Care Home: Ravenscroft

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What the care home does well The staff are friendly. They meet each person`s needs well.Care plans are detailed.Staff will help to arrange health care when this is needed.Staff are well trained.The home is well managed. What has improved since the last inspection? Staff receive regular training (including food hygiene training). What the care home could do better: People`s needs should be looked at before they come here.All care plans need to be up to date.One person needs regular blood tests.Medicines need to be more safely managed.Trip hazards need to be removed. Key inspection report Care homes for adults (18-65 years) Name: Address: Ravenscroft West View Wrekenton Gateshead Tyne and Wear NE9 7UY 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: Lee Bennett Date: 1 2 0 9 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 34 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 34 Information about the care home Name of care home: Address: Ravenscroft West View Wrekenton Gateshead Tyne and Wear NE9 7UY 01914875085 01661824458 ravekris@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashdown Care Homes Limited Name of registered manager (if applicable) Ms Glynis Wilson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 4 0 3 0 care home 5 learning disability old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 5 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 categries: Learning disability Code LD, maximum number of places: 5 Old age, not falling within any other category - Code OP, maximum number of places: 3 Physical disability - Code PD, maximum number of places: 4 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Ravenscroft is a home run by a private owner. It is a large bungalow, set in its own garden. 5 people can live here. There is level access throughout the home. Bathrooms and toilets are easy to get in and out of. Everyone has there own bedroom. Nobody has to share. Care Homes for Adults (18-65 years) Page 5 of 34 There is a minibus here for people to use. This means people can get out and about. Care Homes for Adults (18-65 years) Page 6 of 34 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 Care Homes for Adults (18-65 years) Page 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home The Inspector talked to the people who live and work at the home. The inspector looked documents that have to be kept. He looked at: - Care plans. - Staff files. - Medicine records. - Some of the homes policies and procedures. (Policies are rules about how to do things. Procedures tell Care Homes for Adults (18-65 years) Page 8 of 34 people how to follow the rules.) The inspector looked around the home. (This was to make sure it was safe and comfortable.) What the care home does well The staff are friendly. They meet each person’s needs well. Care Homes for Adults (18-65 years) Page 9 of 34 Care plans are detailed. Staff will help to arrange health care when this is needed. Staff are well trained. The home is well managed. Care Homes for Adults (18-65 years) Page 10 of 34 What has got better from the last inspection What the care home could do better Peoples needs should be looked at before they come here. Care Homes for Adults (18-65 years) Page 11 of 34 All care plans need to be up to date. One person needs regular blood tests. Medicines need to be more safely managed. Trip hazards need to be removed. Care Homes for Adults (18-65 years) Page 12 of 34 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 Lee Bennett St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 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 13 of 34 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 14 of 34 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. Detailed assessments of need are in place, but these are undertaken after a persons admission. Timely assessments are to help make sure the home and the staff team can meet peoples identified needs. Evidence: Before a person moves to a care home they are entitled to have an assessment of their needs carried out, either by a social worker or a health care worker, such as a nurse assessor. This person is commonly known as a Care Manager. Even when a person pays for their own care, they are still entitled to such an assessment. All of the people moving here have their care arranged by Social Services. Nobody has come here by private arrangement. The manager of a care home must also obtain information about those people who would like to come here. This will include a copy of the assessment, and a summary care plan written by the care manager, which explains how each persons needs are to be addressed. This is to make sure their needs are looked at and then can be properly met. Since the last inspection of this care home only one person has moved in. All of the other Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: people living here have done so for a few years. A requirement was made at the last inspection to make sure assessment information was obtained before a person moves in. On this occasion the person moved here from hospital. He was assessed by a social worker 6 weeks after he moved in, but was known to the manager from the other home the manager oversees. The assessments provided by social workers include information about diversity needs, such as those relating to disability, gender, race and culture, as do those undertaken by the manager and keyworker. After a person moves here their needs are periodically reviewed and if necessary reassessed. This is done with the involvement of a social worker as well as other key professionals, such as the speech and language therapist, dietitian, community nurse, and so on. This is to make sure Ravenscroft remains the right place for people to live. It is from these reviews and reassessments that plans of care are developed. Care Homes for Adults (18-65 years) Page 16 of 34 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. All of the people here have care plans and risk assessments, which are detailed but not always kept up to date. This means that staff have clear guidance, but this is not always accurate. Evidence: To help guide the care that staff offer to the people