Care Home: Roshini Care Home

What the care home does well The home is well run with a committed staff team. Comments from the postal surveys were positive with one resident saying they felt "comfortable in the home" and that the "staff look after me". Another resident commented that the home was a "nice place to live". Seven staff returned surveys and overall their responses were also positive. Staff said during the inspection visit that the team works well together and that the Manager was approachable and supportive. The home aims to meet the individual needs of each resident and is hoping in the future to open an independent unit at the back of the home. This would enable residents to work towards further independence and skills. What has improved since the last inspection? The home had no requirements made at the last visit in 2006. The staff team have continued to support the residents living in the home. What the care home could do better: The home must have a robust procedure in place for when new residents move into the home. An initial care plan and risk assessment must be developed to ensure the staff team are working to support the resident effectively and safely. A detailed preadmission assessment can form the basis of the initial care plan whilst the home continuously assesses the resident`s needs. All likely and/or potential risks must be clearly documented and reviewed to ensure all members of staff are aware, as much as possible, of the risks the resident could pose towards themselves or others. There must be a system in place for the medication to be checked and counted. This would ensure that any medication errors are quickly identified and addressed. Routinely checking medication is a way to monitor the running of the home and ensures the residents welfare is protected. We are confident that the Manager will address the above shortfalls and will be able to aim for excellent outcomes for the residents in the future. Key inspection report Care homes for adults (18-65 years) Name: Address: Roshini Care Home 25-26 Villiers Road Southall Middlesex UB1 3BS     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: Sarah Middleton     Date: 0 2 0 9 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: Roshini Care Home 25-26 Villiers Road Southall Middlesex UB1 3BS 02085740392 02085740392 roshini.care@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Satwinder Birk care home 9 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: 9 The registered person may provide the following category of service only: Care Home 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 Roshini is home to nine residents with mental health needs. The home is privately owned and managed and opened in September 2004. The home is situated on a residential street in Southall close to local shopping facilities, transport links and other community facilities. There is parking to the front of the home and a garden to the back of the home. The fees vary and range from £479.89-£660.00 per resident per week. 9 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: An unannounced visit was made on the 2nd September 2009. Before the inspection we looked at: Information we had received since the last visit on the 26th September 2006. The Annual Quality Assurance Assessment, (known as the AQAA). The AQAA gives the Care Quality Commission evidence to support what the home says it does well and gives them an opportunity to say what they feel they could do better and what their future plans are. Any changes to how the home is run and if there have been any complaints. The views of the residents and staff, through the completion of postal surveys. During the visit we: Talked with residents who live in the home, staff and the Registered Manager (who is the Owner and will be referred to in this report as the Manager). Looked at information Care Homes for Adults (18-65 years) Page 5 of 27 about the residents and viewed how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the residents they support. Looked around the home to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the Manager what we found. 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: 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 7 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 8 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. Assessments are carried out before and after admission to ensure the residents needs can be planned and met in the home. Evidence: We viewed the pre-admission assessment on a resident who had moved in a few years earlier. This had been completed and gave some information about the resident. The most recent resident to move in, who was coming to the end of their trial stay in the home, had less information written on their pre-admission assessment. We were informed that this particular resident had not wanted to contribute very much to the assessment process. The home obtains information about a prospective resident from the placing authority. This provides the home with some information about the residents needs and potential risks. We spoke with the Manager about obtaining as much information about a new resident before the decision is made for them to move in on a trial basis. One resident spoken with confirmed they had spent time visiting the home before making a decision to move in. We saw evidence that the home records the visits a Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: prospective resident makes to the home. This is good practice as it ensures the home has offered opportunities for visits and where appropriate overnight stays. The Manager explained that either she or a Senior member of staff would assess the prospective resident and that there would be a meeting at the end of the trial stay to ensure the home can meet their needs. There are no time restrictions for residents to live in the home. The Manager and staff team are aware that some residents will be able to move onto more independent living, whilst others will always need twenty-four hour support. We were satisfied that there is a good