Care Home: Flaxpits House

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Inspecting for better livesKey inspection reportCare homes for adults (18-65 years)Name: Address: Flaxpits House 74 Flaxpits Lane Winterbourne South Glos BS36 1LBThe quality rating for this care home is:two star good serviceA 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: Odette Coveney Date: 1 0 0 8 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 areaOutcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgementCopies of the National Minimum Standards ­ Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000.Reader InformationDocument Purpose Author Inspection report CSCIPage 2 of 34Care Homes for Adults (18-65 years) Audience Further copies from CopyrightGeneral 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.ukInternet addressCare Homes for Adults (18-65 years)Page 3 of 34 Information about the care homeName of care home: Address: Flaxpits House 74 Flaxpits Lane Winterbourne South Glos BS36 1LB 01454776191 01179709301 flaxpits@hotmail.co.ukTelephone 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) :Aspects and Milestones Trust care home 8Number of places (if applicable): Under 65 Over 65 8 8 8 8learning disability physical disability Additional conditions: Male and Female 35-64 years and 65 years and over Date of last inspectionCare Homes for Adults (18-65 years)Page 4 of 34 A bit about the care home SummaryThis 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 serviceChoice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the homeCare Homes for Adults (18-65 years)Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced visit as part of the key inspection process. The purpose of the visit was to review the progress to the two requirements and the three recommendations from the visit in July 2007 and to also monitor the quality of the care provided to the individuals living in Flaxpits House. There have been no additional visits to the service since July 2007. The Commission for Social Care Inspection, now known as The Care Quality Commission (CQC)have received no complaints about the service. There has been no changes within the management structure at the home since the last visit. The provider has kept the Commission informed throughout the process.The registered manager was on duty on the second day of our visit. The focus of this inspection visit was on the general care of a sample group of people who use the service and the environment, including a general tour of the premises and a review of staffing records such as recruitment, selection and training. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service.Care Homes for Adults (18-65 years) Page 7 of 34 The manager completed an annual quality assurance assessment on 14th July 2009 . In addition views were sought through surveys to people who live at the home (2), professionals who support people at the home (2), staff who work at the home (3) no surveys were received from relatives of people who use the service. The inspection was conducted over two days, a total of 7.45 hours.What the care home does well What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care homeIf you want to speak to the inspector please contact Odette Coveney 33 Greycoat Street London SW1P 2QF 02079792000Care Homes for Adults (18-65 years)Page 11 of 34 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 7535Care Homes for Adults (18-65 years)Page 12 of 34 Details of our findingsContents 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 inspectionCare Homes for Adults (18-65 years)Page 13 of 34 Choice of homeThese 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.The home is able to provide clear and detailed information about the services and facilities that available to those who choose to live at Flaxpits House. There is a good pre-admission assessment for any person needing to move into the home, which makes sure that the home can meet the needs of that person.Evidence: The home has a Statement of Purpose and Service Users Guide that is available to people thinking of moving into the home. The documents clearly set out the types of needs that the home can cater for. The information within these documents was comprehensive and contained clear information for people living at the home and their relatives about the services and facilities provided at the home and furthermore contained information about the staff and management arrangements at the home, there was also information about the admissions process into the home and how to raise issues of concern and showed how these would be responded to. This document was being updated at the time of our visit in order to include up to date photographs of the premises.Care Homes for Adults (18-65 years)Page 14 of 34 Evidence: Prospective individuals are given opportunities to spend time in the home before their admission to see the room that is available, meet the staff, the other people living in the home and have a meal with them. After admission to the home people have a trial period, this is for four weeks and can be extended in some circumstances in order to ensure the home is an appropriate placement, after this trial period and full review meeting is held in order to discuss the individuals care plan and their assessed needs and how these are being met. It would be at this meeting that the home would confirm that the home can meet the persons individual needs and how this is done would be discussed. During this visit we reviewed the information held at the home about an individual who had moved into the house since our last visit. We saw that prior to their moving into Flaxpits House the home received a care managers assessment, which outlined the support, wishes and aspirations of the individual, from this, and their own observations, the home have developed a plan of care