Care Home: Highland Mist

What the care home does well Highland Mist provides a relaxed and informal home for people with mental health problems, where they feel safe. Staff understand people`s individual needs, and have been good at motivating them to find meaningful activities. Care plans have been created in collaboration with the service users and their professional supporters, and staff have been effective at implementing plans. One resident said in a survey, `It is still a family home - which makes on the whole a pleasant atmosphere of work for staff and residents alike`. What has improved since the last inspection? Information about the service that is available for the public has been rewritten, to make it full and accurate. The arrangements for storing and administering medication have been improved, to make a safer system. However, the whole system does not yet meet the regulations. The front door bell now works, and the post box has been improved to protect post that is delivered to the home. The staircarpet has been replaced, so it is safe to use the stairs. The hallway has been redecorated, as has the conservatory, to give the residents an attractive environment. Office equipment has been removed from under the stairs, to remove a potential fire hazard. There is now a care office on the ground floor, suitable for confidential discussions. Professional fire safety training has been provided, for people who live at Highland Mist as well as those who work there. Staff each have a training plan, showing their achievements, which highlights when updates are needed. An Assistant Manager has been appointed, to maintain good management of care in the absence of the Home Owner. Two staff members have achieved level 3 in National Vocational Qualification, while the others are working towards level 2. What the care home could do better: If some medication is to be stored on the ground floor at any time of day, a medicine cupboard that meets the regulations must be provided. Staff need training in conflict resolution, to help them deal with situations that may arise. Records kept of residents` cash must show all transactions, be entirely up to date, and signed by the service user, or by two staff. When a resident`s private room is not large enough to meet the National Minimum Standards, they should be offered additional space for storage or social uses. Locks on bedroom doors as well as bathrooms need to accessible by staff in an emergency. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Highland Mist Highland Mist Bronshill Road Torquay Devon TQ1 3HA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Stella Lindsay     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Highland Mist Bronshill Road Highland Mist Torquay Devon TQ1 3HA 01803315749 01803328156 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) : Mrs Susan Irene Ann Hill care home 8 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 8 Highland Mist provides care for up to eight adults with mental health needs. The premises are in a residential area of Torquay within walking distance of shops, and the town centre. There is parking to the front of the home, and a garden with a grassed area and a patio. There is also a shed at the end of the garden for smokers. Entrance to the house is up several steps into the conservatory, which has a table that can seat four and is used for meals. There is a comfortable lounge. The kitchen is suitable to enable residents to work alongside staff. The ground floor also has a shower room with toilet, and three bedrooms, each with a handbasin and a door on to the back yard. The laundry facilities are outside in the yard, accessed through the care office. Stairs lead to the first floor, which has a bathroom with toilet, and five bedrooms. There is a public pay phone. Service users may use the handset of the homes Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home telephone to take private calls in their room. Current charges are 400 - 455 pounds. Escort and transport to medical appointments are provided. The Home has a Statement of Purpose and Service User Guide for the public to view, and the inspection report can be made available by request in the office. Care Homes for Adults (18-65 years) Page 5 of 29 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: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This inspection took place on 2nd June 2009 and was unannounced. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Six residents and two staff completed and returned these. The Home Owner sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It gave us some numerical information about Care Homes for Adults (18-65 years) Page 6 of 29 the service. During our visit we spoke with the Home Owner and two staff members. We met with residents in the lounge and conservatory. We case tracked two people who use the service. Case tracking means we looked in detail at the care two people receive. We spoke to staff about their care, looked at records that related to them, met with them and made observations if they were unable to speak to us. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Highland Mist. