Care Home: James Court

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What the care home does well People have good care plans that tell staff about the support people need. Staff ask how people want care giving.The home is a nice place to live and it is clean and tidy.The staff make sure people are healthy and go to see the doctor if people are ill and have eye and dental checks.The staff ask what people want to do, and help to arrange activities and go to places people like.People can choose to go on holiday and people living in the home went to the Isle of Wight last summer.People can go to church if they want to and Staff will support people to do this.Staff spend time talking to people living in the home so that they feel valued.The staff provide positive support and encourage people to be as independent as they can.Staff help the people living there to keep in contact with their families and the people that are important to them.Staff make sure that people get the medication they need, and when they need it to help to meet their health needs.Staff have the training they need so they know how to help people to meet their individual needs. What has improved since the last inspection? People have the medicine they should have and Medicine is checked to make sure it is the right one.The care plans have been changed and written in a way which puts each person first, and includes how they want to be supported. What the care home could do better: The home has worked hard to improve the standards of support and plans in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: James Court 6 St Pauls Square Burton On Trent Staffordshire DE14 2EF 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: Mandy Brassington Date: 1 1 0 1 2 0 1 0 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 32 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 © (2010) 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 32 Information about the care home Name of care home: Address: James Court 6 St Pauls Square Burton On Trent Staffordshire DE14 2EF 01283740411 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): jamescourt6@hotmail.co.uk Mr Sivasubramaniam Kathirgiamathamby Sathianathan,Mrs Perpetua Jasmine Sathianathan care home 12 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 12 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: Learning disability (LD) 12 Date of last inspection 1 9 1 2 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home James Court is a home for 12 people with a learning disability. There are 3 shared rooms and 6 single bedrooms. There are two lounge areas for people to use. Care Homes for Adults (18-65 years) Page 5 of 32 People eat together in one dining room and can choose what to eat. People can walk to the local shops and a park is nearby. There are many buses people can catch nearby to take you to local places. Care Homes for Adults (18-65 years) Page 6 of 32 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 Care Homes for Adults (18-65 years) Page 7 of 32 How we did our inspection: This is what the inspector did when they were at the care home We spoke to people who live in the home and asked if they were happy and supported by staff. We spoke to some staff that work at the home and watched how they provided care and support. We looked at three care plans to make sure the staff know how to support people in the way they want. Care Homes for Adults (18-65 years) Page 8 of 32 We looked around the home to check if it is a nice place to live. What the care home does well People have good care plans that tell staff about the support people need. Staff ask how people want care giving. Care Homes for Adults (18-65 years) Page 9 of 32 The home is a nice place to live and it is clean and tidy. The staff make sure people are healthy and go to see the doctor if people are ill and have eye and dental checks. The staff ask what people want to do, and help to arrange activities and go to places people like. People can choose to go on holiday and people living in the home went to the Isle of Wight last summer. Care Homes for Adults (18-65 years) Page 10 of 32 People can go to church if they want to and Staff will support people to do this. Staff spend time talking to people living in the home so that they feel valued. The staff provide positive support and encourage people to be as independent as they can. Care Homes for Adults (18-65 years) Page 11 of 32 Staff help the people living there to keep in contact with their families and the people that are important to them. Staff make sure that people get the medication they need, and when they need it to help to meet their health needs. Staff have the training they need so they know how to help people to meet their individual needs. Care Homes for Adults (18-65 years) Page 12 of 32 What has got better from the last inspection People have the medicine they should have and Medicine is checked to make sure it is the right one. The care plans have been changed and written in a way which puts each person first, and includes how they want to be supported. What the care home could do better The home has worked hard to improve the standards of support and plans in the home. Care Homes for Adults (18-65 years) Page 13 of 32 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 Mandy Brassington CQC West Midlands Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 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 14 of 32 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 15 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with relevant information to enable them to make a decision of the homes suitability to meet their assessed care needs. This information is provided in a format which people are able to understand. Evidence: The home has a Statement of Purpose which has information about the service and facilities available to people. Information includes the number of bedrooms and communal areas, social activities, and how to make a complaint. People have a Service User Guide which records