Care Home: Saxon Lodge

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Saxon Lodge 20 Smith Street Shoeburyness Essex SS3 9AL The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Saxon Lodge 20 Smith Street Shoeburyness Essex SS3 9AL 01702295001 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : AnneBoulton@southend.gov.uk Southend on Sea Borough Council care home 13 Number of places (if applicable): Under 65 Over 65 13 13 learning disability Additional conditions: Care and accommodation to be provided to no more than 13 persons. Care and accommodation to be provided to persons between the age of 18 and 65 with a learning disability (LD). Care and accommodation to be provided to persons aged over 65 years who have a learning disability and who have resided in the home prior to their 65th birthday (LD(E)). Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Saxon Lodge is owned and managed by Southend On Sea Borough Council. It is a purpose built care home that has plenty of room for people. There are two lounges, a quiet room and a light and airy dining room. The home is on two floors but there is no lift, so some bedrooms are on the ground floor for people. There is outside space for people to enjoy. There is a small car parking area at the back of the building, and visitors can also park in the street nearby. Everyone who lives at the home has their own room, and nobody has to share. Thirteen people can live at the home. At the moment only ten people live there. Other people sometimes stay there for respite care. Saxon Lodge is near to the local shops and a beach in Shoeburyness. Other facilities and the main town of Southend are not far away. A railway station and bus links are also very close by. Information about the home is made available to people in the Statement of Purpose and Service Users Guide. The current charge paid by residents is from £69.90 to108.10 per week. The balance of fees is paid by the funding authority. People pay for their own are made for chiropody treatment, hairdressing, toiletries and transport. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home When we went to Saxon Lodge, we did not tell people that we were coming. This was so we could see the home as it usually is. Before we went we sent surveys to people living at the home, their families and staff so that they could tell us about what it is like there. A lot of people sent surveys back to us and this gave us good information. Also before we went, we asked the manager to tell us about the home. We asked them to fill in a form to let us know how the home make sure that they keep up good standards in looking after people, and making sure that the home is safe. When we went to Saxon Lodge we spent time with people living at the home, so that where they were able they could tell us about what it was like to live there. We also spoke to the manager, some staff and a relative. We looked around the building to see if it was nice for people to live in. We spent some time in the office looking at different paperwork that would let us see how peoples care is arranged and how the home is managed. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well Everyone told us that it is good to live or stay at Saxon Lodge. The staff at the home have all worked there for some time. They know the people living there very well, and can look after them in the ways that they are familiar with and prefer. The manager is also very experienced, so makes sure that the home is run safely and well. People living at Saxon Lodge are able to decide what they want to do. Staff help them to make choices. Staff at the home help people to lead interesting lives. People can go to day care, take part in different activities and go out and about in the local community. People can stay in touch with their families and have visitors whenever they wish. Care Homes for Adults (18-65 years) Page 8 of 30 Staff at the home make sure that peoples health is looked after. They support people in seeing doctors or other professionals needed to help them. What has got better from the last inspection Some parts of the home have been redecorated so that it stays nice for people. To help people know about the home before they go and stay there, a new information pack has been made. This has pictures to make it easier for people to understand. People living at Saxon Lodge have been Care Homes for Adults (18-65 years) Page 9 of 30 involved in making new care plans about themselves. These are easy to understand, and tell people everything they need to know in order to give them good individual care. Staff working at Saxon Lodge have been on training courses to keep them up to date. What the care home could do better The home has a minibus to take people out, but at the moment not enough staff are able to drive this, and staff are not able to use their own cars. People told us that this is restricting residents lives, and that they cannot go out as much as they used to. People living at Saxon Lodge have also not been able to go away on holiday. This is because staff are no longer able to go with them, and their individual needs make it difficult for them to be supported by staff who do not know them. Care Homes for Adults (18-65 years) Page 10 of 30 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 Vicky Dutton CQC CPC1 Capital Park Fulbourn Cambridge CB21 5XE Tel: 01223 771370 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 11 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People considering staying at Saxon Lodge will be involved in assessments and have good information to help them make decisions Evidence: We saw that there was a Statement of Purpose and Service Users Guide in place which had both been reviewed in April this year. This ensures that people have access to up to date information. The service users guide provided good information for people. Since the previous inspection the home have also developed a further document, Saxon Lodge Picture Guide for Respite Service Users. This provides people with basic information in an easy read format and includes