Care Home: Hemmet House

What the care home does well People who use the service gave very positive comments about living at Hemmet House. When asked what they thought was the best thing about the service they said, `the staff, they make you laugh`, `the company, staff and the other people who live here` and `it`s a good laugh`. Everyone we spoke to told us that Hemmet House was better than where they used to live. People felt they had the opportunity to have more one to one time with staff and to develop more independence. People enjoy the fact that they are close to shopping, transport and entertainment.Each person is supported to follow their own individual interests as well as having opportunities to join others from the service in activities. Staff have developed good relationships with the individuals they support and have been successful in supporting individuals to expand their experiences and develop more independence. People who use the service have access to wireless broadband and one person has placed their PC in a corner of the lounge which can be used by all others have their laptops in their rooms. People who use the service are fully involved in and influence the way the home operates. This is done through regular meetings, the food group and quality monitoring surveys as well as day to day contact with the manager and registered provider. The involvement of individuals who live at the home with the recruitment of new staff is in line with good practice. When asked to grade the service they receive in a range from poor to excellent every person using the service said they would grade the service as excellent. What has improved since the last inspection? A quality assurance system has been implemented which included seeking feedback from people who use the service and their families. This assists in monitoring the quality of the service and developing the service in line with thewishes of those who live there. Individuals have requested things such as Sky TV and their own telephones which have been supplied. People who use the service told us that a large barbecue had been bought and they had enjoyed using this even though it rained heavily when first used. New garden furniture was seen to be well used. Staff have worked to meet the requirements made at the last inspection. What the care home could do better: Consideration should be given to expanding the people consulted through the quality monitoring systems such as other health and social care professionals and visitors to the service. Care planning should continue to be developed to provide more accessible and interesting plans. Consideration could be given to everyone in the service, staff and those who live there, sharing something of their personal history which can provide more understanding of each person`s personal experiences. When new staff are employed a full record of employment history will need to be recorded along with explanations for any gaps in employment and an up to date photograph of all staff needs to be on file. These further checks assist in safeguarding people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Hemmet House 76 Bedington Gardens Carshalton Beeches Surrey SM5 3HQ The quality rating for this care home is: three star excellent 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: Elizabeth OReilly Date: 2 8 0 4 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 judgement Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: Hemmet House 76 Bedington Gardens Carshalton Beeches Surrey SM5 3HQ 02087883947 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : philipwilliams@independentlifestyleoptions.co.uk Independent Lifestyle Options Ltd care home 7 Number of places (if applicable): Under 65 Over 65 7 0 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD (of the following age range: 18 year to 65 years) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Hemmet House provides accommodation for seven disabled adults. It is situated in a quiet residential area close to the shops and facilities of Wallington in Surrey. Bus and train links are also located nearby. Two floors are wheelchair accessible and a lift provides access to the first floor. Information about the service is available in a comprehensive Statement of Purpose and Service User Guide. Fees for the service are #995 per week. There may be small variations according to local authority increases. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home This unannounced inspection was carried out by one regulation inspector over two days. The inspector had the opportunity to speak with all of the people who use the service, two members of staff and the registered manager. The manager provided us with an Annual Quality Assurance Assessment (AQAA) of the service. We have used information from all of the above sources and our own observations during visits to the service to reach the judgments made in this report. What the care home does well People who use the service gave very positive comments about living at Hemmet House. When asked what they thought was the best thing about the service they said, the staff, they make you laugh, the company, staff and the other people who live here and its a good laugh. Everyone we spoke to told us that Hemmet House was better than where they used to live. People felt they had the opportunity to have more one to one time with staff and to develop more independence. People enjoy the fact that they are close to shopping, transport and entertainment. Care Homes for Adults (18-65 years) Page 7 of 30 Each person is supported to follow their own individual interests as well as having opportunities to join others from the service in activities. Staff have developed good relationships with the individuals they support and have been successful in supporting individuals to expand their experiences and develop more independence. People who use the service have access to wireless broadband and one person has placed their PC in a corner of the lounge which can be used by all others have their laptops in their rooms. People who use the service are fully involved in and influence the way the home operates. This is done through regular meetings, the food group and quality monitoring surveys as well as day to day contact with the manager and registered provider. The involvement of individuals who live at the home with the recruitment of new staff