Care Home: Little Ashmill RCH

What the care home does well The environment provides space for the people using the service to access freely. The accommodation is comfortable, homely and warm. People using the service have the support from a dedicated staff team who demonstrated their awareness of individuals needs. People are supported to experience a lifestyle of their choice. What has improved since the last inspection? Two people had new bedroom carpet`s fitted. One person has had a new wardrobe. The dining room and living area have had new display cabinets. There is a new a new `activity` table in the extension. The down stair lounge has been fitted with new curtains. The kitchen has been fitted with a new cooker and dishwasher. The service has appointed a new care manager. The acting care manager has implemented new documents that ensure that the handover is more constructive and informative. What the care home could do better: To provide a more informative and details based on the core standards for the AQAA. To provide the Statement of Purpose and service users guide in an alternative formate enabling the people using the service to understand what the service has to offer. To incorporate the current fees within the relevant documents. To implement questionnaires for staff, people using the service, relatives and stakeholders on a annual basis to obtain feed back about the service. To implement written individual protocols for any medication prescribed `when required`. To ensure that prescribed medication with a limited life is dated when opened. To review the document for peoples finances ensuring that at the end of each week the monies balance. To replace the broken bath panel in the ground floor bathroom. To ensure that the commitment to staff training is maintained.To provide training for challenging behaviour, thus ensuring that peoples needs were addressed in an appropriate manner. To ensure that the fire records and testing are kept maintained at all times. Key inspection report Care homes for adults (18-65 years) Name: Address: Little Ashmill RCH 21 Stanhope Way Great Barr Birmingham West Midlands B43 7UB     The quality rating for this care home is:   one star adequate 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: Wendy Grainger     Date: 1 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Little Ashmill RCH 21 Stanhope Way Great Barr Birmingham West Midlands B43 7UB 01213605842 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashmill Residential Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 6. 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: Physical Disability (PD) 6 Date of last inspection Brief description of the care home Little Ashmill is registered to care for five people between the ages of 18 and 65 who have a physical disability. The property is a detached house, which has been extensively modernised and refurbished to meet the needs of the people who live there. It is situated in a residential area in Great Barr and has shops and a public house nearby. All the people who live at the service have their own bedroom, which is provided with an en suite shower and toilet. All rooms are designed to be accessible to Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 Brief description of the care home those using wheelchairs. There is a vertical lift to the first floor. Little Ashmill is comfortable and well equipped and because of its smaller size, achieves a homely atmosphere. The present Registered Individual Ms Salma Katrina Brown (on behalf of Ashmill Residential Care Home Ltd) has been operating this service since August 2003. The care home charges (Fees) are reviewed annually and people who use the service are notified one month in advance. The only additional charges to people who use the service are for hairdressing, chiropody and Ring and Ride. The current fees charged at Little Ashmill range from £1,000. 00 to £1,200.00 per week. The reader may wish to contact the service to obtain the current fees for the service 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We looked at all the information that we had received, or requested since the the last key inspection. This unannounced key inspection was carried out on Monday 19th October 2009 by one inspector who used the National Minimum Standards for Care Homes for Younger Adults 18 to 65 years and the outcomes for people using the service as a basis. The acting care manager provided written information regarding staffing, staff training, menus and care plans Prior to the inspection we looked at the Annual Quality Assurance Assessment (AQAA), this is a self assessment tool, and had been completed by the previous registered care manager and returned to us before this key inspection. The completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment, which focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the Care Homes for Adults (18-65 years) Page 6 of 30 service. The completed AQAA was limited in its detailed information and completed in a list style format, we were not always able to cross reference the information provided with the core standards inspected. We spoke to the people using the service to ascertain their opinions about the service and care they receive. We discussed the menus with the acting care manager and the staff who do the catering for the people using the service. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: To provide a more informative and details based on the core standards for the AQAA. To provide the Statement of Purpose and service users guide in an alternative formate enabling the people using the service to understand what the service has to offer. To incorporate the current fees within the relevant documents. To implement questionnaires for staff, people using the service, relatives and stakeholders on a annual basis to obtain feed back about the service. To implement written individual protocols for any medication prescribed when required. To ensure that prescribed medication with a limited life is dated when opened. To review the document for peoples finances ensuring that at the end of each week the monies balance. To replace the broken bath panel in the ground floor bathroom. To ensure that the commitment to staff training is maintained. Care Homes for Adults (18-65 years) Page 8 of 30 To provide training for challenging behaviour, thus ensuring that peoples needs were addressed in an appropriate manner. To ensure that the fire records and testing are kept maintained at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may choose to use the service may have a better understanding of what the service offers if information given to them is increased and in formats appropriate to their needs. Evidence: The AQAA we received told us that the service had a tool used for an assessment, which worked well. If there was a doubt about the service meeting an individuals needs the place would not be offered to the person. We saw the service users guide and Statement of Purpose, which provided clear information for people using the service. The documents did not include the current fees for the service. People were not provided with this information about the service in any other format. An alternative formate would enable all the people to understand what the service has to offer. We spoke to staff who confirmed that they had not read either document, they were however aware of their existence. It is recommended that all the staff were made fully aware of the documents. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: We saw from the records that the service carries out an assessment of people wishing to use the service. A trial period would be part of the settling in process. We evidenced from the first care plan that the person had signed the end of the care plan. This confirmed comments by the acting manager that people were involved in their planned care. We spoke to all the people using the service who told us or indicated by various methods that they were happy and well looked after. Care Homes for Adults (18-65 years) Page 12 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 using the service are involved in decisions about their lives, and take an active role where able to do so in planning the care plan and support they will require. Evidence: The completed AQAA told us that people using the service were involved in the care plan to meet the needs of individuals. The care plans were updated and reviewed with the persons involvement. The service encourages people to take risks. People are encouraged to improve their learning skills. We saw that all the people using the service had individual care plans with support they need to meet their needs, including medical and risk assessments. A persons gender is respected by the staff addressing the needs of the same gender.We were unable to evidence a current review of the care plans, which had been projected for July. The previous date for a review had been January 2009 under the previous registered manager. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Individuals were supported by the staff on duty to make a decision about their daily lifestyle. One person told us that she enjoys the home and going to the college, I like it here but would like to go back to my other college, they help me with writing there instead of just knitting. This person was busy knitting when we arrived at the service. Other peoples routines were recognised and respected with one person rising later. One of the people had been away for the weekend to stay with family, this was part of her social routine. We spoke to the relative he told us,My daughter is well looked after here, I always feel welcome when I bring her back. Individuals were supported to take risks, we saw risk assessments in the care plans, following the discussions with the manager during the inspection risk assessments will be reviewed and developed where necessary. A care plan identified that there was a need to monitor the individuals challenging behaviour. Staff were aware how to defuse any situation however, to date they have not received any formal training. This was discussed with the acting care manager, who will address the lack of training. This will protect other people and ensure the staff have the appropriate knowledge to support the person. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are supported by staff to experience and enjoy a social lifestyle. The menus were based on likes and dislikes and provide a balanced diet. Evidence: The completed AQAA told us that the service supports people using the service to enjoy a social and educational lifestyle. The service told us that in the previous twelve months the service had implemented more craft and art work. It was planned to involve the people with the community more. We saw on arrival two people in the lounge, one was waiting to be transported to the local college, where she attends three times a week. We were told that while she Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: enjoys it and meets her friends, I want to go back to my other college when it is ready. The other person indicated to us that he was happy with the staff. We saw pictorial evidence with impressive art work displayed around the walls and a folder that people have a social life outside of the service. During the inspection we saw that staff and management were communicating with the people using the service in a sensitive way showing respect at all times. The menus were based on individuals likes and dislikes, the acting manager has reviewed them since taking up her post, plans include undertaking to further review with the people to organise the winter menus and to ensure they offer a balanced diet. We saw the hot meal served to the person retuning from college it was a good portion size. We were told by the person when asked that I like my meals and this is good. Care Homes for Adults (18-65 years) Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements were in place for the continued health care of the people using the service. People will be further protected when better practices in respect of the medication regime are in place. Evidence: The completed AQAA returned to us told us that the health care regime at the service works well. The service has a safe and closely monitored medication procedure. Arrangements were in place for the