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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. The home takes care to offer its service appropriately. People who are considering moving in have plenty of opportunity to find out about the home before making a decision, and staff are provided with good information about the person and their support needs. Evidence: The home has produced full and accurate information for prospective service users and their representatives about the way the service is organised. Two people had moved in since the previous inspection. We examined their files and saw that information about their care needs had been gathered before their admission. Both had come to Highland Mist because it was considered to be smaller and calmer than their previous placement. One had been able to visit one day per week for two months, to help them come to a decision. The other had to make a move more rapidly. Two staff went to their previous placement to meet them, and to discuss their care needs with the staff who had worked with them. Discharge notes were given, and Highland Mist were able to put in place measures to enable a more successful Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: outcome. Care Homes for Adults (18-65 years) Page 12 of 29 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. The service is working well to involve individuals in planning their care. Reviews focus on identifying what has worked well, and on dealing with any concerns, and the home has worked well with with professionals to work towards good outcomes for service users. Evidence: All residents had care plans. We looked at two in detail. These included a daily plan of personal care where this was needed, and daily records. Information had been provided to staff with respect to one persons communication needs. Pre-admission assessment had alerted the team to risks of self-neglect, alcohol abuse and aggression, and management plans had been put in place, with restraints, including cigarettes being handed in overnight, being recorded in the care plan. A record is kept of any areas of disagreement between the manager and the service user. Care plans had been reviewed within the home, and with the Community Mental Health team. A Care Manager told us that the team at Highland Mist have been effective in Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: implementing plans agreed at the Review meetings. We saw risk assessments and a management plan in place with respect to aggressive behaviour on the part of a resident. A Care Manager told us they appreciated the homes efforts to make clear boundaries for this person, not evicting them, but giving them notice based on certain requirements. This was seen to be working well. Care Homes for Adults (18-65 years) Page 14 of 29 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. Staff had done well to motivate and support people to integrate in the local community and get involved in meaningful activities of their own choice. Evidence: Residents who completed surveys all said they could do what they wanted at different times of day, and most said they could usually make decisions about what they do each day. One was going weekly to a college music course, another went 2 - 3 times per week to the Cool House project which offers a variety of activities, including gardening, crafts, and day trips as well as relaxation groups. One was accompanied by staff to a pub or cafe once a week, while two were able to come and go independently. A Care Manager said the team had been innovative in the way they helped people living at Highland Mist to integrate in the local community. People had been motivated Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: and supported to go to Job Plus in spite of difficulties in their own lives. One was looking forward to a work role, and planning their application process. Residents had been encouraged by staff to make their beds and look after their own rooms. A rota had been started for tea-making and washing up, which had been well accepted, and some residents told us they thought it was a good idea. There are still set times for making hot drinks. This was discussed at a residents meeting, with reasons being provided by the home owner as to why this was necessary. Residents said they were enjoying being involved in providing hot drinks at these set times. Staff were reminded at a recent meeting that residents may have their meals at whetever time suits them. they are encouraged to eat when the meal is fresh, but it can be reheated in the microwave. We saw photos showing a residents recent birthday celebration, when the household had gone to a local pub and enjoyed a karaoke session. One evening just prior to this inspection, a barbeque had been held in the garden, to which guests including a girlfriend had been invited. One resident had difficulties in communicating with family members, and had been supported in making choices about how to contact them. Minutes of a recent Residents meeting showed that people would prefer to have a three day holiday this year, rather than a whole week. Residents had also been able to give feedback on their activities and meals by way of questionnaires. Support staff cook the meals, with help from residents to clear up. There is a white board in the hall showing the menu of the day. During this inspection lunch was corned beef hash with tinned tomatos and baked beans. Some people had fresh fruit for dessert. Five oclock supper was noodles and meat balls, followed by cake and custard. Residents told us very clearly that they enjoyed their food, but one said in a survey they felt the meals could be healthier, and we consider that the inclusion of more fresh vegetables and salads in the meals would be beneficial, with thought given to offering these attractively. The change of main meal from tea time to lunch time had been agreed at a recent Residents Meeting, by six votes to one. Staff were remioned that residents Care Homes for Adults (18-65 years) Page 16 of 29 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. Staff encourage and support residents to access the health care that they need, in a way that is acceptable to them. Evidence: Some people who live at Highland Mist needed prompting with personal care, and encouragement to maintain good hygiene and appearance. Understanding had been reached by discussion with the resident and their care manager with respect to freedom, routine and the need for prompting. One person would not get out of bed without prompting, but is now, with encouragement, getting more active. All needed support with medication and maintaining good health. We saw from records that residents were being supported to access treatment for a variety of physical health problems. Staff observations had lead to people being taken for medical assessments, and