Care Home: Gargrave Road (24) - North Yorkshire County Council

What the care home does well People who use the service are given good information about what is provided. This helps them decide if the service is right for them.The information has been developed into an easy read style and will hopefully be available to individuals soon. People who would like to stay at the respite unit have a full assessment to make sure the service can meet all their needs. People are involved in deciding what care they need and a plan is then drawn up. This gives everyone a say in planning services they will receive. People using the service tell us that Gargrave Road provides, "Good care and we talk about things. Good food and menu of things to eat" "Support me with things like Bowling" "I usually go out with the staff on a weekend to Bolton Abbey" " They couldn`t do anything better, I am happy the way it is" Staff observed at the home showed a good understanding and knowledge of people they support. The staff support people to experience a fulfilling life whilst using the service both in the home and the local community. People using the service also have good opportunities to enjoy their own interests and hobbies and take part in many activities during their stay. What has improved since the last inspection? The home has improved the way in which it gathers information about individuals to make sure that full assessments and care plans are completed. The service user guide and contract are now in an easy read style to support people in their understanding of their rights whilst using the service. Information about staff recruitment and training is now in place. This is important to make sure that everyone working for the service is safe to do so. Risk assessments for areas such as the use of bed rails and self medication have now been completed to make sure that any potential hazards are removed and people are safe. The management of the home has been consistent and responsive to previous requirements raised at the last inspection. The service overall is well run by the manager of the home. What the care home could do better: The manager must complete a thorough fire risk assessment and make sure that Gas safety checks are undertaken regularly at the home. People are well supported with health needs but proper training must be put in place to make sure that staff are safe to undertake specialist health care techniques. All staff should have training, including relief staff. An audit of all staff training should be completed to make sure that people are cared for safely by a well trained and able staff team. The Environment continues to be inadequate in fully meeting the needs of people with a physical disability and at times their privacy and dignity can be compromised. The service should consider developing the quality auditing of their service with client and family meetings and qualitative questionnaires. This is important to make sure that everyone has an opportunity to have their say about the way the service is run. Key inspection report Care homes for adults (18-65 years) Name: Address: Gargrave Road (24) - North Yorkshire County Council 24 Gargrave Road Skipton North Yorkshire BD23 1QJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Trenouth     Date: 1 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Gargrave Road (24) - North Yorkshire County Council 24 Gargrave Road Skipton North Yorkshire BD23 1QJ 01756700720 01756795981 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.northyorks.gov.uk North Yorkshire County Council Name of registered manager (if applicable) Mr David Teague Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service Users up to 5 LD and up to 5 LD(E) up to a maximum of 5 Service Users Date of last inspection Brief description of the care home 24 Gargrave Road is a care home owned and operated by North Yorkshire County Council and registered to provide a service for 5 adults of either gender aged over 18 years who have a learning disability. It provides a respite service for individuals by providing over night stays for people living in the Craven area. The home is located in a mid-terrace Victorian property within walking distance of the centre of Skipton. There is a lounge, dining room, kitchen and bedroom on the ground floor and three bedrooms on the first floor. One bedroom is a shared room which can only be used when people have chosen to share. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 5 5 1 3 1 1 2 0 0 8 Brief description of the care home The fee for the service in November 2009 is £806.82 pounds, the charge is dependent on financial assessment. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service over one day for approximately 6 hours. The inspection also included gathering information and evidence before and after the visit to decide the overall judgement. We looked at records, watched staff working, and talked to people who stay at the respite service. We also looked around the building. The main purpose of this inspection is to make sure the service provides a good standard of care. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations, but only when it is considered that people who use the service are not being put at significant risk or harm. In future, if a Care Homes for Adults (18-65 years) Page 6 of 31 requirement is repeated, it is likely that enforcement action will be taken. We sent surveys to people who use the service and staff to give them the opportunity to comment on the service, fourteen surveys were returned and the comments are included in this report. The manager of the home completed a self assessment form called AQQA, which is information we ask for every year and is used as part of the inspection process. The returned self assessment documentation provides information about staffing and people who use the service. Feedback was given during the inspection to the manager of the home. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 31 The manager must complete a thorough fire risk assessment and make sure that Gas safety checks are undertaken regularly at the home. People are well supported with health needs but proper training must be put in place to make sure that staff are safe to undertake specialist health care techniques. All staff should have training, including relief staff. An audit of all staff training should be completed to make sure that people are cared for safely by a well trained and able staff team. The Environment continues to be inadequate in fully meeting the needs of people with a physical disability and at times their privacy and dignity can be compromised. The service should consider developing the quality auditing of their service with client and family meetings and qualitative questionnaires. This is important to make sure that everyone has an opportunity to have their say about the way the service is run. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well assessed and given good information before they move into the home to make sure that the service will be right for them. Evidence: The service user guide and contract are now complete. These have been updated and produced in an easy read format to help people understand their rights and explain what they can expect from the service. Staff tell us that individuals are encouraged to visit and stay at the respite service to help them decide if it is right for them. People using the service tell us that they were given lots of information and were invited to try the service. one individual said, I looked around and stayed to see if I liked it here Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: When people stay at the respite service staff discuss their stay with them and their families to make sure they have had a good experience and to discuss how they feel about the quality of care. This is important to continually make sure that people have a good experience when using the service. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported to make their own choices about how they wish to live their lives. Evidence: Assessments and care plans were complete and reviews regularly undertaken. This makes sure that the changing needs of people using the service are continually met. The care plans are person centred, this means that individuals decide how they want to be cared for and what is important to them. People clearly participated in their own care plan and made their own decisions about what they wanted to do from day-today. Each individual has a special worker called a link worker, who includes them in their care planning. The link worker, also works closely with the day services that people access, this includes attending joint reviews. This is to make sure that good communication is established and that there is continuity of care between the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: services. The care plans recorded examples of how staff enable people with their personal care, detailing how individuals should be supported to do as much as possible for themselves. This is important to make sure independence and dignity are maintained. The care plans help guide staff to support people with their communication needs. This is important to enable individuals to make decisions and help them express their concerns or opinions. A Mental Capacity Act checklist has been introduced where it is felt peoples rights and liberties may be restricted. This is important to make sure the care they receive is in their best interests. People using the service say, I get up when I want too, if I dont have to go out. Sometimes I like a shower sometimes a bath I can have both One person told us that they like going to the supermarket with the staff to help with the shopping. They also confirmed that they choose the activities that they like to be involved in. they say, I decide what I want to do and where I want to go, I go to the Cinema, Bowling and the Pub if I want Staff were able to give examples of how they support individuals to make their own decisions, this can be a range of decisions i.e when to get up or retire, choosing what to wear or eat, what to buy or where to go on a day trip. Staff commented, We promote clients rights and choices At Gargrave Road we help clients to do as much as possible for themselves, we work continually with families to make their stay as comfortable as possible Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: We support people to make independent choices away from home Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who stay at the home are supported in their choice of activities to ensure they experience fulfilling lives both within and outside the respite service. Evidence: There are many varied activities happening throughout the week, which are appropriate to the needs, age and abilities of the people living at the home. People continue with their organised activities whilst staying at the respite service. In addition to this staff also support people to enjoy further activities such as personal shopping, walking, bowling, the cinema, eating out and day trips. A trip to Wembley is planned for the weekend to watch the football. Staff tell us that peoples birthdays are always celebrated, recently one individual had a special birthday party which was recorded on on to a DVD by the staff for the family Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: as they were unable to join them on that day. The service has received funding for a Laptop Computer with broadband access and all people who use the service have access to this. It was clear from discussion with individuals that this had been a popular resource. There was a positive and comfortable atmosphere and friendly banter between the staff and people living at the home. Individuals are encouraged to be involved with the planning of menus and shopping for food in the home. Staff said that they encourage everyone to be involved and individuals have the opportunity to eat what they like and try different foods. A well balanced diet is encouraged. one individual said, I decide what I want to eat and my favourite is Spaghetti Bolognese The staff tell us that people living at the home are supported to eat together and the staff join them to encourage a relaxed meal time. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported with health needs but proper training must be put in place to make sure that staff are safe to undertake specialist health care techniques. Evidence: People use the service for a short or over night stay and therefore families or carers usually organise health care and appointments. The health care needs of each person are clearly recorded in their care plan and the information is comprehensive. The details included peoples nutritional needs and any specialist health care that is required. The staff we spoke with all seemed to understand the emotional and health care needs of each individual to make sure everyone was supported and their needs are met. The staff check all the medication coming into the home carefully. The medication is then stored in a safe place and the recording systems are accurate to make sure that everyone is safe. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Staff have training in specialist care to support people with a Learning Disability or where they have specific physical needs. Staff training in specialist invasive health care techniques, such as the administration of rectal diazepam was inadequate. This was discussed with the manager. Staff must be trained by a specialist practitioner and their work continually monitored. This is to make sure peoples health needs are met safely. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns will be taken seriously. Evidence: The complaints procedure is available in the Service User Guide in an easy read style and staff have access to grievance and complaints procedures in their own policies and procedures. There have been no complaints received by the home or Care Quality Commission (CQC). Staff have a good understanding of the communication needs of people living at the home and therefore interpret when individuals may have concerns. Link workers contact individuals and their families after they use the service to make sure that they were happy with their stay. Staff tell us that they have completed training in Adult Protection and understand their responsibilities when they have concerns for a persons welfare. There is an Adult Protection procedure in place which everyone has access to. There have been no complaints received by Care Quality Commission (CQC) or the home regarding this service during the last year. The staff tell us that there are robust Policies and Procedures in place around adult protection. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: All financial transactions are accurately recorded in the individuals personal money record. These records are checked daily and recorded on the written handover information that the staff complete as part pf their daily record keeping. This is important to protect people from financial abuse. The manager is required to submit accident and incident reports, this helps establish patterns and highlight issues. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a very clean and comfortable home but the environment does not meet the needs of people with Physical Disabilities. Evidence: This was an unannounced visit and the home was found to be reasonably decorated, well maintained and very clean throughout. Lounges and the dining room are comfortable and furniture appropriate for the needs of people staying at the home. Individuals can have a key to their room if they wish. There is a shared room and three single bedrooms at the home. One bedroom on the ground floor has tracking hoists and a hi-low bed fitted to support people with their mobility needs. The shared room can only be used when two people expressly wish to share a room together. The manager told us that there are two people who presently use the service who make a request to share this room. In the surveys when asked what the service could do better staff tell us, Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: To not have a room that is shared and be under pressure to fill beds. There is some provision of mobility and disability equipment in the home, a tracking hoist has been installed in the downstairs bedroom. However the storage of special equipment is limited. Most of the additional equipment is stored in the walk in shower which means that staff are constantly having to move equipment out to use the shower safely. Privacy is also difficult to maintain for people with a Physical Disability as the shower and ground floor toilet area are adjacent to communal areas of the home. One person using the service commented, We need more room in the shower There are long standing issues related to the suitability of the premises, which do not promote the privacy or dignity of people staying at the home. This is due to the layout of the building, poor access and lack of special mobility provision and storage. Relatives tell us, the new home is long overdue, this has been going on over a 10 year period. I find care in the community a little hard to accept when this has been going on so long The service hopes to relocate to another area of Skipton where a purpose built unit will be provided to meet the needs of people using the service. The manager says that it is hoped the building will be completed by next Summer. Relatives recently attended a meeting where the Director of Services made a commitment to complete the new respite unit Croft House, in early 2010. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at the home benefit from a well supported and trained staff team who are competent and understand their needs and work in the best interests of each individual. Evidence: During the visit staff records were reviewed. Staff recruitment records were complete and information about staff training available. There is a good mix of male and female staff in the staff team, which is important to give the right support to people using the service. Discussion was held with the manager that whilst the training for permanent staff was good for relief or bank staff working at the home it was limited. There appeared to be no clear audit of relief staff training. This could mean that some staff working at the home do not have the right training to undertake their work safely. Some staff commented, More training is needed for relief staff to ensure that they are up to date and do not retain knowledge that is out moded Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: Permanent staff spoken to confirmed that they had received regular training and said that the service supported them and encouraged them to undertake further training. One commented that they would welcome more training to develop their understanding of areas such as Asbergers Syndrome and Autism. Many staff at the home have completed National Vocational Qualification (NVQ) level 2 and above. The service has 6 out of 8 permanent staff trained to this standard. Staff rotas were reviewed and staffing levels appear good. Staffing hours are concentrated into the evenings and weekends with additional staffing provided through the night to meet the needs of people staying at the home. Staff rotas show that there was always a minimum of two staff on during the day and one to two at night depending on the needs of the individuals staying overnight. All staff are given a job outline and a copy of the homes code of conduct. Roles and responsibilities are also clearly explained to individual team members. Staff tell us that they had regular supervision with their manager and that team meetings are held regularly. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has improved in the last year with many of the areas of concern last year being addressed, this shows that it is important to the management of the home to run the home in the best interest of the people who use the service. Evidence: The registered manager has been in post for 17 months and has provided consistency during this period. Prior to this the respite service has had a long period of instability with a succession of different managers. The manager holds the Registered Managers Award (RMA) and is now undertaking NVQ level 4 in care. He has many years experience in caring for people with a learning disability. Staff say, The last year has been better, the service has improved Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Over the past year we have had the same manager and a stable care team, staffing has been consistent and staffing levels good Staff have regular supervision and tell us that there are regular staff meetings. The senior staff now support relief staff with individual supervision. I have regular supervision and now I supervise some of the relief staff, which is a better way of making sure everyone gets support Areas of Health and Safety were reviewed, including Gas, Electrical and Fire safety. Most of the certificates were updated although a Gas safety inspection was overdue. The manager arranged for the Gas system to be checked within the week. Also all staff needed up to date Fire safety instructions. The manager must also complete a Fire risk assessment as concerns were raised about the laundry, based on the first floor, being a potential fire hazard. The area manager visits the home regularly to support the home and completes a report of their findings. This is important to make sure that the quality of care is maintained in the service and the manager well supported. Link workers continually seek the opinion of individuals and their families about the care they receive. Care planning and reviews are also an opportunity to make sure that people are satisfied with the service they receive. The service should however consider developing the quality auditing of their service by holding client and family meetings and surveying all stakeholders with qualitative questionnaires. This is important to make sure that everyone has an opportunity to have their say about the way the service is run. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 All staff, including relief staff 28/02/2010 must have the necessary training. Staff must also be trained in specialist health care techniques where agreed by the Gp and medical services. This is to make sure that all staff are able to care for people safely. 2 42 13 A Fire risk assessment must be completed and all staff must have fire training. To make sure everyone in the home is safe. 30/01/2010 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 39 The service should consider developing the quality auditing of their service with client and family meetings and Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations qualitative questionnaires. This is important to make sure that everyone has an opportunity to have their say about the way the service is run. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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