living here, a care plan file is compiled. This is written in an assessment format, with plans of action also detailed. All of the people living here have had these plans developed. These are all written up, evaluated and reviewed by the manager and a key worker; a member of staff who works with a named service user and takes a lead on the planning and delivery of care. Of the two cases we looked at in detail, one had been reviewed and updated to detail their increased needs. But for another person, the information on the file we looked at was out of date. It is important that care plans are updated to help ensure the information and guidance for staff is accurate and reflects their current needs. The practice that we observed (for example when helping people with meals) reflected the guidance in the care plans. The documentation is written in a person centred way; that is they reflect each persons unique needs and preferences as outlined in the care plan. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: They are also signed off as read by staff, which helps to ensure everyone is aware of how to support the people living here. Care plans include areas of support needed around each persons culture and beliefs. Closely linked to care planning arrangements are risk assessments. These are written up by a key worker when there is an identified area of risk, either to the service user or to others, by that persons behaviour or needs. They follow a standardised format, and detail the area of risk, its severity and likelihood, consider the benefits of certain risks being present, and outline how unnecessary risks are to be managed. We found that areas of risk were being clearly documented and include assessments aimed at promoting each persons Independence and opportunities to participate in the local community. Again, one persons risk assessments were up to date, the others not. Both care plans and risk assessments are a formal way of documenting decisions about important matters affecting a persons care and lifestyle. The people living here sometimes find it hard to make direct comments about the care and support they receive, long term plans, and so on. This is because they may at times use different means of communication, such as facial gestures, body language, certain behaviours and so on. The people here can make their immediate needs and wishes known to the staff, and this is helped as staff have got to know these people over a long time. Staff have received training so they are aware of what to do should they, or other professionals, have to make decisions on a persons behalf, where their liberty might be limited. Care Homes for Adults (18-65 years) Page 18 of 34 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 living here are assisted to spend their time in an active and fulfilling way, reflective of their personal preferences, culture and needs. Evidence: On the day of the inspection, the people living here were supported with some activities in the home, and some also had a short walk out to the local shops. Activities included service users and staff spending time socialising in the kitchen, watching TV, listening to music, helping around the home and having a walk out. There is a vehicle available here to help people get out and about (dependant on their being a driver on duty), and trips out include outings to the coast, to the local shops, to the pubs and for meals out. The people living here have also had the opportunity to take holidays in small groups. As well as going out and about or being occupied whilst in the home, contact with friends and relatives can affect the quality of life enjoyed by people. The staff will help the people living here to maintain regular family contact and we were told visitors are made welcome. One person has, since moving here, joined a local church, and has developed a Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: new social network and friendships since going there. As well as having rights to keep up family contacts and to lead a varied and fulfilling lifestyle, the people here retain rights around how they are helped, and what staff do when they put themselves at risk of harm. To help meet these rights there is clear guidance in care plans and risk assessments, aimed at ensuring people are supported to get out and about safely. Risks may be associated with certain activities, and include areas such as crossing the road, using the minibus or accessing the shops. Most risk assessments have been regularly reviewed, and if necessarily updated to keep this information and guidance up to date. As noted above some need to be reviewed and updated. Staff were nevertheless able to explain to us clearly the individual needs of each person living here, any risks they may face, and how these are managed. The routines in the home appeared to be flexible, and generally people tend to congregate in the main kitchen / dining room. Some disruption to peoples routines has been caused by building works to attached a self contained unit to the home. Some people were spending their time elsewhere in the home so they wouldnt be disturbed by the noise created. Meals form an important part of peoples daily routine and lifestyle, and are taken in a shared kitchen diner. Some people will take their meals separately due to their preferences and particular needs. Staff do not share mealtimes, but they will provide support and assistance when necessary. The dietary needs of each person are explained in their care plans, and there is a record kept of meals planned and provided. Where help and prompting is needed staff are able to explain the help they offer. Care Homes for Adults (18-65 years) Page 20 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each individual’s personal care and health care needs are generally well supported by systems that ensure privacy is respected and that health and welfare is monitored and maintained, however monitoring arrangement for some need to be tightened. Medication is not always safely managed. Evidence: The people living here have their personal and healthcare needs explained within their assessments. Each person has care plans relating to various health needs. These detail what each persons health care needs