Care Home: Harwood Road

What the care home does well Service users who have a range of mental needs and are of varying ages, are provided with good support by a well-managed staff team. Service users commented in their surveys on the support they received - `give you a lot of help when you need it` and `I have received much encouragement`. Service users also noted their appreciation of the communal meals provided. Staff work closely with service users` care management teams and with relatives. The accomodation, which is consists largely of self-contained bed-sitting rooms, is appreciated by service users, who commented on the privacy afforded as well as the opportunity to become more independent. Although the building is not suitable for anyone with mobility problems because of the number of flights of stairs, staff have been successful in supporting service users who have become more frail as a result of age or ill-health. Recording is of a good standard. What has improved since the last inspection? Steps have been taken to to promote equalities and diversity issues by incorporating targets within the service user involvement plan. A formal session on equalities and diversity has been held with service users. Celebrations of the cultural background of service users have taken place, which included St Patrick`s Day. Staff are supporting religious observation and have taken steps to encourage a wider choice of meals, rather than the traditional roasts. Service user involvement initiatives continue to be developed in the service. Staff have worked hard to support one service user whose mental and physical health has deteriorated. A permanent staff team has been established, with the majority of staff having achieved NVQ 3. As part of staff`s professional development, the Manager has arranged basic counselling skills training for 3 staff, which will start shortly. Staff meetings are taking place weekly instead of fortnightly to allow more time for staff development and training, including case presentation. The establishment of a stable and more confident staff team has allowed the Manager to offer a placement for a Social Work student later this year. CQC has been notified of incidents as reguired under regulation 37. What the care home could do better: There are only two requirements from this inspection. Any restrictions under the Mental Health Act should be clearly recorded on service users` care plans. The hot water in the room of any frail service user should be checked regularly to prevent the risk of scalding. Key inspection report Care homes for adults (18-65 years) Name: Address: Harwood Road Harwood Road 95-99 Harwood Road Fulham London SW6 4QL     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: Sheila Lycholit     Date: 2 6 0 5 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 27 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 27 Information about the care home Name of care home: Address: Harwood Road Harwood Road 95-99 Harwood Road Fulham London SW6 4QL 02073717142/45 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: stuart.johnston@hestia.org www.hestia.org Hestia Housing care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Harwood Road is a registered care home providing accommodation and support for fifteen people with long-term mental health needs. The service is provided by Hestia Housing in a building owned and maintained by Shepherds Bush Housing Association. The building consists of three Victorian terraced houses that have been converted into an inter-connecting building. Thirteen service users have a self-contained flat with kitchen facilities and an en suite shower or bath and lavatory. Two people have a single room and share a bathroom and kitchen. The flats are situated on the ground, first and second floor of the building. There are two sitting rooms, one smoking and Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 15 Brief description of the care home the other non-smoking, on the lower ground floor. There is also a patio/garden area to the rear of the home. The service is not suitable for anyone with a mobility problem, as there is no lift and all areas are accessed by a number of steps, including the front entrance. Staff provide support throughout the day and evening, with one member of staff sleeping-in at night. The home is well located, close to Fulham Broadway, providing good access to transport links and local amenities. Fees for 2009/10 are £850 per week for new service users. Care Homes for Adults (18-65 years) Page 5 of 27 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 health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced visit took place on Tuesday 26th May 2009 from 10.05am until 5.30pm. The Manager, who had completed an annual quality asssurance assessment (AQAA) was on duty and made himself available throughout the visit. Two support workers were on duty, who were later joined by 2 more support staff. In addition to the Manager, one new member of staff was spoken with in private. The service was fully occupied with 15 service users in residence. A number of service users were at home, while others were attending day services, engaged in outside activities, or shopping. Several service users were spoken with during the visit and 9 returned surveys, all of which were positive about the service. Care Homes for Adults (18-65 years) Page 6 of 27 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 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 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. Recent admissions have been well planned, with prospective service users having a structured transition to the project. Evidence: The files of the two service users who have moved to the project since the last inspection were looked at. Both service users had previously spent long periods in hospital. Records showed that comprehensive information about their needs was provided by their care management team, including discharge notes, case conference reports and risk assessments. Harwood Roads own assessment form was completed, though its format does not elicit all relevant information and would benefit