for the individual, this is well written and sufficiently detailed in order to guide and direct staff practice. During our last visit to the service a requirement was made that licence agreements must be in place for all service users and must contain full and detailed information. This was because the information in respect of weekly fees held at the home within the terms and conditions of the placement had not been updated since 2005. We were most disappointed to find that this requirement had not been met and for the most recently admitted individual into the home they did not have a licence agreement in place. We discussed this with the manager who appeared to not have understood the rationale for the requirement, this was again explained to the manager who was able to rectify this at out visit and updated the weekly fees charged on the licence agreements and confirmed to us that an updated version of this document would be made available to all who live in the home, with a copy available to them in their own rooms for their information.Care Homes for Adults (18-65 years)Page 15 of 34 Individual needs and choicesThese are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Peoples 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.Care plan information provides detailed information on how individuals wish to be supported in the manner most appropriate for them. People are supported to make decisions where they are able. Risks are well managed and people are supported to lead safe lives.Evidence: During this visit we read three care plans as part of the case tracking process. This means that we spend time reading the records of the people that we select, and decide by meeting them, and talking with the staff caring for them, whether the care plans give the complete picture of how to meet a persons needs. In all three instances this proved to be the case. We received two completed surveys from people who live at the home, they indicated that they were happy with the service being provided by the home and no concerns were raised to us. The home uses a person centered planned approach and gathers and recordsCare Homes for Adults (18-65 years) Page 16 of 34 Evidence: information in the form of ELPs, (essential lifestyle planning approach) in order to find out information about the persons life to try and gather as much information about them as possible. Information from these ELPs was included in the care plans we read and information recorded was detailed and it was evident that information had been gathered over a long period of time and staff had got to know individuals and how they wished to be supported. Communication techniques were also well documented so that staff knew how best to communicate with each person and included areas such as important factors surrounding peoples behaviors and how best that they should be assisted and enabled. Within individuals records we saw that the home supports people to take risks as part of an independent lifestyle. Clear information about the decision making processes are recorded within risk assessments, which are written and recorded in conjunction with individuals care plans. We saw that assessments had been completed in areas of peoples lives such as; risks of getting in and out of bed, walking around the home and outside of the home and support for people at night who have a poor sleep pattern. We did note that one assessment referred to bedsides as cot sides and another as a listening monitor as a baby monitor, the wording within these assessments should be changed to reflect that people are adults and are treated as such.Care Homes for Adults (18-65 years)Page 17 of 34 LifestyleThese 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 who live at the home are well supported to access the local community and to take part in appropriate activities.Evidence: During our visit to the home people were out and about participating in activities of their choice, people were out for lunch and shopping. We spent time talking with a person who is independently employed by another organisation to support people with their leisure and social activities, they told us that the home supports the individuals well to ensure that they are involved in the decision making process about where to go and to choose what they would like to do, these were well recorded within care plans, files notes and minutes of review meetings. Within notes we saw that people have been supported with activities of their choice and have been encouraged to be part of the local community, this has included visiting places of local interest such as Snuff Mills, Blaise Castle, attending local social clubs and therapeutic activities such as hydrotherapy reflexology and massage. We saw that people have been encouraged toCare Homes for Adults (18-65 years) Page 18 of 34 Evidence: make choices about their annual holiday and that one individual had recently been to Minehead, another person had been on a Mediterranean cruise. We spoke to staff about how people are supported with their religion and were informed that people are encouraged and assisted to maintain their faith, one person attends church regularly and enjoys the recitals that are performed. The manager and staff talked with us about forthcoming daycare arrangements and the changes that that are anticipated due to the current day care provider withdrawing their services. We were informed that work is currently in progress to ensure that individuals day care levels, opportunities and flexibility will not be limited, the manager was confident that the new arrangements will allow more freedom to co ordinate activities that will be more person centered and tailored to the individual, will will review this when we next visit the home. The home have clear menu planning arrangements which are based upon the wishes, preferences and