is in line with good practice. When asked to grade the service they receive in a range from poor to excellent every person using the service said they would grade the service as excellent. What has got better from the last inspection A quality assurance system has been implemented which included seeking feedback from people who use the service and their families. This assists in monitoring the quality of the service and developing the service in line with the Care Homes for Adults (18-65 years) Page 8 of 30 wishes of those who live there. Individuals have requested things such as Sky TV and their own telephones which have been supplied. People who use the service told us that a large barbecue had been bought and they had enjoyed using this even though it rained heavily when first used. New garden furniture was seen to be well used. Staff have worked to meet the requirements made at the last inspection. What the care home could do better Consideration should be given to expanding the people consulted through the quality monitoring systems such as other health and social care professionals and visitors to the service. Care planning should continue to be developed to provide more accessible and interesting plans. Consideration could be given to everyone in the service, staff and those who live there, sharing something of their personal history which can provide more understanding of each persons personal experiences. When new staff are employed a full record of employment history will need to be recorded along with explanations for any gaps in employment and an up to date photograph of all staff needs to be on file. These further checks assist in safeguarding people who use the service. Care Homes for Adults (18-65 years) Page 9 of 30 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Elizabeth OReilly 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 02072390330 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available on what individuals can expect from this service. Care has been taken to make sure that the moving in process was tailored to meet the needs of individuals. People who use the service are fully involved in developing the web site for the service. Evidence: People who use the service made very positive comments about moving in. Individuals told us; I am really happy here, I feel more independent and I have more freedom here. Information about the service is available through the Service User Guide and the web site for the home. People who use the service confirmed that they were supplied with a copy of the Service User Guide. A web site for the home provides good information. The manager informed us that discussions had been taking place around making a video, directed by and involving all of the people who use the service. This would provide more easily accessible information for anyone considering moving into the home. Page 12 of 30 Care Homes for Adults (18-65 years) Evidence: The manager told us that before the service started operating each person thinking of moving in was visited individually and invited to visit the house along with their family. Following assessment individuals were invited to make several more visits to familiarise themselves with the house, choose decor and furnishings. Before moving in the group were brought together in the house for a meal to get to know each other a little better. The admission process was carried out over a six month period. Individuals confirmed that they felt they had made their own decisions about moving in and had good information on what life there might be like. People told us they had chosen colours and furniture and one person informed us that as they were the first to view the house they had the pick of the bedrooms. Care Homes for Adults (18-65 years) Page 13 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are encouraged to set their own goals and make their own decisions. Individual support plans are in place. Support plans could be further developed to make them more accessible and person centred. The right to take risks is acknowledged by the service and staff support individuals to take on new activities. Risk assessments are carried out and reviewed. Evidence: Each person is provided with a support plan which sets out individual needs and personal goals. We looked at a sample of three plans during the course of this inspection. The first plan we looked at, although partly written from the individuals view, tended to focus on the persons disability and needs rather than strengths and goals. This plan could have been produced in a more person centred way. The manager informed us that this particular plan was about to be reviewed and updated. On the second visit to the service, the following week, we saw that the plan had been updated and was produced in a more person centred manner with more focus on the individuals strengths. The other plans we looked at were person centred and up to date. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Consideration should be given to further developing support plans to make them more accessible and interesting to the person concerned. Consideration should also be given to requesting, developing and including a life history from the individuals perspective. This could provide staff with a better understanding of the person and their previous life experiences. Should this be developed it is recommended that staff are included and are asked to complete their own life history first. This was discussed with the manager at the time of these visits. People who use the service confirmed that they were involved with their support plan along with their keyworker. They also confirmed that they were supplied with a copy of their plan. The manager reported in his assessment of the service that people who live at the service are responsible for making decisions about every aspect of life in the home. This includes; food and times of meals, shopping and leisure activities, reviewing job descriptions, shortlisting, interviewing and inducting new staff. People who use the service confirmed that they make their own decision about the home through their house meetings. One person told us I decide what to do, I make my own choices. Individuals are encouraged to expand their experiences, set their own goals and take on new activities. Risk assessments are in place and reviewed. Care Homes for Adults (18-65 years) Page 15 