information about the home and an A-Z leaflet which details what people can expect from the service; this is supported by colour pictures to promote peoples understanding. The manager told us that there have been no new referrals to the home since 2006 and all vacancies are within shared rooms. The manager said that they would consult people living in the home about any person moving into shared accommodation, to ensure people were happy with a change to their living arrangements and how compatible people were. Page 16 of 32 Care Homes for Adults (18-65 years) 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 can be confident their assessed care needs will be met and are able to make decisions on the support and assistance they need to ensure their health and welfare. Evidence: We looked at three peoples care plans and risk assessments. These documents describe the support that people need to manage their day to day lives. Each person has a profile written in the first person which describes how they like to be supported and what they like and dislike. The service had identified that the plans could be improved and have received support and training to develop new person centred plans. Two people have the new plans completed and we saw that that plans are person centred and recorded how support should be provided to meet each individual identified need. The manager reported that staff or family members discuss the plans with the individual to ensure they agree and understand and where possible people who use the service record their views and sign the plan. If a risk has been identified there is an assessment of risk completed to determine how to minimise risk and keep people safe. One plan we looked at recorded that a person has Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: complex needs and may damage property. The risk assessment records the type of usual behaviour seen and how the person can be supported along with a protocol for as required medication. These assessments promoted peoples independence whilst ensuring their safety and the AQAA recorded that the service recognises that risk taking is a part of all our lives. Discussion with the manager confirmed staff had received training for the management of complex behaviours which included how to deescalate any behaviour and to use diversion techniques. This should ensure staff members are skilled and competent to manage behaviours properly. Some people who live at the home are unable to communicate their views verbally and speech and language therapists and advocates are used to ensure people are able to voice their views. There are two people currently using the service of an advocate to gain their views and wishes about day care provision and education. Care records showed plans were reviewed regularly to reflect peoples changing care needs. The manager stated a formal review took place every six months with the individual and important people, including care professionals. This ensures people receive the appropriate support and assistance to meet their needs. The staff that we spoke to were able to describe and show us how they supported people to maintain good health and respond to any concerns that may arise. Care Homes for Adults (18-65 years) Page 18 of 32 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. People can be confident they will be supported to partake in their chosen social interests, so they are able to live a lifestyle of their choice. Evidence: People living at the home enjoy a range of opportunities for social, education and leisure activities. Several people attend a local centre for structured activities during the day and were out when we visited. The home is within walking distance of the town centre and well placed for accessing local amenities in Burton. We talked to three people and saw the daily activities planned for the day. We found that people regularly take part in activities such as cinema, church, shopping and clubs. People have also done activities such as going to concerts, day trips, meals out and enjoy going on holiday. Staff reported that where possible people go out individually or in small groups. On the day of our visit one person went to have his hair cut and chose to go out for lunch at a Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: pub. He told us, its nice to go out, and I like going out with my key worker. One family member told us that in a completed survey that my family member has gained confidence and takes part in things around the home and activities, they particularly enjoy the holiday. My family member has made a new circle of friends. We observed activities throughout the day and saw that people were involved in craft and needlework activities, and completing copper pictures. One person told us how they were responsible for many household tasks and it was evident that they were enthusiastic to help around the home and took a pride in their work. People are supported by staff to learn, develop or maintain skills by taking responsibility for things around the house. This might include maintaining their own rooms, doing domestic tasks around the house, and preparing and cooking food. People living in the house are supported and encouraged to keep in touch with families and friends in a number of ways. Some regularly spend time at their relatives homes; others have visits at the home and keep in touch by telephone, according to the wishes of those involved. A family member told us within a completed survey I know my family member is happy at James Court by how they are always ready to go home. Care records shows peoples religion, and one person told us they liked to attend Church services. The manager said some people like to go to Church and this is arranged, other people who live there do not show an interest in attending church, unless it is to celebrate religious events such as Christmas and Easter and people are supported to attend these events too. One person showed us the holiday photographs from the previous year to the Isle of