dietary requirements of people who live at the home, these are well recorded at the home. Since our last visit to the service the home they have been visited by South Gloucestershires Environmental Health Department and have been awarded a 5 star food hygiene award for good standards of hygiene and food hygiene at the home.Care Homes for Adults (18-65 years)Page 19 of 34 Personal and healthcare supportThese 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 are well supported with their personal support and healthcare services are accessed as required. Medication is well managed at the home.Evidence: Within care records we saw that individuals emotional state and how they were to be supported was detailed and gave information about cognitive and communication difficulties, with any history of specific, individualised support requirements. Staff were directed to use various approaches to each situation such as someone becoming upset or anxious. Care plan reviews were done as incidents occurred such as falls and changes in healthcare, as well as the recommended six monthly reviews. There was also evidence of the home referring situations they needed advice and further guidance. This was particularly so for an individual at high risk of falling. The home had requested a Physiotherapy referral from the GP, and visit had taken place. Advice was given for staff to follow to help with a persons mobility and so reduce the risk of a fall. Detailed risk assessments had been completed to ensure that every area which could lead to an increased risk was reviewed and discussed. This went fromCare Homes for Adults (18-65 years) Page 20 of 34 Evidence: basics of decent foot wear, the environment, to walking and getting in and out of bed. This attention to falls management is commended. There was comprehensive information about meeting the whole range of peoples physical needs including details such as recording when the person last had a sight/dental check and the date when they would need an annual check up. Peoples health is also monitored by the use of other assessments for example their nutritional status, and then if necessary a record is kept of those people at risk from being malnourished or dehydrated. These have been seen by us at previous visits when there had been a concern for an individuals health in this particular area. Peoples weights are also done monthly to make sure there is no significant weight loss, records of these are in place. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support and advice from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. We noted that in the front of the medication records folder there was a sample of staff signatures, these are staff who are trained to give out medication. This list of signatures was out of date with some new staff members, who had been trained, not included on this list as were there other signatures of staff who have left the service. It is recommended that this signature list is reviewed and updated as needed in order that accurate information is recorded and held. Two completed surveys were sent to us from visiting professionals who visit individuals at the home, they raised no concerns to us. In response to the question What does the home do well ? , one of the professionals said: They look after residents in a nice home, respecting their needs and privacy.Care Homes for Adults (18-65 years)Page 21 of 34 Concerns, complaints and protectionThese 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 living in the home are protected from abuse by the homes policies and procedures and staff training. Any complaints received are fully investigated and viewed as a way of improving the service.Evidence: There is clear, well written complaints procedure, a copy of this was in each individuals file and also they had a copy of this document in their room. Information about how to raise a concern or complaint in held within the guide about services and is well written within the homes statement of purpose. The home also has a clear policy in respect of how to raise issues of concern and this had been discussed with people who live at the home. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint, individual had been provided with a pictorial version of this document and the format can be amended in order to be produced in a larger format for those with sight difficulties. It also directs the complainant to the CSCI (now the Care Quality Commission) and South Gloucestershire Social Services. A copy is also available to relatives should they request it. The Commission has not received any complaints about the home. We reviewed the complaints logbook for the home, we saw that a recent complaint hadCare Homes for Adults (18-65 years) Page 22 of 34 Evidence: been dealt with promptly by the home with an effective response to the issue in order that it was resolved effectively. The homes policy and procedures for safeguarding adults from abuse is readily available to staff. Staff told us they have received training in the safeguarding of vulnerable adults and we saw evidence of this on staff files. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, two references and satisfactory Criminal Record Bureau disclosures.Care Homes for Adults (18-65 years)Page 23 of 34 EnvironmentThese 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.Flaxpits House is a well maintained, well furnished and provides a pleasant and homely environment in which to live.Evidence: Flaxpits House is located within the semi rural area of Winterbourne, it is a pleasant location and is within walking distance to the local duck pond and amenities such as the post office, bank, chemist, optician as well as local shops. The accommodation provided at the home is all on the ground floor.We visited some shared areas of the home, the kitchen, bathrooms and some bedrooms. For both of our visits the home was fresh and cleanliness was of a very high standard. This included areas unseen by visitors: bathrooms, toilet areas and the medication storeroom. Since our last visit to the home the lounge and dining area have been redecorated, making these areas homely and more inviting. The home is well equipped with specialist items such as wheelchairs, mobility aids, sensor mat, hoists and bed rails. Bathrooms also have facilities to make assistance with bathing or showering as easy as possible. Efforts have been made to ensure that the environment is as safe as possible. Fire precautions are in place and on the whole fire regulations are complied with (see management section of tis report). Water temperatures are controlled, there are hand washing facilities in every bedroom andCare Homes for Adults (18-65 years) Page 24 of 34 Evidence: elsewhere in the home. Infection control policies and procedures are in place. There is parking to the front of the house and a well tended rear garden, staff have been supporting people who live at the home to grow tomatoes, and beans, since our last visit new seating in the garden has been provided and a garden swing installed. During our visit we saw people who live at the home enjoying the area and making full use of the facilities.Care Homes for Adults (18-65 years)Page 25 of 34 StaffingThese 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. Peoples needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.The home ensures that all staff have been employed following robust recruitment and selection processes. Staff are committed to providing a good service to those people in their care and advocate well on individuals behalfs.Evidence: The home maintains a core of staff that have worked there for many years providing consistency and experience. During the visit the manager and staff were able to demonstrate a clear understanding and knowledge of the individuals who use the service, and of their role in the home. During our visit three staff members spoke to us about the staffing arrangements during the weekend, we noted that other staff members had raised similar concerns during supervision and team meetings in respect of the use of agency staff during weekends. Staff were concerned about the lack of continuity and consistency of care for people living at the home. We discussed this with the manager who accepted that their had been some difficulties due to changes in staffing arrangements and changes in the staff roles for the home, the manager assured us that staff concerns had been noted and were being addressed and that recent interviews would balance the situation and provide a more consistent service. At the time of the visit the staffing levels were sufficient to meet the needs of the people living there. This judgement was based upon the fact that people were able to make choices about the lifestyle such asCare Homes for Adults (18-65 years) Page 26 of 34 Evidence: getting up when it suited them. Staff were also seen engaging in social activities and supporting people promptly with their requests for assistance. The Manager has been able to demonstrate that on occasions when extra staffing had been required for a particular situation when one person needed one to one supervision during the evenings this had, and would be provided. Information contained within individual staff files were all of a consistent standard. The files for three staff were reviewed; including a recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. It was difficult to find information within staff files as records within these were all loose leaf and the files were not ordered in any way. In order to locate information and make the files more accessible it is recommended that consideration is given to the re organisation of staff files. During this visit we reviewed staff training records and saw that within the past twelve months staff have completed training in protection of vulnerable adults, fire safety, managing good practice and diabetes care. We also note that nine staff have completed a National Vocational Qualification at level two or above in care practice. Records did not fully show that staff have received sufficient amounts of training required, the manager said, with confidence, that staff have completed the required amounts of training and that records were in need of review. It is recommended that staff training records are reviewed and updated in order to reflect accurate staff training undertaken, any shortfalls in training must be addressed.Care Homes for Adults (18-65 years)Page 27 of 34 Conduct and management of the homeThese 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. Peoples opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.People living in the home benefit from a Manager who is competent, caring and promotes their rights. Any decision made is based upon what is best for the people in the home, and they are included as much as possible in that processEvidence: Ms Dionne Brown started at the home as manager on 2003 . She has passed the fitness process with the Commission for Social Care Inspection, now CQC. This means that she is the registered manager. Ms Brown is responsive to advice and recommendations from other people, and acts upon them if that benefits the people in her care. Ms Brown is experienced, appropriately qualified and committed to improving the quality of life for the people who live at the home. Practice observed was of good relationships between those who live at the home, staff and management. Staff at the home fully engaged with us during this visit and was able to locate all of the necessary information and documents easily. This shows that the home has goodCare Homes for Adults (18-65 years) Page 28 of 34 Evidence: systems in place and is well run. The home has good systems for monitoring the quality of the care provided to the individuals living at Flaxpits House these included regular reviews of care plans, review meetings where the individual was involved, supervisions and staff meetings. There are also no current complaints recorded for this service. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered manager was sufficiently detailed. Within the AQAA, completed by the manager prior to the inspection she reported that: Client care has improved and staff are now taking a greater interest in improving the lives of people who live at the home, communication has improved with supervision and staff meetings. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individuals expectations and an evaluation of their performance and how this can be developed. Staff spoken with said that they are positive that the team are committed to ensuring the needs of those living at the home are met, that ideas and suggestion are listened to with regular individual supervision being held for continuity of care and effective communication. There was evidence that the home ensures so far as is reasonably practicable. The health and safety for those who live at the home staff and visitors. The home has robust policies and procedures in relation to aspect of health and safety. During our last to the service we were concerned to note that a ceiling hoist was being used with no assessment to demonstrate that all safety factors had been considered. A requirement was made that a risk assessment must be developed for the use of this ceiling hoist. At this visit we found that the hoist is not used at this current time as the person for who it was obtained has since left the home, a senior member of staff we spoke with, and the manager, confirmed that should this piece of equipment be used in the future staff would be re trained in the use of this aid, professional occupational therapy advice would be sought and a risk assessment would be completed, in line with the individuals assessed need as would be recorded in their care plan. During this visit we reviewed risk assessments that were in place, as part of this we reviewed the assessments in respect of control of substances hazardous to health (COSHH), we found that these assessments had not been reviewed or updated since 2007. We recommend that COSHH risk assessments are reviewed in order to ensure that accurate information is in place.Care Homes for Adults (18-65 years)Page 29 of 34 Evidence: The fire logbook was viewed and was well maintained. The home was completing the appropriate checks on the fire equipment and recording of training and testing of equipments were satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency, however, it was identified that there were staff who have not received sufficient amounts of fire instruction during the past twelve months. It is required that staff must received this instruction/training in order to ensure that they are fully aware of their role and responsibility and the expectations placed upon them should a fire emergency occur. When we reviewed the fire logbook we saw that their had been a fault with the closure mechanism on the lounge fire door, the home had contacted the appropriate contractor and the fault had apparently been repaired, however, during our visit we found that this door was still not closing properly, a staff member on duty we spoke to about this and contacted the contractor to request another call out, we re visited the home six days later and this fault had still not been repaired. The manager rang the contractor whilst we were on site to request another visit. It is required that this fire door is repaired in order to ensure its closure and assurance that this will be effective should a fire emergency occur.Care Homes for Adults (18-65 years)Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.No Standard Regulation Requirement Timescale for actionCare Homes for Adults (18-65 years)Page 31 of 34 Requirements and recommendations from this inspectionImmediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.No Standard Regulation Description Timescale for actionStatutory 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 setNo Standard Regulation Description Timescale for action14223The registered person must make adequate arrangements for persons working in the care home to receive suitable training in fire prevention.05/09/2009This instruction/training is required in order to ensure that staff are fully aware of their role and responsibility and the expectations placed upon them should a fire emergency occur.24223The registered person must 25/09/2009 ensure that the premises are kept in a good state of repair.This fire door is to be repaired in order to ensureCare Homes for Adults (18-65 years) Page 32 of 34 its closure and assurance that is will be effective should a fire emergency occur.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 Recommendations120It is recommended that the list of staff sample signatures is reviewed to ensure it contains clear accurate information of those staff who have been trained to give out medication. In order to locate information and make the files more accessible it is recommended that consideration is given to the re organisation of staff files and to give the files a format and structure. Staff training records to be reviewed and updated in order to reflect accurate staff training undertaken. Control of Substances Hazardous to Health (COSHH) risk assessments should be reviewed in order to ensure that accurate information is in place.2343 435 42Care Homes for Adults (18-65 years)Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website.Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication maybe 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 34 of 34 - 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!