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported to make their own decisions about how they spend their time and are encouraged to widen their experiences. Individuals have a varied lifestyle and take an active part in the local community. Food is of an excellent quality and individuals are fully involved in planning the meals provided. Evidence: People who use the service told us they were involved in a number of activities. Individuals attend a variety of colleges and work placements. Each person we spoke to was happy with their day to day activities. One person told us they were looking forward to attending a new centre at a local college. The manager informed us that individuals were being encouraged and supported to increase their independence. People are encouraged to use public transport and or the Taxicard service. This was confirmed by individuals who told us they used local bus services and showed us their Taxicard. The service also has its own transport. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Individuals talked to us about the various activities they enjoyed which included going to the pub, horse riding, drama and dance, bowling, going out for meals and visiting their families for week ends. One person talked about a theatre production they were preparing for. Staff informed us that there was no pressure for individuals to do anything if they did not want to but that there were always a number of options which people could choose from if they wished. People who use the service confirmed that it was up to them to decide if they wanted to join with others in an activity or do something on their own with staff support. At the time of the first visit to the service one person was on holiday in Africa with their family. Other people told us that they had taken part in a sailing holiday, gone camping and had a holiday on a barge. Arrangements were being made for two people to attend an activities holiday in the Lake District. One person told us they were looking forward to taking another holiday on a barge. Individuals confirmed that they could invite friends and family to visit them at the house. People told us that they could relax in the lounge or if they wanted a little more privacy and quiet could use their own room. People who use the service are involved in a food group which meets each week to discuss and make decisions about the meals. Information on the menu is added to the web site for the service. Regular competitions are held in which the winner is asked to devise a three course meal of whatever they like which is then prepared and eaten as a dinner with everyone. Discussions with individuals evidenced that this is a source of enjoyment to everyone. People who use the service assist in the kitchen and are becoming more involved in preparing, choosing and shopping for food at weekends. Individuals told us they often choose to have a take away during the weekend. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to live a healthy lifestyle and take responsibility for their own health care. Medication is well managed. Evidence: People who use the service told us that staff were available to support them with their personal care when they wanted it and in the way they wished. A number of individuals told us they did not need any assistance with their personal care. We found good information available on the individual health needs of people who use the service. Each person is registered with a local GP practise. Individuals are supported to attend the surgery which is a short distance away from the home. We looked at a sample of medication records. These records are well maintained with systems in place to record all medication coming into the service and being returned to the pharmacy. Medication profiles are now in place which assist in ensuring up to date information is available on present and previous prescriptions. Staff are supporting two individuals to manage their own medication which is in line with the aims of the service to provide opportunities for people to become more independent. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: The manager informed us that they were looking to providing more support and encouragement to assist people to take on further responsibility for managing their health care needs including booking and attending appointments. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are provided with good information on what to do if they are not happy with anything. Staff are provided with training on safeguarding people. Evidence: The service has systems in place to record any complaints along with actions taken and outcomes. The manager informed us that to date no complaints have been received about the service they provide. No concerns have been raised with the Commission about this service. People who use the service told us that they were provided with information on how to make a complaint. One person told us it was explained to me how to make a complaint if I was not happy with anything. Other people who use the service told us they would speak to their keyworker or the manager if they had a problem. Individuals expressed confidence in the staff and particularly the manager to listen to them if they had a complaint. Clear, individual records are kept of any money held on behalf of people who use the service. records show all deposits and expenditure. People who use the service sign for their own money taken out. Each person has their own bank account and is supported if necessary by staff to manage their own money. All but one relatively new member of staff have received training through the local authority on safeguarding people. This ensures that staff understand their role and Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: responsibility in reporting any allegations or suspicions of abuse as well as an understanding of how and who to report issues to. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are provided with comfortable, well maintained home. Evidence: Hemmet House is a large detached property in a residential area. The house was refurbished prior to opening and provides spacious accommodation which meets the needs of the present group of people living there. The garden and house are accessible to people who use a wheelchair. There is a large garden with raised beds, a pond, seating, tables and a barbecue. One individual told us they enjoy helping out with the gardening. Individuals were happy to show us their bedrooms and made positive comments about the house. People confirmed they were encouraged to furnish and decorate their rooms according to their own taste and interests. All areas of the house we saw during these visits were clean and well maintained. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service feel well supported by the staff group. Staff are provided with good opportunities for training which ensures that individuals are supported by a well informed staff team. People who use the service are involved in staff recruitment. Evidence: People who use the service made very positive comments about the staff. People felt supported, one person told us my keyworker helps me do different things, another told us the staff are very good. Individuals told us they get on well with their keyworker and that they knew if they were not happy they could ask for another person to take on this role. Staff told us they felt they worked well as a team and they were well supported by the management. Staff receive regular one to one supervision and each person receives an annual appraisal of their performance. These processes assist in ensuring that staff are all working in line with the aims and objectives of the service. Staff and people who use the service confirmed that there are sufficient staff on duty to meet the needs of individuals. The service does not use agency staff which ensures that people who use the service are supported by staff they are familiar with and who have a good understanding of their strengths and needs. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Staff are provided with good opportunities for training. Three staff have completed NVQ level three training and one person has completed NVQ level two. All staff have completed training in first aid, moving and handling, food hygiene and medication. The majority of staff have completed health and safety training and four staff have completed training on person centred planning. An induction programme is in place for all new staff. People who use the service are involved in the employment of any new staff to the home. Individuals are involved in reviewing job descriptions, shortlisting candidates, taking people on tours of the house, interviewing and decision making. We looked at a sample of staff files. Evidence of checks being carried out on staff before they started work in the house were in place including Criminal Records Bureau checks. Copies of references were on file. In future all prospective staff members must be asked to provide a full record of their employment history. An explanation for any gaps in employment must be sought and recorded. This will further assist in safeguarding people who use the service. An up to date photograph of each member of staff should also be kept on file. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the relevant skills, knowledge and experience to manage the home. People who use this service feel their views are listened to and influence the way the service is run. Staff make regular checks on the building and equipment to ensure the health and safety of people who use the service and visitors. Evidence: The manager has completed the Registered Managers Award and NVQ level four in social care. He also has a BSc Degree in Applied Psychology and has worked with young adults for many years. The registered provider is also directly involved in the service on a day to day basis. People who use the service made very positive comments about the manager who was viewed as approachable and supportive. Individuals told us that if they had any concerns or problems they could go to the manager with these and felt confident that he would deal with them. Staff informed us that they felt well supported by the management team. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: The manager provided us with his own assessment of the service (AQAA). This document was completed to a very high standard. The managers assessment was considered and detailed and in line with our findings. The service has developed systems to monitor the quality of the service provided which includes surveys to people who use the service and their relatives. Feedback from surveys is used to improve the service. Consideration could be given to including other people involved with the service in these surveys such as, care managers, GPs and other professionals or visitors. Regular house meetings also assist in ensuring the views of people who use the service are heard and promoted. These meetings are run by the individuals who use the service and they choose if they wish any of the staff to attend. the manager informed us that he is usually invited to these meetings. We looked at a sample of the records kept to protect the health and safety of people who use the service. Checks are carried out on the fire alarm system every week, the system is serviced every six months and a fire drill was last carried out in August 2008. Staff we spoke to had a clear understanding of what to do should the fire alarms be activated at night. Care Homes for Adults (18-65 years) Page 26 of 30 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 action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action 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 6 Consideration should be given to further developing support plans to make them more accessible and interesting to the person concerned. Consideration should be given to including a life history in support plans from the persons perspective. Staff could also take part in this process and make available their own life history. In future any new staff to the service will need to provide a full employment history. The manager will need to seek and record an explanation for any gaps in employment. This will assist in safeguarding people who use the service. Staff files should be up dated with a more recent photograph of each person working in the service. Consideration should be given to seeking the views of other people involved with the service as part of the quality monitoring process. Page 28 of 30 2 6 3 34 4 5 34 39 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 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) 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. 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