Wight. Staff reported that people have requested to go back there again this year. People are able to have a holiday during high season to enjoy the summer weather and two people told us, we love the carnival there, we join in everything, we were right near the beach, it was lovely there, and I like us all going on holiday like one big family, this is my family here as well as my family at home. Menus were varied, nutritious and were appropriate to the cultural background of the people living there. Discussions with people at the home and minutes of their meetings show they are consulted about what they want to eat. People living at the home told us that the food is good. We saw that there were good stocks of food in the home to include fresh fruit that was available to people. There is a record of what people have eaten so that they can monitor if people are having a healthy diet. Care Homes for Adults (18-65 years) Page 20 of 32 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. People can be assured they will be given the relevant support and guidance so their needs will be met the way they prefer. Evidence: The AQAA and care records we looked at show people have access to health care services when needed; this was also confirmed by two people who live there and staff members. Care records show people have access to relevant health care services, such as a doctor, optician, dentist and dietitian. We saw evidence that two people had received a speech and language assessment. One person was visited on the day of our visit; the manager reported that this assessment was to support communication as the person was making decisions about their future with the support of an advocate. These arrangements and practices supports peoples understanding and ensure their health care needs are met. Discussion with staff and inspection of records revealed where health needs had been identified prompt action and advice is taken, and we saw that people were supported sensitively to meet any need. Information from professional health carers within completed surveys reported the staff support has always been there during treatments, the standard of personal hygiene has always been exceptional. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: The AQAA recorded that all aspects of personal care is undertaken in a sensitive and professional manner, and during our visit we saw staff had a good relationships with people and supported people sensitively where personal care was required. The people living there were dressed in individual styles that reflected their age, cultural background, their gender and the weather. People said that if they needed support staff would go with them to buy their clothes. One person told us, I go shopping with my key worker when I want some new clothes, I can go shopping when I want. Another person was enthusiastic to show her range of clothes and how they were stored. People looked clean and attention had been given to their personal care so helping to raise their self esteem. On the day of our visit one person went to have their hair cut and told us it was cut in a style of their choosing. There was no one living in the home from an ethnic background, the staff confirmed they would be able to provide a service for people from different ethnic groups and would access relevant services to assist with communication and culture awareness. Records and discussion with the manager indicates that all staff who administer medication have been appropriately trained to do so. At the front of the persons Medication Administration Record (MAR) there is a photograph of them so that unfamiliar staff would know who to give the medication to. Some people are prescribed as required (prn) medication and protocols are in place stating how, when and why this should be given so it is not misused. Medication administration records were examined and there were no gaps in recording. Staff demonstrated a good knowledge of how to administer and manage medicines to ensure peoples health. An internal audit of all medicines is carried out twice a week. It is recommended that this audit be recorded to show how this is monitored and the outcomes of the audit. Care Homes for Adults (18-65 years) Page 22 of 32 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 have access to the homes complaint procedure, enabling them to share their concerns and promote their rights. The Policies and procedures adopted by the home protect people from the risk of abuse. Evidence: People have access to the homes complaint procedure and individuals are encouraged to raise any concerns. The service keeps a copy of any complaint, concern or compliment raised and the outcome of any investigation. This shows how the service responds to individuals so they receive a good service. During our visit, we asked how people would share any concerns, and all people responded that they would talk to their key worker or staff, and they were confident that staff would listen. The AQAA recorded that the service believes a fundamental principle in quality care is to welcome complaints and sees a concern, complaint or whistle blowing as a learning tool and a moral and legal obligation to investigate, report and correct any matters that need it one can gain so much more from this open minded, open door approach. People are able to have an advocate to support them raising concerns or when making decisions. Two people are currently using an advocate with choosing how they would like to have day time activities or education. The AQAA reported that staff have had an opportunity to attend recent training for safeguarding adults and the manager was implementing the new guidance into policies and procedures. This should ensure staff are aware of the various aspects of abuse and are able to recognise the signs to ensure peoples protection. We spoke to two staff members who confirmed they had received Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: safeguarding training; they also told us how signs or allegations of abuse