from revision. Both new service users visited the project on a number of occasions, meeting staff and other service users and viewing the accommodation. In the latter stages of the transition, visits included overnight stays. An assessment of each visit is normally made by the key worker, though it was noted that the key worker was not always on duty during the visits . It would be good practice for transition visits to be arranged for times when the designated key worker is available to provide consistent support to the Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: prospective service user and to aid the assessment. Induction check lists had been completed for both new service users. A copy of a contract and tenancy agreement were seen on each of the files looked at, as well as regular statements of charges and payments made. Care Homes for Adults (18-65 years) Page 10 of 27 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. Care plans are of a good standard. They are regularly reviewed and show service user involvement. Risk assessments are generally comprehensive and up to date. Evidence: The individual files of four service users were looked at, including those of two people who had moved to the service since the last inspection and two people who currently have high needs. Each of the files was in good order, with all essential information. Checklists indicate that files are regularly audited. Each of the files seen contained an up to date care plan, which had been discussed with and signed by the service user. The Manager confirmed in the AQAA that service users receive a copy of their care plans. Care plans cover all aspects of the individuals care and support and are updated at least every 3 months. In addition to care plans, key worker reports provide a review of developments and progress made in relation to the care plan. In contrast to key worker summaries, some daily notes seen were very brief, giving little more information than complied with medication. Files show that key workers work closely with service users care management teams. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: Additional support guidelines and monitoring sheets were seen for one service user who has experienced a deterioration in his health and is requiring considerable support from staff following his discharge from hospital. Service users independence is supported and few restrictions apply. The house rules are set out in the service users guide. Where a service users assessment indicates they may be able to live in a less supported setting, steps are taken to assist them in moving on. One service user who has lived at Harwood Road for many years is planning to move to less supported accommodation nearby. Staff have made progress in obtaining advocates for a number of service users, in line with the service development plan. Service users receive good support to take part in the running of the service. Hestia Housing employs a designated member of staff to encourage involvement, who produces a regular newsletter, to which service users at Harwood Road have contributed. Residents meetings take place weekly, with notes of the meeting made available. In addition to agreeing menus and outings, recent residents meetings have looked at subjects which affect their lives such as advocacy, care standards and data protection. Up to date risk assessments were seen on each of the files looked at. Risk assessments are normally shared withe service user. The risk assessment and care plan for one service user did not clearly state restrictions imposed under the Mental Health Act, although this information was available elsewhere on file. Care Homes for Adults (18-65 years) Page 12 of 27 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. A range of activities is provided, in addition to service users individual programmes. Service users independence is supported. Good relationships are maintained with families and friends. Healthy eating is promoted. Evidence: Service users are supported to take part in local work projects, adult education and leisure activities. One service user is completing a NVQ in customer care. A number of service users continue to attend programmes to develop social and emotional skills at the hospital which they previously attended as an in-patient. A number of service users have received training in IT and the Manager is hopeful that after many requests internet access will be provided for service users at the project. The Manager has arranged for three staff to attend a counselling course which will allow key workers to provide more psychological support to service users. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: In addition to individual activity programmes, there is a monthly programme of group activities to encourage those service users who have difficulty in motivating themselves to arrange social and leisure activities. The activities programme is discussed at residents meetings and includes two cinema trips each month, one of which is with staff, a pub lunch and an outing to a museum, race meeting or other place of interest. A weekly coffee morning has been started, which the Manager reports is well attended. Some service users go on an annual holiday which they pay for themselves. The services welfare budget is not sufficient to fund holidays but the Manager is hoping to fund raise to allow all service users who wish to take part to go on a day trip on Eurostar. Records show that good relationships are maintained with families and friends. Where appropriate, families attend reviews and meetings and a number of service users regularly visit their families, a number of whom live fairly locally. Staff encourage healthy eating by providing 3 cooked main meals a week and daily sandwiches. Supplies for breakfast, including bread, milk and cereals are available for service users to help themselves in the main kitchen. A cookery group has been established to encourage service users to prepare a wider range of meals and service users are encouraged to take part in the preparation of the communal meals and daily sandwiches. Staff have held a discussion