pre-admission process in place at the home. Care Homes for Adults (18-65 years) Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place for the majority of residents but need to also be developed and available for new residents. Residents receive support to make daily decisions about their lives. The health and safety of residents and others could be at risk due to the lack of risk assessments being in place. Evidence: We viewed two residents files. On one file we could see a detailed care plan that had been updated and recorded the health, social and personal care needs of the resident. We were informed that residents, if they want to, attend their reviews and are able to contribute to the review meeting. We discussed further ways the staff team might wish to involve residents views such as evidencing and recording their opinions on their care plan. The Manager agreed to amend the care plan so that this would be incorporated in the future. We viewed a sample of monthly summaries which are a Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: useful way to reflect and monitor how the resident has been over the past month. Areas such as their health needs are noted along with compliance of their care plan and times when they might have missed taking their medication. We also looked a a sample of daily records and these show good details about the resident and what they have done each day. We looked at another file and this was regarding a resident who had moved in twelve weeks ago on a trial basis. The home had not completed an initial care plan and were using the information given to them by the placing authority. Whilst it is acknowledged that the resident is staying on a trial basis, there must be a care plan and risk assessment based on information given to the home and information obtained during the weeks the new resident is settling into the home. We were informed that the staff team assess the resident during the trial period but there was no written evidence of this continuous assessment. We observed that residents can choose how they spend their time. One resident said they can spend time in their bedroom or with others. Residents are consulted about decisions that affect them. We were informed that resident meetings take place. Residents have an allocated member of staff to support them, they are known as a keyworker. One resident said they can meet with their keyworker when they have something to discuss. There were no risk assessments to view on the two files seen. One risk assessment dated 2007 was in relation to a day out and potential risks this could have posed. Having viewed information about one of the residents, from previous reports, and hearing about their needs from the staff team, we would expect to see detailed risk assessments that the resident could pose both to themselves and towards others. This shortfall was raised with the Manager and must be addressed for the safety and welfare of all the residents and others. Taking manageable risks is all part of living in a home in the community but the staff team must be confident that where possible the home has taken steps to assess identified risks. Care Homes for Adults (18-65 years) Page 12 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 to take part in activities both in the home and in the community. Residents are supported to maintain social relationships with families and friends. The rights of the residents are respected and promoted within the home. The home provides well balanced and varied meals for the residents. Evidence: Residents are encouraged to take part in the daily activities held in the home, such as bingo, reading newspapers and listening to music. One resident goes to work in a voluntary capacity. Whilst others access the community resources such as swimming and the cinema. Some residents spoken with said they mainly liked to watch Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: television, whilst others said they take part in whatever is offered to them. Residents, where possible, use public transport and some can go out without the support of staff. Residents come from a range of cultural backgrounds and can attend their preferred place of worship, such as the temple or church. Observations during the inspection visit showed that staff spoke to some residents in their preferred language and we were informed that some staff can speak various languages, such as, Punjabi, Hindi and Gujarati. We noted that the residents cultural needs had also been recorded on the care plan viewed. The home provides the occasional day trip and some residents go on holidays with their relatives. Residents are supported to maintain social relationships, such as regular contact with family and/or friends. One resident said they have a mobile phone and can contact family as and when they want to. The home had held an award day and relatives had been invited along to see residents pick up various awards. This also gave relatives an opportunity to meet other relatives, who they might not usually see. Residents spoken with confirmed they are able to lock their bedrooms for privacy. Those asked also said they received their own personal mail. Staff were seen to interact positively with residents throughout the inspection visit. Responses from the resident surveys said that staff treat them well and listen to what they have to say. The home has a cook who provides the meals at lunchtime four days a week. The staff team provide the other meals. Residents have a small kitchen they can use for drinks and breakfasts. The home records the meals residents have eaten in the home. This is important so that staff can monitor the meals eaten, as there are three residents with diabetes. The meals are varied providing residents with a well balanced diet. Those residents asked said they enjoyed the food in the home. The Manager informed us that where a resident is ready to move onto more independent living, then staff would develop a cooking programme to begin assessing how well the resident can make meals. Staff would then offer support and guidance