Care Home: Mill House

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What the care home does well On walking into the building you feel a calm and relaxed atmosphere that showed on peoples faces who were noted to be smiling and enjoying conversations with staff. Staff know the residents well and build on that foundation of knowledge to plan, with the resident, the way forward. Each person is looked at as an individual and each one has a lifestyle that is suited to their needs with aims to promote as much independence as possible for that person. Care plans are made to be led by the resident where suitable. Unfortunately some residents have become institutionalised and to change the focus to promoting independency does not always work. The home recognises that not every care model suits all and uses the care plan documents in a way that fits the individual. The home encourages choice and has various examples as to how this works from every day meals to the various ways residents spend their days. What has improved since the last inspection? Since the last inspection the home has introduced care plans under the title of `Recovery Model`. Examples of these, such as `Managing Anxiety`, show how the focus on areas to be improved on and action to follow is led by the resident with support from a key worker when required. The medication management has been improved by ensuring procedures and risk assessments are in place for staff. A new Pharmacy provider has also improved this system and 6 monthly Pharmacist audits are in place along with weekly checks by the Senior staff in the home. The environment is in the middle of a refurbishment programme and on the day of this inspection many areas that have been completed show a vast improvement than found at the last inspection. Although there is still work going on, the residents spoken to all voiced how much nicer their home now is. The staffing levels in this home have improved greatly. On duty now are suitable numbers of staff to meet the needs of the residents. More staff when more residents are in the home such as evenings and weekends. The home has also recently recruited a cleaner and a new cook who interact and help with residents as part of the staff team. The home is cleaner and areas such as the kitchen and dining area has improved the look of the home to make it inviting and the taking of meals more of a pleasure which has been reflected by residents comments. What the care home could do better: The staff need guidance on how to manage someone with diabetes. Signs to look for in high or low sugar monitoring and when to act. Staff supervision needs to be in place and established to show that at least 6 supervision sessions are carried out in the year.Some areas of training for staff do need to be in place such as The Mental Capacity Act and Deprivation Of Liberty. Key inspection report Care homes for adults (18-65 years) Name: Address: Mill House Litcham Road Gayton Kings Lynn Norfolk PE32 1PQ     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: Ruth Hannent     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Mill House Litcham Road Gayton Kings Lynn Norfolk PE32 1PQ 01553636654 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Regard Partnership Ltd Name of registered manager (if applicable) Ms Dianne Eaton Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 21 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home The Mill House is a Care Home which provides care and accommodation for up to 21 adults of both sexes who have mental health difficulties. There are four units of accommodation which are all linked together and share a garden. There are many changes of level within the building and there is no passenger lift to the first floor and so the Home is not suitable for residents who have physical disabilities. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 21 2 1 0 1 2 0 0 9 Brief description of the care home Inspection reports are made available in the Home. Fees currently range between £375.00 to £1,200.00 per week. Fees are agreed on an individual basis dependent on need. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection visit was carried out over a period of 5 hours and assisted by the Manager of Mill House and the Locality Manager for the Regard Partnership Company. Information received prior to the visit has also been used to complete this report. This includes notifications received from the home since the last inspection, comments on surveys from residents, staff and health professionals. The Manager had completed and returned the AQAA (Annual Quality Assurance Assessment) with comprehensive details enabling us to gather some information about the service and its delivery of care and support. On the day of this visit we toured the building, discussed the service with staff and spoke to residents about their day to day lives at Mill House. Records were looked on staffing, care plans, medication, personnel, training and health and safety. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The staff need guidance on how to manage someone with diabetes. Signs to look for in high or low sugar monitoring and when to act. Staff supervision needs to be in place and established to show that at least 6 supervision sessions are carried out in the year. Care Homes for Adults (18-65 years) Page 7 of 27 Some areas of training for staff do need to be in place such as The Mental Capacity Act and Deprivation Of Liberty. 