group on diet and lifestyle to promote healthy eating. The Manager commented that staff are looking at providing alternative snacks to the sandwiches which have become less popular. The menu for the communal meals is decided at residents meetings. A list of African and African/Caribbean dishes was displayed on the residents notice board to encourage a more varied choice of meals. On the day of the inspection a member of staff was preparing a meal that included a chicken casserole, which was well attended. The range of catering provided by staff was extended to improve service users nutrition and to encourage some people to come down to the communal area and to join other service users. Feedback from service users surveys confirms that they particularly value the opportunity to take part in a communal meal. Each service user receives £23 per week to spend on food in addition to meals and snacks provided by the project. Service users are encouraged to shop independently, though they are expected to obtain receipts for purchases. One person is currently accompanied by staff to ensure that the allowance is spent as intended. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and health care 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. Service users receive good support to meet their health care needs. Evidence: Service users at Harwood Road do not normally need assistance with personal care, other than prompting, although one person is currently receiving high support because of a deterioration in his physical and mental health. Records show that staff are working with health care colleagues, including the District Nurses, to try to improve his condition. Service users are registered with local GPs and encouraged to keep appointments with dentists, opticians and podiatrists. One service user is receiving treatment at a local hospital, where he is supported by his family and staff. Records show that staff have taken steps to ensure that all his appointments are clearly recorded and that they are familiar with his condition and treatment. Key workers normally accompany service users to appointments with their psychiatrist and liaise with the care management team. MAR sheets and the storage of medication were looked at. Medication was safely stored in locked cabinets and facilities for storing controlled drugs are available that complies with the Misuse of Drugs Act. Most medication is supplied by Boots using a Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: pre-measured system. Medication and storage is audited by Boots twice yearly. Staff make a daily check of Clozapine. A procedure to support service users to handle their own medication is in place, which involves an assessment and regular monitoring. Four service users were handling their own medication to varying degrees at the time of the inspection. Recent MAR sheets were seen which were up to date and fully completed. The list of signatures was not up to date as the name of a new member of staff who was handling medication was not included. This omission was rectified straightaway by the member of staff responsible for medication. Care Homes for Adults (18-65 years) Page 16 of 27 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. The service has a published complaints procedure that encourages service users to raise complaints and concerns. The vulnerability of a number of service users is recognised and steps taken to protect them where necessary. Evidence: The AQAA and complaints file show that 6 complaints were received in the previous 12 months, all of which were satisfactorily resolved. The complaints file confirms that staff take steps to elicit service users concerns, for example at residents meetings. Complaints are recorded in detail and complainants receive a written response from the Manager where a formal complaint has been raised. One safeguarding referral has been made since the last inspection. The issue raised continues to be investigated. Records show that staff take steps to assess service users vulnerability and as far as possible protect them from exploitation. Risk assessments regarding financial vulnerability were seen on file. Staff have attended training in safeguarding adults and some staff are booked on the local authoritys safeguarding training. The Manager provides training in safeguarding for staff and for other Hestia services. Care Homes for Adults (18-65 years) Page 17 of 27 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. The building is well located and provides largely self contained facilities. Communal areas are attractively decorated and furnished and are kept clean and tidy. Evidence: 95-99 Harwood Road is located close to Fulham Broadway, with its shops, public transport and other services. There is a bus stop outside the house. Thirteen rooms are bedsitting rooms with a kitchen and bath or shower room. Two rooms share a kitchen and bathroom. Service users commented in their surveys on the good standard of cleanliness in the building and also that they value the privacy that the accommodation provides. There is a large kitchen on the ground floor where service users can also prepare meals and where breakfast supplies are kept. There is a laundry room for service users to wash their clothes. A new drier has recently been installed. There are two sitting rooms with TVs, one of which leads out to the garden, which is looked after by one of the service users. A part-time domestic assistant who works 4 hours a day Monday to Friday cleans the communal areas, while service users are assisted by staff to clean and tidy their own flats. There is a programme of maintenance and redecoration by the Housing Association that owns the building. Service users accommodation is decorated by the handyman. In addition to checks by the Deputy Manager, a number of room checks Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: are undertaken during the monthly regulation 26 visits by the provider. The Manager reported that problems with the water pressure experienced by service users at the last inspection have been resolved. The home has no sluicing facilities as these have not previously