are, how they are to be met and which other professionals are involved in helping them. Their needs are supported and met, where appropriate, in private. Specialist support and advice has been sought and obtained where necessary, and multi-disciplinary input (such as that from the Speech and Language Therapist, community nurse, podiatrist and so on) is made available. One person whose care we looked at has seen their needs increase rapidly over the past six months. To ensure she is properly supported the staff team have arranged for healthcare professionals to provide guidance and arrange for specialist equipment to ensure her needs continue to be met here. For another person we found that their needs had greatly reduced and were generally being met well here. However, we could not find evidence of regular blood tests having been arranged. These are important as this person is at risk of medication toxicity. Also the guidance kept on file does not include all that currently Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: detailed by the National Institute for Clinical Excellence (NICE) particularly the specific advice in relation to older people. More generally, the registered manager, and other staff in the team, help the people living here to access local primary health and secondary treatment services. This is so people get the help and healthcare they need to keep well. With the exception of the case above, we found that the results of healthcare visits, screening, and routine monitoring are recorded within each persons care file. This can help ensure that staff follow any advice and guidance that has been made by the relevant professional and that people get prompt access to the care that they need. Linked to these health and personal care arrangements is the support given with medication. Due to their levels of need, service users are not able to administer their own medicines, and designated staff will help in this area. Staff at the home have had medication administration training (the safer handling of medication course). This has been supplemented by in-house guidance. The system used here includes a monitored dosage system (where the pharmacist dispenses medication in a four week supply of colour coded blister packs), as well as liquid form medicines and tablets supplied in the manufacturers original packaging. The medicines themselves are stored in a locked cupboard, however we found storage arrangements to be insecure. The lock on the cupboard used was broken, and it could be opened by simply inserting and turning objects such as a coin, knife or key for another lock. The cupboard could also be access by removing the drawer above the cupboard. Medicines requiring cold storage were also stored loosely in the fridge. We also saw that medicines were being potted up all at once, then administered to the people concerned after they were documented as having been given. We saw one person received their medication from a second member of staff. This is termed as secondary administration, as the medication is removed from its original container, and documented as administered by someone else. This practice can increase the likelihood of errors occurring. The medication administration records (MAR) that are used to document who has received which medication have been developed and compiled by staff in the home, rather than preprinted and supplied by the community pharmacist. We found that when some people had gone on holiday there had been a duplicated day for the same medicines on two separate administration records. It was also recorded for the same medicines that they had been administered twice by two separate staff (one on each separate MAR). We tried to see if an error had or had not occurred, but this could not be verified as the stock counts undertaken in the home did not indicate at what time of day they had been conducted, or if they were done before of after medicines have been administered. This means that for some medicines not in the monitored dosage system the person checking or auditing the stocks cannot be certain how many tablets should be present in the home. Care Homes for Adults (18-65 years) Page 22 of 34 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. Clear systems help protect people from neglect, abuse and self-harm. Evidence: A clear, written complaints procedure is available at the home. Because of peoples communication needs it is not possible for everyone to always make direct comments on the quality of care they receive or to be aware of or use the homes procedure. Staff have therefore to be mindful of each persons behaviour, gestures, and body language to gauge how they feel. The staff here have received training on adult safeguarding and abuse awareness matters. Both the care providers and the local councils adult protection procedures are available here for staff to refer to. There have been no complaints or safeguarding alerts made to us since the last inspection. Care Homes for Adults (18-65 years) Page 23 of 34 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. Ravenscroft provides a homely and comfortable environment, with adaptations available to meet peoples current and changing needs, but limited storage to safely keep the increasing amount of equipment needed. Evidence: Ravenscroft is a purpose built bungalow, that allows for easy access for people who are physically frail or disabled. It is domestic in style, and each persons bedroom has been personalised to suite their tastes. The home is clean throughout and there is good odour control. At the time of the inspection extensive building works were taking place to build a separate unit. This has caused some temporary disruption to the people living here. Some areas of the home have suffered from wear and tear, and areas including the kitchen and utility room need to be refurbished. Four wheelchairs were being stored in the corridor, presenting a trip hazard. Storage in the home is limited, but as building works are ongoing there is an opportunity now available to review and provide additional storage space for the home. Overall the bungalow provides a comfortable home, and the people living here appear relaxed and comfortable in their surroundings. Care Homes for