staff took trouble to find professional help that the residents were prepared to accept. These included a recent diagnosis of diabetes, major dentistry, and endocrinology treatment. People were accompanied to their appointments if they wished, and transport was provided. A Care Manager said the team had done Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: excellent work in helping a resident to accept their condition. We spoke with a District Nurse who was making a regular visit to a resident during this inspection. She said she found the staff to be responsive and helpful, and was satisfied with the way that medication was managed in the home for her patient. One resident told us that they feel well as long as mealtimes and medicines are adhered to. Another appreciated the staffs support in keeping them off drink. Three staff and two resident were planning to support each other in stopping smoking - to start the following week. Residents were being encouraged to access suitable psychological treatments. Highland Mist had a policy and procedure for the safe administration of medication. The supplying pharmacist had inspected their system on 05/12/08, and recommended that the policy be improved with respect to three areas; - how changes in medication for residents are communicated to staff, how errors are dealt with, and a policy on giving medication covertly. These had all been put in place, to assure safe and consistent administration. We examined the Medication ADministration records, and found them to be accurate. PRN medication had been recorded when given, with an explanation of the reason, and the result. A list of staff who have been assessed by the Registered Manager as competent to administer medication was still needed, with the signature that they use on these records. A solid medication cupboard had been installed in the upstairs office, to provide secure storage. This was an improvement on the previous arrangements. Medication was brought down to the kitchen when it was due to be given, and the residents came individually to the hatch to receive their medication. Some medication was seen to be stored in the kitchen, and the storage provided downstairs was not satisfactory. This means that th requirement to provide safe and suitable storage for medication is outstanding, as the whole system needs to safe and secure. Care Homes for Adults (18-65 years) Page 18 of 29 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. Highland Mist has an open culture that encourages service users to express their views and concerns in a safe and understanding environment. Evidence: All residents who completed surveys said they knew how to make a complaint, and all but one said they knew who to speak to if they were not happy. One resident had made a complaint about aggressive behaviour by another service user. The manager took action in response, which had proved effective. Staff need training in Conflict Resolution, to help them deal with situations that may arise. The home had a policy and procedure with respect to safeguarding adults, which included information about who must be contacted if any allegation of abuse is made. Some newly recruited staff had not received training in the protection of vulnerable adults. Staff had attended training on the Deprivation of Liberty safeguards. We did not see evidence of training in the Protection of Vulnerable Adults, but the Manager said they were awaiting certificates. They had not yet had training on the Mental Capacity Act with regard to residents capacity to make decisions. Residents at Highland Mist are encouraged to be independent, and to express their views. House meetings are held on Monday mornings at least monthly, with records kept of decisions that had been made. Care Homes for Adults (18-65 years) Page 19 of 29 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. Residents find this home to be comfortable, and use the limited space to suit their life styles. Evidence: Highland Mist has a patio and garden at the front of the house. A shed had been moved to give more space on the patio, which is much used by residents. A barbeque had been provided. There is a smoke house built of blocks by the front gate, where residents told us they feel independent while still safe. A new door bell had been fitted and was found to be in working order. The front door was fitted with a new lock, and a secure post box had been installed. The front door is accessed via a conservatory, which provides a seating area where half the residents regularly take their meals. The others eat in the lounge, as there is no dining room. New blinds had been provided in the conservatory, it had been redecorated, and new lamps and plants made it a pleasant area. One upstairs bedroom is well below the National Minimum Standards of 10 square metres, and had no chair or table. Alternative accommodation, or additional space such as a private lounge, should be offered to the occupant, otherwise this room would be suitable as a sleeping in room for staff. Currently, staff have a fold-up bed which they set up in the residents lounge. The Manager said that it could be put in the Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: downstairs care office, and that residents do not use the lounge unsupervised, because the gas fire is considered a hazard. Residents are comfortable in this house, though not all standards are met in relation to private or communal space, which overall would be sufficient for seven service users. There is a bathroom on the first floor, which has had a new shower installed. There is also a communal shower on the ground floor. One bedroom had an en suite toilet, all had hand basins. The upstairs bathroom had a bolt which could not be opened by staff in an emergency, and new locks had been fitted to bedroom doors, which could be deadlocked from inside. During this inspection the home owner booked a carpenter to put correct locks on the bathrooms. Residents were very pleased that the home owner had provided