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 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and 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 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does offer information, invite and encourage visits and assess potential residents before admission to ensure the home is suitable for the needs of that person. Evidence: The AQAA tells us that the prospective residents and any commissioners are provided with a Statement Of Purpose, Service users Gide, Home brochure and Inspection Reports enabling all to make an informed choice about the suitability of the home to meet their individual needs. One particular resident spoken to gave a picture of the number of over night stays taken in a guest room before a decision was made to move in permanently. He said it was his choice and how the slow transition had helped the anxiety of moving in. The Manager informed us that no person moves into the home without a full assessment and relevant information gathered from other professionals involved. This information was seen in a care plan of 1 resident. No-one appeared inappropriately Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: placed and although one person had recently been moved on due to inappropriate behaviour this would not have been discovered at an initial assessment. 1 survey received from a health professional commented on the appropriateness of placements at this home and wished there were more like it. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents now have a care plan model that focuses on their future, empowering them to take responsibility of their own development and improvement with the support of the staff. Choices are part of the improvement/development for residents with risks assessed as identified and written in the care plan. Evidence: During this visit we looked at 2 care plans to assess the change from the original model to the new format mentioned in the AQAA. The details of residents are held in the main folder but introduced now is a care plan called the Recovery Model which uses a star outcomes framework. This shows the empowerment and involvement in the individual needs of each resident. It identifies areas that need improvement and follows up with action plans on how to move forward and improve these areas, from managing their anxiety to managing their finances. It is led by the residents themselves who actively get involved in their own development and sign the Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: documentation along with the key worker to show that involvement. The decisions are taken when the person is ready to move forward and begin to manage some of their day to day lives that have been identified as requiring support and encouragement. A resident was able to tell us about the improvements he has made with the support and use of the homes Recovery Model methods. The home has improved the recording of risk management with all actions taken supported by a risk assessment, with dates noted of the reviews of these risks and written were any adjustments required. The past inspection report asked for risk assessments on the money management for residents which is now in place and seen. The home hold regular meetings with residents to discuss the day to day running of the service. The changes in the home due to the refurbishment has meant a lot of communication to each resident to ensure they know what is happening in their home. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported in their everyday lives with education, day to day activities, leisure activities and meals that are enjoyed and chosen by each one. Evidence: This home is part of a group of homes that interact and share facilities. The night before this inspection the residents, with the other establishments, had hired the local village hall and held a big Christmas party. Walking around the home residents, who had not gone out to an activity, education or day centre were reading, listening to music or planning shopping with a staff member. The home had a volunteer (who has been involved for many years) working with a couple of residents on table decorations. Two other residents were playing a board game with staff. One resident had just returned from walking his dog with another one telling us about his trip to Nottingham on the previous day and the train changes that he had taken. On the wall in the office is a large wipe board divided into the days of the week showing the Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: various places residents need to go to or what there activity for the week is planned. The AQAA also tells us that sessions at the local sports centre are now in place for badminton and swimming. In September of this year 10 residents have enrolled on adult courses ranging from skills for independent living, computer skills, making music and cookery. (The service now has areas in the home that have kitchen facilities for residents to practice their cooking skills). During the afternoon of the inspection a reflexologist arrived to carry out a session with some residents which occurs on a regular basis. Comments from residents tells us they enjoy their lives and that staff are very supportive with helping us have trips out and planning holidays. The home work with residents to keep in touch with their family when possible. 1 resident has their family visit regularly, another is taken to see their relative and 1 who has his family in New Zealand keeps in touch via emails. There is also a guest room available for anyone who would prefer to stay overnight. Residents all have lockable doors and all participate in keeping their rooms clean and tidy. Staff were noted to knock and wait to be invited in. The menu for the week was on display in the dining area and all residents are verbally asked what they would prefer to eat. Comments received from the surveys sent out prior to this inspection state the food is good and that they have a choice. The Manager tells us that there is always a variety of choices and that 2 residents who are vegetarian are catered for. Care Homes for Adults (18-65 years) Page 15 of 27 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. The home have good support for the health of the residents who see specialists as and when required to meet their needs. The homes policies and procedures are carried out, staff are trained and clearer reporting and risk assessment documentation is completed ensuring safe handling of medication is carried out. Evidence: The majority of residents at Mill House are able to manage their own personal care with prompts and encouragement from staff. There are a number of bathrooms around the property for sharing and some have their own shower facility. The health care needs are supported by the local GP with other health professionals called upon as and when required. The Consultant Psychiatrist, Community Psychiatric Nurse and Outreach workers are just some of the support offered to the home. The diabetes nurse supports people with diabetes and has been contacted recently to ask for training in this subject to support residents with diabetes. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: The medication for all the home is stored in locked trolleys in a large locked room next to the office. The room at present is not ideal and is, in the next couple of days following this inspection, to be refurbished. The carpet is to be removed, bars will be at the window and the place will be painted. A requirement at the last inspection was to improve the procedures for PRN medication. This has been completed and seen were clear guidelines in a folder in this medication room. The home has also completed risk assessments on medication for each person but on checking a person who is diabetic did not have any details about the signs to look for in hypos or hypers and what is the safe readings on the blood sugar monitoring for staff to know how,when and what to do if this person becomes unwell. Medication administration charts appeared completed correctly. All medication is now supplied by a new Pharmacist who carries out at least 6 monthly audits. The Senior worker or the Manager have their own checking system carried out weekly which was seen and also discussed with the Senior on duty. Appropriate comments were seen and it was noted the dates for these checks were weekly. The AQAA also tells us that staff are trained in medication administration and the training matrix shows this is happening as an e-learning for most staff with 3 others having the advanced medication training. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can feel confident that their concerns and complaints will be listened to and acted upon. People who live at this home are protected from abuse, neglect and harm. Evidence: The home has reported complaints received within the home. One was investigated thoroughly by the companys Location Manager (spoken to by us) and no evidence was found and the resident complaining was happy with the outcome. The Commission has not received any complaints. The Manager told us, and details of meetings in various formats were seen on how the home communicate to residents by meetings in a group or one to one sessions. We are told these regular meetings are to encourage residents to speak out about any concerns. Comments on the pre inspection surveys from residents are full of praise for the staff about the support offered and all ticks were positive in the box about Do you know how to complain. Residents are safeguarded by the homes procedures for training in this subject by elearning and or Norfolk County Council training. This was noted on the training matrix and on discussion with staff. The Manager also ensures all CRBs and references are returned before recruiting staff. This was noted in the personnel files seen. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is improving the environment to a much better standard and it is clean and hygienic. Evidence: The home at present is going through a big refurbishment programme. At the beginning of the year, when the last inspection was carried out, a number of requirements around the environment were made, especially the bathrooms. These have now been addressed and although only half of the home has been completed to date with the other half due to be finished by the Spring the improvement is great. A large kitchen and dining room is inviting with attached a small kitchen area for the residents to work alongside the cook or support staff on their own cooking skills. There is another new kitchen attached to a refurbished quiet room and 2 bedsits have small kitchenette areas again for residents to cater for themselves with support. Some bathrooms have been gutted and new suites and decoration has greatly improved these areas. The main lounge is cosy with nice new furniture, curtains and carpet. Bare brick work has been plastered over and painted to stop the dust on the stairs and dining room walls. Individual bedrooms have been decorated and new linen has been purchased with the residents, to choose the colour schemes they would like. Pictures for the walls were being chosen by a resident from a variety on the computer on the day of this inspection with the plan to share some ideas at the next residents meeting. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: If the rest of the refurbishment is completed as well as the first half this home will have made great improvements to the service, making it more comfortable and homely. One concern on comments received has been the lack of cleanliness in the home. This has recently been addressed with the home now employing a full time cleaner. All areas seen appeared clean and no unpleasant odour was detected. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team do have the qualities and are on duty in suitable numbers to meet the needs of the residents. Recruitment is carried out safely and staff are trained to carry out their role. Supervision is still not carried out fully to date but plans are in place to improve. Evidence: One of the requirements at the last inspection was to increase the staffing levels to meet the needs of the residents. This has taken place and the home now always have three care staff in the building and sometimes four according to individual needs of the residents during the waking day. The staff were seen during this visit with lots of various activities happening. A number had been taken out to various places in and around Kings Lynn and some were interacting on a one to one basis in the home. The night rota now includes a waking night staff member to add to the sleeping in, on call, staff member. The comments both on the day and written in the surveys received are all positive. The staff are friendly and have time for us was just one comment stated. During observation and listening to comments by the staff it was evident that the staff are knowledgeable and know the residents. The home has also introduced a cleaner and a new cook to the home who both interact and include the residents in their day Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: to day jobs. The house is much cleaner and the new kitchen is spotless. The training matrix in the home and confirmed by the Manager shows a high number of staff have NVQ 2 or above in health and social care. The Senior spoken to gave competent and clear answers to questions that show her skills and competencies. Due to the allowed increase in staffing, the home has held a huge recruitment drive and had a very good response with a number of staff being recruited around the same time. Induction packs were seen for three new staff that showed the progress each one is making. The company has a policy that all staff have a six month probationary and this is written in their contracts. The most recently recruited staff files were seen bar one that was on its way to the home from head office. This company have a stringent recruitment process and ensure all the personnel details are in the personnel folder before forwarding it to the home. The folders seen at the inspection were correct with CRB clearance given and two references in place. The training matrix given to us at this inspection and from comments received on the 3 staff surveys received, the home does support the staff with good training and induction. The matrix shows a large number of staff are using e-learning to train and the company has just signed up to a training company called Choice Support Training, who have an in depth mental health training and will be taking the staff yet to qualify through their NVQs. The matrix does show that only 2 staff have been on the Mental Capacity Act training and as this is a topic that is mandatory the home needs to get more staff trained in both the Mental capacity Act and Deprivation of Liberty. There has been some problems in ensuring staff have regular supervision due to the previously limited number of staff on duty. Now this has changed with the recent recruitment of new staff and the Manager showed us the recently constructed supervision file that now dictates which Senior or Manager will supervise who and dates planned for the one to one sessions. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a competent, qualified Manager who ensures quality is assessed and improved for the residents and safety for all people in the home is in place as much as it is possible. Evidence: The AQAA has been completed by the Manager and returned to us with clear details on how the service is delivering the care required for people with mental health problems. The Manager has many years of experience and is a qualified Mental Health Nurse. She also has a Registered Managers Award and was registered by the Commission to manage Mill House earlier this year. The AQAA tells us that the home has regular quality checks carried out by a regulation 26 visit from senior management within the company. Copies of these were noted in the office and appeared completed in detail with comments and interviews with residents and staff as well as building checks. The Manager has also sent through to us the annual quality assessment results for the home which show a high level of contented residents, family members and 1 professional. The Manager talked about Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: the continuing programme to improve the service delivery and the evaluation processes to ensure the quality is moving in the right direction. The home has given a staff member a lead in health and safety and this person has attended the basic health and safety course and the fire risk assessment course. This person is responsible for the weekly fire alarm checks and has completed the fire risk assessment for the building. The home has now been split into 5 areas with staff taking areas of responsibility to check and record the safety of the building, (seen). Contractors carry out annual checks of equipment in the building and noted at this inspection was the water checks by Connaught Compliance, Contract Fire Servicing for all appliances dated for servicing on the 10/09 and PAT testing next due on the 09/10. The Manager also showed us the terms written while builders are on site and risks assessed while the contractors are refurbishing the home. The majority of the staff have used the e-learning on COSHH and during the tour of the building it was noted that all chemicals were locked away. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 It is good practice to have instuctions for staff on the signs to be aware of for people who have diabetes and also to understand the results of the blood sugar monitoring and what they should do if it is too high or too low. The home needs to build the training programme to ensure all staff have the Mental capacity Act and Deprivation Of Liberty training. Supervision for staff needs to take place 6 times a year and records kept for inspection from now on. 2 35 3 36 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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