to the resident so that they are able to cook for themselves. Care Homes for Adults (18-65 years) Page 14 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. Residents are supported to access healthcare resources. Arrangements for the counting and checking medication could be improved to ensure the welfare of the residents are promoted. Evidence: We were informed that overall most of the residents manage their own personal care. Staff are aware of those residents who need additional support and guidance to manage their personal care. One of the care plans viewed gave clear guidance for staff to know how to support the resident in this area. Female residents are only supported with their personal care by female members of staff. The staff team is a mix of genders and so this meets the needs of the mixed gender of residents currently living in the home. The Manager had just developed a form to record when a resident had seen an optician or dentist. We discussed with the Manager the benefit of having all health appointments recorded on a form so that it is easy to monitor any changes in health needs and staff can then easily see how often residents are seeing health Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: professionals. The Manager agreed that this could be further developed and will look at this being introduced. All residents have a GP and can see other specialist professionals. One resident had sometimes refused to see a Podiatrist and this had been an issue, as their nails had become long. We were informed that eventually the Podiatrist was able to cut their nails. The Manager is aware that staff must not cut the toenails of residents without training and that those residents with diabetes need their nails cut only by a professional. Any issues with residents refusing to attend routine health appointments need to be recorded on their care plans. We were informed that staff do not administer medication until they have received training. New staff also spend time watching staff handle and administer medication. Medication is locked in secure and safe cabinets. The Manager informed us that there had been some problems with the Pharmacist issuing the home with Medication Administration records (known as MARS records). Therefore the ones we viewed were written out by staff on the homes own MARS Records. These had all the necessary details on them except they did not have a section for staff to write the quantity of medication in the home at the time of starting the MARS Record. Therefore we could not carry out a count on the medication to see if all was in order. This was discussed with the Manager and senior member of staff. We were shown a system the home has to record medication that needs to be ordered and what is in the home at the time of ordering but this is not a robust system that would identify if any medication errors had occurred. In order for the Manager to be confident that the homes medication systems protect the welfare of the residents, regular counts and checks on all medication must be in place. This would also include checks if there were any residents who were self-medicating. At the time of the inspection visit we were informed there were no residents self-medicating. The Manager was aware that should a resident be able to manage their own medication, then this would need to be carefully managed and risk assessed. Care Homes for Adults (18-65 years) Page 16 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. Appropriate procedures are in place for the management of complaints. Guidance and training is in place for staff regarding recognising and reporting abuse. Systems are in place to safeguard residents finances. Evidence: The home has a complaints procedure in place and we viewed the complaints form that is used to record any complaints. There had been no complaints in the home. Those residents asked said they would talk to the Manager if they had any concerns and that they felt they would be listened to. The home has its own policy on adult abuse and has the Local Authoritys policy and guidance. The Manager was aware of obtaining the updated No Secrets document once it is published by the Department of Health. One member of staff said they would talk to the Manager if they had any concerns and all of the seven surveys returned by staff confirmed that they knew what to do if they had any concerns about a resident. Staff receive training and information on adult abuse. This should be offered on an ongoing basis. We counted and checked one residents personal money. This was correct at the time of the inspection. Staff obtain receipts for any financial transactions made using Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: residents money. Three residents have their relatives handle and manage their finances. 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 well maintained, safe and welcoming. Evidence: The home is situated on a quiet road that has good local amenities, such as shops and public transport. The home was being painted in the communal hallway on the day of the inspection. The home is well maintained with the Manager updating the home on a regular basis. The home has had new windows fitted and has a new fridge/freezer. There are future plans to update the first floor bathroom. The home has a part-time cleaner and the home was clean and comfortable. Care Homes for Adults (18-65 years) Page 19 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. Residents are supported by an effective and experienced staff team. The staff receive relevant training and are supported by supervision sessions. This enables them to work to a high standard and deliver good care. There is a robust recruitment procedure in place to protect the residents. Evidence: The staff team is stable with no current staff vacancies. Staff have a mix of experience, skills and knowledge. Those asked said the team work well together and that communication is good. Residents spoken with during the visit said they could talk to the staff team and that they were helpful. Staff confirmed that