them each with a digibox at the time of switch-over. One was described as over the moon to have a television and digibox in their room. The hallway, landing, and stairwell ceiling had all been repainted, and a new staircarpet laid. We found the home to be generally in good order, and residents were happy with its cleanliness. It was agreed at a recent house meeting that staff would clean toilets last thing at night and first thing in the morning. The laundry is in the small yard at the the back of the house, accessed through the care office. The ground floor bedrooms at the back of the house also have access to this yard and to the back gate. We found that the home owner had offered rooms suitably to people who lived there, for ease of access or security, depending on their needs. Care Homes for Adults (18-65 years) Page 21 of 29 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. Staff were available to consistently meet peoples support needs. The people living at Highland Mist had confidence in the people caring for them. Evidence: Residents said in surveys - at present the staff all work hard and, the staff have a laugh with you. We saw staff interacting with people who live at the home in a lively but respectful way. We were given a rota, which showed that there were two carers on duty at all times, except at night, when one person was on sleeping-in duty. The Manager was often additional to this during the week, and an administrator worked three days per week. A volunteer was working from 11.30 - 2.30pm two days per week. The staff who completed surveys confirmed that this was sufficient to meet residents individual needs. We saw that the Manager made sure there was someone available to take service users to appointments and review meetings. We looked at the files of three recently recruited staff, and saw that the documents needed to ensure they did not pose a potential threat to residents had been obtained, including in the case of the volunteer. Induction training had included mental health awareness, medication, and food hygiene, and there were records of supervision sessions where feedback had been Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: given on performance. Staff who had not yet achieved NVQ level 2 had been enrolled to start this course in July 2009. A member of the Community Mental Health Team had provided training on Well-being and Recovery, in March 2009, and told us that staff at Highland Mist were open to new ways of working with their clients. Care Homes for Adults (18-65 years) Page 23 of 29 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 leads her team in providing a responsive service to the people who live at Highland Mist. She has shown that she deals effectively with safety issues, some of which still remain. Evidence: Mrs Sue Hill is the registered provider, and manages Highland Mist on a day to day basis. She has promoted a Support Worker to the role of Assistant manger, and she has administrative support three days per week. Mrs Hill that told us that she has completed the Registered Managers Award, and is awaiting her certificate. She is now engaged in working for the NVQ 4 in Promoting Independence, and an Advanced Diploma in Integrative Counselling. We were provided with a Quality Assurance Audit, dated May 2009, which showed how the home checks regularly for safety in the environment and medication, and how people who use the service and other interested parties are able to give feedback. The Manager said that no money was currently held in the office. Staff confirmed that residents were keeping their own money in safes in their rooms, and this was working Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: satisfactorily. However, the Manager told us that she was expected to provide a daily cash allowance to one resident, whose affairs were managed by the Court of Protection. She told us that she was subsidising this payment while she awaited a cheque to cover this expense. She had not kept a record of these transactions. She said that she would start a record immediately, so that when the cheque arrives, it is clear why she is keeping some of the money. We found that some upstairs windows were able to open wide, thus posing a potential hazard to residents. Mrs Hill supplied us with a receipt for work done, showing that window restrictors were fitted four days after this inspection. The electrical installation had been tested on 29/05/09. The Fire safety system had been serviced professionally on 25/05/09. Fire training was provided in the home on 6th March 2009. This included staff as well as people who live at the home, whose certificates were on display in the hall. The electrical installation had just been checked. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R 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 1 20 13(2) Safe and suitable storage for 31/08/2008 medication must be provided. Care Homes for Adults (18-65 years) Page 26 of 29 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 20 13 All medication kept in the home must be stored safely to guard against any possibility of theft. 19/08/2009 2 23 13 Locks on bedrooms doors must not have a deadlock in case staff need to access the room in an emergency. 17/07/2009 3 23 18 Staff need training in Conflict Resolution to help them deal with situations that may arise. 19/09/2009 4 41 16 The Manager must keep accurate records of cash kept on behalf of service users, and cash that is lent as a subsidy so that the ownership of any money is clear and recorded. 18/07/2009 Recommendations Care Homes for Adults (18-65 years) Page 27 of 29 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 17 Thought should be given to incorporating more fresh vegetables and fruit into residents meals, in a way that is acceptable to them. Service users should all have sufficient private and communal space, so they have space for furniture, fixtures and fittings, as well as social activities. 2 23 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!