continued health care of all the people using the service. At the time of this inspection no person was receiving care from any consultant. One person receives care from the district nursing service twice daily. We were told that the service has excellent support from the nurses and general practitioners. We observed the medication system and morning administration, it was completed in a sensitive knowledgeable manner. Staff confirmed that they had received training for Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: the safe handling of medication. This was also confirmed from the training records. The service had the required equipment for the safe keeping of controlled drugs. There were some shortfalls in the medication system, which were fully discussed with the manager, area manager, and director of the service. The service needs to create written protocols for medication given when required. Eye medication and creams need to be dated when opened. This practice will protect the people by ensuring no out of date medication would be used. Care Homes for Adults (18-65 years) Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although most people are able to make a complaint some are not as the complaints information available may not be understandable to them. Robust finacial processes and record keeping would make sure that people are beter protected. Evidence: The AQAA we received told us that the service deals with any safeguarding issues in a straightforward and transparent manner. The service completes a detailed, and cross referenced ,daily record of peoples finances. The service has a trained staff team with a good understanding or their responsibilities to wards the protection of the people in their care. The AQAA indicated there had been no complaints received since the previous inspection. There had been one issue referred to the safe guarding team; this had been investigated and found unsubstantiated. We saw that the service had in place a complaints process. The procedure is included in the Statement of Purpose and service users guide. There was no evidence of an alternative format, which would ensure that all the people using the service had an understanding of the process. The people using the service do not require an advocate Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: at the time of this inspection. We were assured by the manager and the staff that any allegations of abuse or identified abuse would be acted upon immediately. We were aware that the acting manager had reviewed the training records, which were unclear, this was the result of the poor records she had inherited when she took up her post. She has arranged for refresher training for the Protection of Vulnerable Adults for November 2009. This will ensure that all the staff have current knowledge to protect individuals. We checked two peoples finances, one of which was incorrect and short by a small amount. The records did not identify where the amount had been lost. The records in general were not satisfactory and did not provide an audit for the management. Records did not show finances received, items spent on and any money taken out. The acting manager who has inherited the system will review the records, ensuring more details were entered. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The design and layout of the service enables people to live in a warm comfortable environment. Evidence: The completed AQAA we received told us that the service is comfortable and safe with constant reviews to make improvements. The peoples art decorate the walls. The service had a good report from Walsall Councils infection control review with over 90 achieved. We observed the service to be comfortable, warm and offered plenty of space for the people using the service and wheelchairs. Communal areas were bright with a large patio window at one end of the lounge. There were various touches of homeliness on the walls and within the display cabinets. We saw peoples bedrooms to be personalised as the person wishes with lots of favorite items around them. One person was having a new carpet fitted during this inspection, this plus decorating the room will further enhance the persons environment. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: We identified to the manager that to further protect the people wardrobes were required to be secured to the wall. The acting manger arranged for this to be completed before we left the service. We discussed the need for risk assessments to be considered within the bedroom areas in particular for items stored on top of wardrobes. We were told by three of the people that they liked living at the service. When we looked around the premises we saw that people had been provided with equipment to meet their special needs. The AQAA told us about a CCTV camera, we were told by the area manager that at this time it was not connected, when operating it would not be intrusive in the service but for the outside areas of the building. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A consistent staff team support the people using the service and maintain their safety. Planned staff training will further enhance the knowledge of the staff. Evidence: The AQAA completed by the previous registered manager and received prior to the inspection provided very limited written evidence in respect of the recruitment process and staff training. We evidenced staff in sufficient numbers to meet the current needs of the individuals at the service. They were attentive to one person who was unwell and remained in bed. The acting care manager had not been formally registered with us. She had been in post since mid August 2009. During this time she had identified that records were inadequate, training and induction records were not available or out of date. We spoke to staff who confirmed that they had received training for medication and first aid but not aware of the dates. During the inspection we observed the staff who demonstrated their skill and knowledge of the people in their care. There was no evidence within the training records that staff had received the required training for Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: the Mental Capacity Act and Deprivation of Liberties. We evidenced within the office that the acting manager had booklets for staff to read on the Mental Capacity Act and Deprivation of Liberties, she will be ensuring staff have access to the documents while sourcing external training. The service had in place recruitment policies that ensures the staff who are appointed are suitable. We saw two staff files that contained Criminal Records Bureau and Protection of Vulnerable Adults checks, these had been carried out prior to employment. This practice means that people using the service are protected by the process. Some documents relevant to the initial induction training for the two staff seen could not be evidenced. We evidenced the acting managers arrangements for all the staff to undertake mandatory training during October and November 2009. This practice will ensure staff are competent and protect the people using the service. We spoke to people who told us that they are good to me, I need help and they do it for me. We had thumbs up and smiles from other people when asked about the staff indicating they were happy with them. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service cannot always be assured that they are protected by the procedures in place in the event of an emergency. The acting manager and staff were competent and safeguarded the people in their care. Evidence: The AQAA provided by the service could have been better completed. Information provided was limited, in a list format and did not fully reflect the true situation of the service for example; we found short falls with financial records and records to show that fire safety is robust. We saw evidence to confirm that senior managers are undertaking monthly visits to the service to assess the service and record their findings. We told the senior manager that we were worried in that shortfalls we found during our visit had not been picked up by him as they should to make sure that the service is being run in the best interests of those who use it. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: The service does not at the time of this inspection have a registered care manager. The acting care manager is a registered nurse with the Registered Care Managers Award level 4 plus many years of experience as a manager in a nursing agency and health care. since taking post in mid August 2009 she has arranged mandatory training for all the staff including medication. Previous records were incomplete and inconclusive, to cross reference that training had taken place. Her role is supernumerary to the staff rota, she has plans to move the service forward to protect the people using the service, while supporting the staff. She plans to enroll for the National Vocational Qualification in Care level 4 and to be an assessor for care. As part of her role as acting care manager she will be undertaking part with all the organised mandatory training. We have to date not received an application to register the acting manager ensuring she complies with the Registered Homes Act. We identified serious concerns when evidencing the poor records for the protection of the people in the event of a fire records were incomplete identifying the last fire drill had occurred during February 2008. The manager the following day provided us with evidence of a drill taking place in November 2008 and March 2009. The person responsible for activating fire drills had not been trained to execute a drill. This was to be rectified at the next fire training day on the 22cd October arranged as an emergency by the acting manager. The service did not have an annual fire risk assessment, or contingency plans, or individual fire risk assessments for people using the service in the event of an emergency. This put people at risk in the event of an emergency. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 13 The person responsible shall 05/11/2009 ensure the safety of the people not take unnecessary risks to the health and safety of the people To ensure the safety of the people arrangements need to be made to ensure the service is safe in the event of an emergency Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 To consider alternative formats for the statement of purpose and service users guide ensuring that people using the service were aware what the service offers. The manager should ensure that all the staff have access and were fully conversant with the content of the statement of purpose and service users guide The current highest and lowest fees for the service should be included in the statement of purpose and service users guide, to comply with the National Minimum standards and previous inspection report. Page 28 of 30 2 2 3 2 Care Homes for Adults (18-65 years) 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 4 5 6 9 To ensure that care plans are reviewed on a regular basis with the involvement of the individual person. To review the risk assessments, ensuring that risk assessment contains the details of the measures to take when any risk is recorded. To create written agreed protocols for medication that is required when necessary. This will ensure that people are protected and received medication suitable to their needs. To ensure that any tropical and prescribed medication are dated when opened this will prevent out of date medication being administered. To review the system and recording in respect of peoples monies, ensuring That they protect the individual with more robust relevant details. To ensure the safety of the people using the service, risk assessments should be in place to include the peoples bedrooms and personal items. To ensure that the service has a training and development programme for each of the staff underpinning their knowledge. To ensure that all new staff receive structured induction training within the first six weeks of appointment. Including the principles of care, safe working practices. To ensure that an application is made for the acting manager to comply with the Registered Homes Act. 6 20 7 20 8 23 9 26 10 35 11 35 12 43 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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