Adults (18-65 years) Page 24 of 34 Care Homes for Adults (18-65 years) Page 25 of 34 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 people living here are supported by a well trained and partially qualified staff team, whose numbers are sufficient to meet each persons identified needs. Evidence: For new staff recruited here care providers have to carry out robust pre employment checks. This is to ensure unsuitable people are not employed here. We looked at the records for a sample of the staff recruited here since the last inspection. We found that suitable pre-employment checks, including the receipt of a Criminal Record Bureau Disclosure or POVA list check and two, or more, references have been obtained before they started duty. Overall staffing levels have been remained the same since we last inspected. At the time of the inspection, 8 out of the 13 support staff were qualified to NVQ level 2 in care [or higher]. Staff also receive regular training opportunities, and topics have included: - Fire Safety. - Moving and Handling. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: - Safer Handling of Medication. - Specialist medication training. - Food Hygiene. - Safegurading Adults. - Infection Control. - Deprivation of Liberty / Mental Capacity Act. Training is one of the topics discussed at each staff members supervision session. These are one to one meetings that are held between a staff member and manager to discuss their performance, training needs, personnel and personal matters. These occur on a regular basis, to allow staff to feel supported and informed about developments at the home, and actions are agreed where necessary. Care Homes for Adults (18-65 years) Page 27 of 34 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. Service users benefit from living in a generally well managed home, where quality and health and safety is regularly checked, but this doesnt always ensure the home is suitably free from hazards. Effective implementation of such systems can help ensure the service remains focused on the needs and safety of the people who live here. Evidence: Ravenscroft is overseen, on a part time basis, by the registered manager. She is supported by a deputy manager who works here full time. The registered manager is NVQ qualified in care and management. She has also attended a range of training to keep her knowledge and skills up to date. As well as ensuring her own knowledge and practice remains up to date, the registered manager undertakes a number of quality checks and audits to ensure the standard of care is up to current good practice levels. These include the use of questionnaire to seek the views of people who are related to or support the people living here. The homes owner also carries out periodic inspections, and the manager completes an annual self assessment document to review how well the service meets certain key standards. From these checks a plan of action is developed, with the aim of improving the quality of Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: service received by the people living here. Just as the quality of the care provided is checked, so are matters affecting health and safety. Therefore regular checks on the building are carried out, water and fridge / freezer temperatures are monitored, working practices that could present a risk are looked at, and safe ways of working (for instance by the use of lifting aids) introduced. The home is generally free from hazards to health and safety, but some were observed by us including wheelchairs stored in the corridor and unlocked storage of household chemicals. Also large amounts of builders waste materials have been piled up in the car park. The chemical information sheets obtained to inform staff of what to do if they have an accident with a chemical product are not all up to date. Also records for former members of staff were found stored in a cupboard to which all staff have access. Care Homes for Adults (18-65 years) Page 29 of 34 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 1 2 14(1)(a & b) The manager must obtain a 02/11/2007 social workers assessment in respect of prospective service users before they move to the home. This is so she is clear that the home can meet peoples needs and develop appropriate plans of care. Care Homes for Adults (18-65 years) Page 30 of 34 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 1 6 15 Each persons care plan must 30/10/2009 be kept under review and updated without undue delay This is so everyone is kept well informed about how each persons needs are to be met. 2 19 12 The registered manager 30/10/2009 must ensure that regular blood tests and general health checks are arranged with the relevant medical professionals (and evidence retained) for a service user at risk of medication toxicity (in line with current National Institute of Clinical Excellence (NICE) guidance). This is to ensure the health of service users is monitored and maintained. 3 20 13 Medication management 30/10/2009 Page 31 of 34 Care Homes for Adults (18-65 years) 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 arrangements must be reviewed to ensure there is: - safe and secure storage for all medicines. - accurate recording of medicines administered. - robust and clear stock checking and recording arrangements. - no secondary administration. - regular quality audits. This is so medicines are kept safe, and the likelihood of errors is minimised. 4 41 17 Confidential staff records (for 30/10/2009 former employees) need to be stored in the home so that they cannot be accessed by other staff. This is to ensure peoples confidences are maintained. 5 42 13 Health and safety practices 30/10/2009 must be reviewed to ensure that trip hazards (such as wheelchairs stored in the corridor and builders waste) are minimised and chemicals are safely stored. This is to ensure that the people living, working and visiting here are kept safe. Care Homes for Adults (18-65 years) Page 32 of 34 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 24 Worn kitchen and utility room cupboards should be replaced. Care Homes for Adults (18-65 years) Page 33 of 34 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. 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