pictures of the home and staff. On surveys those who could respond felt that they had been asked about going to the home and had been given information. Everyone living at Saxon Lodge has lived there for some time and there have been no permanent admissions since the previous inspection. The manager is aware of appropriate admissions processes and these are highlighted in the service users guide. The Annual Quality Assurance Assessment (AQAA) completed by the manager said, We have an in depth admission procedure involving the service user, family, carer, Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: advocate and other professionals, such as OT, if needed. People who use the home for respite care have been using Saxon Lodge for short stays for a long time. Where one person had recently been admitted as an emergency we saw that appropriate information and a Social Services assessment and care plan was in place. Care Homes for Adults (18-65 years) Page 14 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People can feel confident that the home will be responsive to their changing needs and respect their choices. Evidence: Each person has a file in place containing care plans, risk assessments, ongoing care information, and other documentation. These provide staff with good information to enable them to care for people in a way that meets their individual needs and preferences. The home have also now nearly completed developing person centered plans for everyone. These folders have been developed involving the resident and their families. They provide a colorful and detailed picture of the person, their history, likes, dislikes, preferences and routines. The files would enable any staff to deliver good person centered and individualised care. During the day people made choices about where they went and what they did. Peoples right to make choices is recognised and encouraged. Examples of this were given during the day, for example, choosing not to go to day care, when to get up and so on. Regular residents meetings are held, and everyone living at Saxon Lodge has an Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: advocate who meets with them regularly. This provides further opportunities for people to express their choices and preferences. Information was available on a Peoples Parliament self advocacy group, but no one at the home currently chooses to be involved in this. Where people make choices that may not be in their best interests, for example refusing care, this is clearly documented, and actions needed by staff highlighted in care planning. Alongside this management are proactive in seeking assessments from other professionals, and ensuring peoples rights are recognised and protected through assessments under the Mental Capacity Act and Deprivation of Liberties safeguards. Care files contained risk assessments relevant to individual needs. Actions and processes for managing these risks was in place. Care Homes for Adults (18-65 years) Page 16 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People enjoy a lifestyle that suits their needs and preferences. Evidence: People are encouraged to take part in a variety of different activities and recreation both in and outside the home. Some people attend regular formal day care on some days each week. Others choose to stay at home. Personal files, talking to people and other information showed that people enjoy going shopping, eating out, attending a local club, swimming, music and dancing, gardening and other activities according to their personal preferences. One person said, I like football, bowling and ice cream. There was evidence around the home of activities undertaken by people. This included photographs and examples of artwork. During the day people went where they wished in the home and followed their own interests such as music and DVDs. People are supported in using, and being part of the local community. For example during the day one person went to the local shops and another the local hairdresser. A number of people living at Saxon Lodge are aging, and some are developing care needs Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: associated with dementia. Management recognise this and are looking into different activities that may help to stimulate and maintain their abilities for as long as possible. Some staff are soon to attend a course on activities for older people. Information was available on a notice board about different clubs and activities that are available locally. Staff keep an eye on local websites to see if any events or other opportunities are coming up that would interest residents. On surveys five relatives felt that the home always supported people to live the life they chose, and two that they usually did. The home has a minibus available to facilitate community access. However a member of staff said that there were not enough trained drivers for this. A big issue for people which was raised on surveys by relatives and staff, is that staff are no longer allowed to use their cars to take individual residents out and about. People said, More service users are staying at home during the day. We need to provide more activities for them. Staff are not allowed to use their cars to take service users out. Taxis are very expensive, and not all service users would be able to use the bus. This has effected the service users quality of life, Let staff use their cars to take residents out. Residents are being restricted and loosing out on what they love doing, and Staff are not allowed to take residents out in their cars now which is silly. They are all adults and have been doing it for years. The residents now miss out which is not fair. Staff are also no longer allowed to escort and support residents on holidays. As many people living in the home have complex and/or communication needs families are not happy for them to go away supported by people they do not know. People are not therefore able to have a holiday away from the home. The manager said that they try and compensate for this by organising day trips to different