been required. The local specialist laundry service is currently being used for one service user. Care Homes for Adults (18-65 years) Page 19 of 27 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 majority of staff have achieved NVQ level 3 and staff have access to an established training programme, which has recently been expanded to include counselling skills. Sound communication systems are in place and staff receive good support through regular staff meetings, supervision and annual appraisal. Evidence: All staff posts are filled, with a new member of staff starting at the beginning of the month. Over the past 2 years the staffing establishment has contracted by 2 posts, following the loss of funding for 2 Assistant Support worker posts. Sleeping-in was reduced from 2 to 1 member of staff just before the last inspection in 2008. In spite of the reduction in staffing, the team has continued to develop the service and to provide as much 1:1 support as possible. In discussion, the most recently appointed member of staff confirmed that he had received a thorough, structured induction, which had started with two days training at Hestias head office and that core training had been booked. New staff are recruited by Hestias HR team and the Manager, who confirmed in the AQAA that satisfactory CRB checks have been received for all staff. The project will offer a social work placement from the start of the next term. A volunteer has been recruited, who has a background in business support, to assist Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: with some administrative tasks. Training records show that staff have access to an established training programme, including accredited training. The Manager has identified the need for staff to acquire therapeutic skills as part of their professional development and 3 staff are booked to attend a counselling course shortly. Staff receive good support from the Manager who has increased staff meetings from fortnightly to weekly to allow for staff development and training, including regular case presentation. Notes of staff meetings are recorded in detail and displayed on the notice board in the staff room. Two staff files were seen, which as at previous inspections, were in very good order. Supervision notes are detailed showing that staff receive regular feedback on their performance and have an opportunity to review their work with all the service users that they are key-working and to discuss their training needs. Staff also receive an annual appraisal. Care Homes for Adults (18-65 years) Page 21 of 27 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 Manager is experienced and well qualified and has introduced a more therapeutic and supportive approach to working with service users. Service user involvement is well established in the organisation. Health and safety is given a high priority. Evidence: The Manager, who has completed NVQ4 and the RMA, is experienced in working with people with mental health problems. He has additional qualifications in counselling and therapy and has taken part in Hestias management development programme. He is well regarded by staff and has created a more cohesive staff team. Hestia has a programme of regular service reviews, which as well as obtaining service user feedback, includes service users on the review team. Hestia has a designated member of staff with responsibility for service user involvement. Initiatives include a regular forum and newsletter and service user involvement in staff selection. Good attention is paid to the health and safety of service users and staff, with systems of regular checks and monitoring. Accidents and incidents are recorded in detail and CQC have been notified where required. Risk assessments for lone-working were seen Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: on file. A fire risk assessment is available which is regularly reviewed. Fire drills take place every 3 months. Since the last inspection, drills have been planned for different times of the day. The fire alarm is serviced regularly and the fire panel was replaced earlier this year. Checks to reduce the risk of Legionella take place every two years. Records show that staff were chasing up the next visit by the contractor, which is overdue. In addition staff regularly de-scale shower heads. Staff check the temperature of the hot water at different outlets but as noted at the last inspection, in addition must make sure that any particularly frail service users are not at risk of scalding by checking the temperature of the hot water in their room. Signs have been placed around the building to warn service users and staff where the water is set at a higher temperature, for example in the kitchen. monthly visits on behalf of the provider take place. Reports of visits are detailed and copies are forwarded to CQC. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 42 Hot water in the rooms of any frail service users should be checked regularly to ensure that the temperature does not exceed 43C. To prevent the risk of scalding. 30/06/2009 2 9 12 Any restrictions affecting a service user for example under the Mental Health Act must be clearly stated on in the care plan and /or risk assessment. To ensure that staff and the service user are aware of any restrictions and do not take action that could breach the terms of an order. 30/06/2009 Care Homes for Adults (18-65 years) Page 25 of 27 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 2 Consideration should be given to reviewing the Harwood Road admission form to ensure that all essential information is requested. Where possible, visits by prospective service users to the project should take place when the designated key worker is on duty. Daily notes would benefit from more detail. When new staff have completed their in house training in handling medication, it is recommended that a written assessment of their competency is made, which is signed of by a senior member of staff. 2 4 3 4 6 20 Care Homes for Adults (18-65 years) Page 26 of 27 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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