staff meetings take place. The Manager supports and encourages staff to complete an NVQ qualification. Two staff are currently studying for NVQ level 4. Staff confirmed in the postal surveys that they receive support from the Manager and there are enough staff working in the home at any one time. We viewed the rota and saw that approximately once a week the Manager works a shift alongside a member of staff. This is seen as good practice as this enables the Manager to spend time with Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: residents and see what they do with their time and see how staff work and support the residents. Two members of staff work on each shift and at night there is a sleeping-in and waking night member of staff. We viewed two staff employment files. Both had all the required information needed to ensure the home follows appropriate recruitment checks. All staff have a Criminal Record Bureau check carried out and references are obtained. Each member of staff has access to training and new staff go through an in-house induction. Evidence was seen of this induction and demonstrates that new staff are informed about how to work in the home. Staff surveys also confirmed that staff receive training. The Manager informed us that she is keen to ensure staff receive training on diabetes and Mental Health. We also discussed the importance of ensuring staff have an awareness of dementia, as residents who become older could be diagnosed with this condition. Each member of staff has an individual training record and there is an overall training plan for the whole staff team which ensures the Manager can plan future training. Training is accessed from an external training company, the Local Authority and in house workshops and training. We viewed a sample of supervision notes and saw that this form of support is offered on a regular basis. Those staff asked stated that they had one to one supervision on an ongoing basis. Care Homes for Adults (18-65 years) Page 21 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 Manager is providing clear leadership in the home and provides support to both the residents and staff team. The views of the residents are listened to and acted on. Regular servicing and maintenance checks are in place to ensure the home is safe to live and work in. Evidence: The Manager, who is the Owner of the home, has experience of running care homes and has obtained the Registered Managers Award. The Manager was receptive to the inspection process and was committed to making any necessary improvements in order to raise the standards within the home. The home had not been inspected for almost three years and during this time the Manager had continued to reflect on the running of the home and look at ways to make improvements for the benefit of the residents. Staff spoke positively about the Manager and residents felt they would be able to talk to her if they had an issue. A staff survey said their ideas and problems Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: are listened to by the Manager. The Manager currently supervises all the staff but will be looking at sharing this responsibility in the future. The home has various ways it reviews the quality of the care being provided in the home. Annual surveys are given to residents, relatives and professionals. Responses are looked at and acted on. Resident meetings are held and the Manager has a visible presence in the home and meets with residents or staff as and when needed. The Manager informed us that she also has a development plan and business plan. We talked with the Manager about the benefits of developing a short report that is available for the residents and inspection that shows the work the home has done to make improvements over the year and future aims and objectives. The Manager agreed to act on this as it is another way of bringing together the main things that have occurred in the home and areas still to be addressed. Servicing and maintenance agreements were in place for facilities and equipment. We viewed a sample of checks and found these to be all up to date. Water temperatures had not been taken on a regular basis. Whilst we acknowledge that the residents are not older people and the home has thermostatic controls fitted to the water supplies, it is good practice to keep a check on the water to ensure there are no faults with the system. The Manager agreed to action this and we were confident that this will be part of the ongoing maintenance checks that are carried out in the home. Fire drills had been held on a weekly basis, but had not recorded the time or who attended these drills. This was raised with the Manager who agreed to alter the record keeping of these drills. A fire risk assessment was completed in April 2009. We advised the Manager, as they have not been visited by the London Fire and Emergency Authority for some years, that she might wish to check with this organisation for any updates that have occurred, such as new fire Regulations. This ensures that the homes risk assessments and procedures are in line with current good practice and legislation. Care Homes for Adults (18-65 years) Page 23 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 24 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 1 6 15 Residents individual needs must be assessed and recorded onto a care plan. To ensure the staff team know how to effectively and safely support a resident, a care plan must be in place. 30/09/2009 2 9 13 Potential and identified risks 09/10/2009 must be recorded onto a risk assessment. To ensure the health and safety of the resident and others is protected, risk assessments must be in place. 3 20 13 There must be a robust 11/09/2009 system in place to count and check the medication that is in the home. To ensure the home protects the health and safety of the residents, there must be regular counts and checks of all medication in the home. Care Homes for Adults (18-65 years) Page 25 of 27 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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