places. Most people living at Saxon Lodge have families that are involved with their ongoing care. People can welcome their friends or family at any time and their involvement is welcomed. The home uses a four weekly rotating menu, which staff said was changed frequently according to the season and residents choices. Menus viewed and records of what people had eaten showed that a range of different foods are offered. People are encouraged to make individual choices through the use of pictures, and from items being nicely displayed for them to choose from. We saw that mealtimes were flexible according to peoples routines and wishes. People had their lunch when they wished. Where possible they were supported in getting their own lunch. Where people needed assistance with eating this was done in a caring and sensitive manner. Care Homes for Adults (18-65 years) Page 18 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People receive good personal and health care support to meet their individual needs. Evidence: People living at Saxon Lodge benefit from being looked after by a team of staff who have all worked at the home for some time. Staff know the residents very well and support them in maintaining their preferred routines and style. This is supported by a strong key worker system and good care planning. Relatives felt that residents receive good care: My [relative] is looked after very well and is very happy where they are, Everyone is very good to X. X needs specialist care so it takes a little time for people to get used to their needs. All the staff in Saxon Lodge are very good with them, I particularly like the personalisation in support given to all residents, and, The love and care my [relative] receives in Saxon Lodge could not be any better were some of the comments made. Staff said: We provide for individual needs and support with excellent personal care, We promote a high standard of care which in turn actively promotes all aspects of a service users life creating security and safety also, We deliver high standards of care, and We put the service user first Records viewed showed that people access good health care support to meet their varied needs. A range of different professionals are involved in individual residents Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: ongoing care including doctors, chiropodist, optician, dentist pharmacist, community psychiatric team, and the behavioural team. Health checks and preventative screening are encouraged but the manager reported that this can be difficult to achieve as people often refuse. Peoples health is monitored. Because the home is small and the residents known well by staff, any concerns or changes are quickly picked up and appropriate actions taken. Peoples weight is also monitored so any changes can be noted and actions taken as necessary. No one living at Saxon Lodge is able to manage their own medication. We looked at systems in place to ensure that this aspect of their care is managed safely. We saw that each resident has their own medication folder in place with a photograph, any relevant protocols and other information. No errors or shortfalls were noted in the system, and good processes were in place such as daily auditing. The manager was however advised of practice issues to address. Any handwritten entries on peoples medication sheets should be checked and signed by a second member of staff to verify instructions, quantities and so on. To provide a good audit trail any boxed/bottled medication should be dated on commencement. A training matrix, discussion and staff records showed that staff have received training in administering medication. The manager said that the pharmacist also conducts some staff training, and that their competence is periodically monitored. Care Homes for Adults (18-65 years) Page 20 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are cared for safely through procedure and practice in the home. Evidence: The Local Authority that own and manage Saxon Lodge have a comprehensive complaints process in place, and a leaflet was available explaining this. There was no easy read or symbol version available that would assist residents in understanding the complaints process. The Picture Guide for Saxon Lodge said We have a complaints procedure that staff, an advocate or your family can support you with. No complaints have been made and recorded at the home, or made to us (CQC) since the previous inspection. On surveys people living at Saxon Lodge said that they knew who to talk to if they were not happy. Those who were able said that they knew how to make a complaint. Relatives also said that they knew how to raise concerns, and felt that staff would react appropriately. One relative said, I have not had a need to raise any concerns. However staff efficiency leads me to believe they would respond appropriately. It would be a strange inconsistency if they didnt. Staff spoken with and on surveys were aware of the complaints process and of what to do if people had concerns. One said, I would give them a comments, compliments and complaints leaflet which explains clearly what to do. I would help fill out forms on peoples behalf if they needed help and pass on the form to the relevant department as per policy and procedure. There are clear and good safeguarding procedures and guidelines in place and available to staff. A training matrix showed that staff have received training in Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: safeguarding adults. Since the previous inspection management have used the safeguarding system appropriately to manage concerns. Care plans viewed recognised individuals behavioural needs and gave staff clear guidelines for managing these. Where appropriate we saw that the behaviour therapy team had been involved. However staff have not received training in managing challenging behaviour that might assist their knowledge and practice. Care Homes for Adults (18-65 years) Page 22 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a pleasant home. Evidence: Saxon lodge provides spacious and comfortable