would be reported. People who live at the home need assistance to manage their money. We looked at two financial records and found both were accurate. We saw that the records had been checked to make sure that no mistakes had been made when recording what people had spent. This should contribute to a safe system of looking after peoples money. Care Homes for Adults (18-65 years) Page 24 of 32 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. People who use services are encouraged to see the home as their own. The home is a pleasant, safe place to live and people have personalised their home to reflect their interests. Evidence: The AQAA recorded that the service has ensured that the physical environment of James Court provides for all individual requirements, and the home is appropriate for peoples particular lifestyle; and is above all, homely, clean, safe and comfortable. During our visit we found that the home is kept clean and tidy, and good standards of hygiene are maintained throughout making it pleasant for people to live in. In February The home was awarded a five star rating by Rate my Place, the food safety star rating scheme supported by Staffordshire Council. This is the highest rating awarded by this scheme which means that people are able to be confident in the standards of hygiene in the home. People who live in the home are supported to take responsibility for ensuring it is clean and one person told us they help to tidy up, take out the bins, unload the dishwasher and keep their bedroom tidy. it was evident that the person took pride in completing these tasks and was very enthusiastic to show us their room and how tidy it was. Care Homes for Adults (18-65 years) Page 25 of 32 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. Skilled and competent staff ensure peoples assessed care needs are met to ensure their safety and welfare, and staff recruitment practices ensure people are protected from potential abuse. Evidence: Staff records showed the homes recruitment procedure is thorough to ensure people are protected from potential abuse. Three staff records were inspected and demonstrated the organisation has robust recruitment practices. All records included a photograph, an application form, two written references, and a Criminal Records Bureau Check (CRB). Staff confirmed they had these safety checks. These checks should provide assurance that staff members are suitable to work in the home. Training records show that the majority of staff have a National Vocational Qualification in care, some at level three. This exceeds the standard and means that care staff have the skills and knowledge to meet the needs of the people living there. Staff training records showed that staff had regular training in how to meet the needs of the people living there. Staff told us they receive the induction and training they need, one staff told us that the manager is supportive and ensures they are able to do training to update their skills. Recent training undertaken by staff has included medication, food hygiene, safeguarding adults and health and safety. Some staff have had training about Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: the new Mental Capacity Act and Deprivation of Liberty Safeguard legislation. The manager told us that all staff will receive this training to ensure people are safeguarded. Staff spoken with had good knowledge of the needs of people who lived at the home. People who use the service told us staff treat them well and listen to them. One person told us that the staff here are great and were like one big family, the staff do anything for you. The manager told us they communicate with all professionals and day service provision to ensure consistency. Within completed surveys we were told we have developed a long standing effective communication system with the staff and find the home is very responsive to any queries or concerns we raise. A health care professional to holders within completed surveys that where possible staff try to empower people to say what they would like to themselves. Care Homes for Adults (18-65 years) Page 27 of 32 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. People are able to benefit from a management style based on promoting independence and rights and enabling people to live a lifestyle of their choice. Evidence: It is evident from observation and discussion with staff, that the manager is extremely enthusiastic and committed to promoting peoples rights and providing a quality service. The manager discussed her commitment to providing a good service and the AQAA recorded how external support had been used to ensure the service was able to develop and continue to meet recognised practices of good care. The manager told us that they will continue to develop systems in the home and person centred plans to support people. Staff commented they feel valued and part of a supportive team and would have no hesitation approaching the manager who is supportive and recognises personal achievement. Staff were very positive about the experiences of working in the home and reported I can speak to the manager about anything, she is very supportive, and we have a lot of opportunities for training, which we benefit from. Prior to our visit the manager completed an Annual Quality Assurance Audit (AQAA) for Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: us. The AQAA was completed to a high standard and related to the National Minimum Standards for each outcome area. Evidence within the AQAA was sampled and found to be accurate. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 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 20 To maintain a record of the internal medicines audit to demonstrate how the service ensures good standards to ensure medicines and medication practices in the home are monitored. Care Homes for Adults (18-65 years) Page 31 of 32 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 © (2010) Care Quality Commission (CQC). 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