. The Manager agreed to make two radiators that have high surface temperatures and are Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: not fitted with individual thermostatic control valves safe. She explained that a new boiler had been fitted recently and it is much more efficient at delivering hot water around the house than the old one had been. The Manager also undertook to repair or replace a damaged cabinet in a communal bathroom to improve infection control in that area. Care Homes for Adults (18-65 years) Page 20 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment processes are followed to ensure only properly vetted people work at the home. Staff members are caring, but the home must be more able to readily show they have the necessary skills to meet service users care needs and are available in sufficient numbers at all times. Evidence: The last year has been very unsettled for the home with changes in some key personnel and increased care needs for some residents. The Manager acknowledges that staff training has resultantly not been as up to date as it should. The home has provided us with a training matrix that shows there are some gaps in mandatory training and staff members have not had training in social care for people with a learning disability. The Manager has undertaken to organise relevant training in the soonest possible time. Until this is done, it is not evident that all members of staff have the skills to meet residents needs and to comply with current legislation and good practice guidelines. NVQ training is also to be arranged for Support Workers. Robust recruitment processes are followed to ensure only properly vetted people work at the home. People applying to work at the home have to complete an application Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: form, provide two references and have Independent Safeguarding Authority (ISA) and Criminal Records Bureau (CRB) checks and attend an interview. New staff have to undertake an induction programme. We inspected the file of the most recently recruited staff member and the required documentation is in place. Staffing levels are geared to peak times of activity and residents attendance at day centres. Taking account of the high needs of one resident and that another is funded for one to one care, the staffing levels must be reviewed to ensure that adequate numbers of staff are always on duty to meet residents needs, to comply with contractual agreements and to enable them to participate in activities they may choose, particularly at weekends. The staff roster should include details of which staff member is allocated to provide one to one care and which staff member is designated as being in charge when a senior staff member is not included on the roster. Residents indicate they like the staff and find them approachable and kind. Throughout the site visit there was evidence of good relationships between staff and residents. Conversation and activities were inclusive and residents were given time to express themselves. Care Homes for Adults (18-65 years) Page 22 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home ethos is to promote residents interests, it would benefit from a more a more clearly focussed management approach with particular regard to recording and reporting. Evidence: The two owners, Ms. McGinty and Miss. Reeves, jointly manage the home and are registered nurses. Both are currently undertaking their NVQ 4 qualification. One hopes to complete hers by May 2010 and the other later in the same year. At our inspection of 7th April 2009, the Managers had expressed the intention of improving care plans and risk assessments to reflect better the quality of care given. This had not been done and, as detailed earlier in this report, it is consequently difficult for the home to provide clear evidence of the monitoring of care and competencies of the staff. The Managers acknowledge they should have better recognised that they have been directing resources in meeting the increased care needs of two particular residents when alternatives should have been sought. The Managers had previously worked in the home part time, coordinating their shifts to Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: provide cover. Ms. McGinty tells us they both now work full time to take account of changed staffing numbers at the home and to address the improvements required. Documentation has been forwarded to us since our visit to the home, thereby providing some evidence this is being done. Residents and members of staff say they find the Managers approachable and supportive. The Manager described how there is a quality assurance process is in place, which elicits views from residents and their relatives and other health care professionals such as Care Managers. The standard of cleanliness in the kitchen and surrounding area is good. During our visit, we saw that COSHH guidelines were being adhered to, thereby helping keep people safe. Staff and residents spoken with have a good understanding of emergency procedures. The Manager stated that records of maintenance and safety checks are in order. These were not inspected on this occasion. Care Homes for Adults (18-65 years) Page 24 of 30 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 25 of 30 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 7 17 The registered person shall maintain records as specified in Schedules 3 and 4. It is a legal requirement for the registered person to keep records of care that are up to date and specific in detail of information required. All service users must have a comprehensive care plan that is inclusive of personal, health and social care needs by the given timescale, if not sooner, and which is maintained thereafter. Daily records must be made more regularly to provide evidence of how individuals needs and welfare are being monitored and met. 31/05/2010 2 9 13 The registered person shall ensure that unnecessary risks to the health and safety of service users are 31/05/2010 Care Homes for Adults (18-65 years) Page 26 of 30 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 identified and so far as possible eliminated. It is a legal requirement for the care home to minimise risks as far as is practicable. Risk assessments must be more comprehensive and recorded in response to incidents and changes in service users welfare. Comprehensive risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. 3 20 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. It is a legal requirement for the registered person to make arrangements for the safe administration of medicines. Arrangements must be made so that all records of medicines administered must be made in accordance with good practice guidelines. This must be done by the given timescale, if not sooner, and maintained thereafter. 31/03/2010 Care Homes for Adults (18-65 years) Page 27 of 30 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 4 35 18 The registered person shall, 30/04/2010 having regard to the size of the care home, the statement of purpose and numbers and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. It is a legal responsibility to ensure there are always adequate numbers of staff on duty to meet the care needs of service users and to ensure the home is complying with contractual agreements with commissioners of the service. A review of staffing levels, taking into account service users current needs and contractual agreements with commissioners must be undertaken. The details and results of the review must be received by the Commission by the given date if not sooner. 5 35 18 The registered person shall, having regard to the size of the care home, the statement of purpose and 30/04/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 numbers and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. It is a legal responsibility to ensure the staff group has the knowledge and skills to meet service users needs. A detailed training plan to show that all staff will have received mandatory training and training in social care for people with a learning disability must be must be received by the Commission by the given timescale. This must include details of training courses attended and booked, including details of the training providers and any accreditation they may have. 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 29 of 30 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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