communal accommodation for people. Bedrooms and communal areas are available on both the ground and first floors. Outdoor space is available for people to enjoy. The home is set within the local community with public transport and other facilities close by. The manager said that since the previous inspection internal decoration has taken place, with corridor areas and some bedrooms having been redecorated. The outside of the premises could however do with some attention. Fencing is broken, paintwork deteriorating, and an area of garden not currently used by residents overgrown. Everyone has their own room. Although these are quite small, and one person commented about this, saying there was not much room to dance, all rooms were homely and people had personalised their individual space. At the site visit the home appeared clean and there were no offensive odours. A housekeeper is employed and works every morning. A suitable laundry area is available. Training records showed that most staff have undertaken training in infection control. For some staff this was some time ago. The manager said that update training was planned. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are looked after by caring and well trained staff. Evidence: During the day we saw that staff had a very good understanding of peoples needs, and worked with them in a kind, caring and friendly manner. Permanent staff at the home have all worked there for a number of years and know the residents very well. A member of staff said, The whole care team are very supportive. We are lucky that the care team is also diverse so bring a lot of knowledge. People felt that staff have the right skills to do their job. A resident said, Carers can understand what I am trying to communicate. Relatives said, As far as I have seen carers are very capable of looking after these people, and, I believe they are fantastic carers as they are extremely kind to my [relative.] I believe they have the right skills. The home have achieved a high level of staff attaining National Vocational Qualifications (NVQ) in care. Out of 18 permanent relief or bank staff from assistant officer to care assistant, 17 have achieved and NVQ, many at level three. The previous inspection identified that the recruitment of staff was carried out to a good standard so that residents were safeguarded. No new staff have been recruited since the previous inspection but staff files viewed were well organised and showed that all appropriate checks had been undertaken. The home currently has some vacancies for care staff, but as the home is planned to be closed these have not been Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: recruited to. This means that agency staff are used at the home. The AQAA identified that in the three months prior to the AQAA being completed 97 shifts had been covered by agency staff. The manager said that the same core group of agency staff are normally used to provide consistency for people. They also demonstrated good practice in confirming that agency staff were who they said and had been safely recruited. Files showed that a good induction programme was in place. Staff have regular supervision and detailed annual appraisals. A member of staff felt that what the home did well was, Give good training and support staff. Although some staff on surveys felt that training could be bettered, records viewed showed that staff training is ongoing and seeks to meet the changing needs of residents and changing legislation. For example plans for staff to attend courses in the nutritional needs of the elderly and dementia care. Some staff have attended training in the Mental Capacity act and Deprivation of Liberties and further training is planned. Some staff have attended user led training, Learn from Me. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a safe and well managed home where they are encouraged to have their say. Evidence: Saxon Lodge benefits from having an experienced and competent manager in post. They are qualified, and since the previous inspection have completed their Registered Managers award. This is a recognised qualification for people managing care homes. Relatives said, I appreciate that all managerial staff have their fingers on the button and are aware of the needs of each and every resident, and, Saxon Lodge is very well run. There are strategies in place to monitor the quality of the service. A quality assurance exercise using questionnaires was undertaken last year. The action plan arising from this was sent in to us (CQC) in November following this exercise. It was detailed and showed that peoples views had been listened to. People have regular opportunities to comment on the service through residents meetings, discussions with their advocates and one to one conversations. As is required by Regulation, a monthly visit is carried out to the home by a senior person in the organisation. This is to ensure that the home Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: is complying with standards. These visits include talking to people living in the home. Other checks and audits such as medication audits and audits of finances contribute to the overall monitoring of the home. No health and safety issues were highlighted during the site visit. The AQAA identified that systems and services are checked and maintained on a regular basis. The staff training matrix showed that staff training in core areas such as moving and handling, food hygiene and first aid is ongoing with updates planned over the coming year. Fire records viewed were well maintained and a fire risk assessment was in place. A recent fire service visit in February this year had highlighted no concerns. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 22 23 To assist peoples understanding the homes complaints procedure should be available in an easy read format. So that staff have good skills in assisting people, training in managing challenging behaviour should be offered. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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