Care Home: Tager Centre

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What the care home does well Service users benefit from a well trained and dedicated staff team. The service is now well managed and improvements have been beneficial to service users. Service users benefit from a purpose built home where their needs have influenced the design and layout of the building. What has improved since the last inspection? Not applicable as this was the first inspection following registration What the care home could do better: Ensure that the current management arrangements are supported by existing systems such as proprietor visits. Enhance the living environment according to individual service users needs. Further support service users to be involved with the running of the home. Ensure that all staff complete documentation appropriately and accurately to present a comprehensive record of the service provided to service users. Key inspection report Care homes for adults (18-65 years) Name: Address: Tager Centre Nine Mile Ride Ravenswood Village Crowthorne Berkshire RG45 6BQ     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: Sally Newman     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Tager Centre Nine Mile Ride Ravenswood Village Crowthorne Berkshire RG45 6BQ 02033013621 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Vernon.Ambris@norwood.org.uk Norwood Ravenswood Ltd Trading as Norwood Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Tager Centre is part of the Norwood organisation based at the Ravenswood Village nr Crowthorne, Berkshire. The home has been newly built and established to accommodate up to sixteen service users aged between 18 and 65 in units of 4. The home accommodates service users with autism who may also have severe communication difficulties and behaviour that challenges the service. The home Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 Brief description of the care home provides 24-hour staff support. Fees currently range from GBP 67,060 to GBP 259,333 per annum. The fees do not include the cost of chiropody, hairdressing and toiletries. 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 peterchart Poor Adequate Good Excellent How we did our inspection: This service has been rated a 2 star good service. This was the first inspection of the service since it was first registered in January 2009. The inspection was conducted over the course of 3 days and included a visit to the service of 7 hours duration. Time was spent in discussion with the temporary manager, their assistant and two members of staff were spoken to in private. In addition, the Business Manager responsible for the home spent some time explaining the background to the current situation. Observations of activities within the home were conducted and other staff and service users were spoken to briefly. Due to the complex communication needs of the current service users it was not possible to obtain and comprehensive account from any individual about what life was like living in the home. Some communal areas were seen and a range of documentation was examined. Information provided by the service prior to the visit has been used in the evaluation of outcomes for service users. Care Homes for Adults (18-65 years) Page 6 of 30 All outcome areas have been judged as good. These ratings have been applied because of the clear and substantial improvements that have been made to the home by the appointed temporary manager since May 2009. This manager has been assisted by a senior member of staff well known to her and the support of the current staff team has ensured that the necessary changes have been successful. All indications are that this service will continue to improve and will strive to provide the highest quality of care for the service users. It was noted that the difficult situation that the service was going through, with lack of clear management direction, was not noticed as early as it might have been due to extensive changes to the senior management team and to the lack of proprietor visits. No recommendations or requirements have been made as a result of this inspection. The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, cultural and racial needs. No complaints have been received by the Commission about this service since the last inspection. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 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 9 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. Prospective service users and their representatives are provided with appropriate information and have their needs thoroughly assessed prior to a place being offered. Moving into the home is well managed according to individual needs and all service users are provided with a contract. Evidence: Evidence was provided from examination of documentation, from information provided by the service prior to the visit and from discussion with the temporary manager and staff. All prospective service users and their representatives are provided with a range of information including the Statement of Purpose and a Service Users guide. It was noted that the Statement of Purpose required some updating to take account of staff members who had left the home. Transition plans are implemented that includes a comprehensive assessment of needs and details the process for individual arrangements for moving into the home. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: All service users are provided with a copy of their contract. Care Homes for Adults (18-65 years) Page 11 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. Individual service users are as fully involved in decisions about their lives as possible and are supported to play an active role in the care and support they receive. Evidence: Information was obtained from examination of 4 plans of care and associated documentation, from information provided by the service prior to the visit, from discussion with the temporary manager and staff and from observations made throughout the home. It was apparent from discussion that plans of care had been transferred from previous services when individuals moved into the home with little change or updating. The temporary manager has been overseeing the home since the end of May and in this time all plans of care have been reviewed, reorganised and updating of all essential information such as risk assessments has been undertaken. However, it was acknowledged that this work was still ongoing and that standards of documentation still required significant improvement. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Staff spoken to were much happier with the changes that had been implemented since the temporary managers appointment and the consistency of working in smaller teams was already proving to be beneficial for service users. Examples were given where individual service users were displaying a significant reduction in the incidence of challenging behaviours. There is now a clear key worker system in place and discussion with staff provided sound evidence that this role was clearly understood in relation to their responsibilities for ongoing assessment of need, completion of documentation and attendance at reviews. Service users are encouraged and supported to fully participate in the running of the home and in the wider organisation around the village. Service user meetings had met with a mixed response and alternative formats were being explored with a view to more successfully engaging individuals with expressing their views. One service user had been supported and provided with preparation to be involved in the recruitment of staff. Information was obtained from examination of 4 plans of care and associated documentation, from information provided by the service prior to the visit, from discussion with the temporary manager and staff and from observations made throughout the home. It was apparent from discussion that plans of care had been transferred from previous services when individuals moved into the home with little change or updating. The temporary manager has been overseeing the home since the end of May and in this time all plans of care have been reviewed, reorganised and updating of all essential information such as risk assessments has been undertaken. However, it was acknowledged that this work was still ongoing and that standards of documentation still required significant improvement. Staff spoken to were much happier with the changes that had been implemented since the temporary managers appointment and the consistency of working in smaller teams was already proving to be beneficial for service users. Examples were given where individual service users were displaying a significant reduction in the incidence of challenging behaviours. There is now a clear key worker system in place and discussion with staff provided Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: sound evidence that this role was clearly understood in relation to their responsibilities for ongoing assessment of need, completion of documentation and attendance at reviews. Service users are encouraged and supported to fully participate in the running of the home and in the wider organisation around the village. Service user meetings had met with a mixed response and alternative formats were being explored with a view to more successfully engaging individuals with expressing their views. One service user had been supported and provided with preparation to be involved in the recruitment of staff. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who use the service are supported to make choices about their lifestyle and are encouraged to develop their life skills. Social, educational, cultural and recreational activities are provided and offer individual choice with a view to meeting aspirations and expectations. Evidence: Evidence obtained included information provided prior to the visit, a range of documentation maintained within the home, together with discussions with the temporary manager and staff. Prior to the appointment of the temporary manager there is little evidence to support that significant progression with individual service users had taken place. Staff were working across all four units undermining the process of staff and service users really getting to know each other. This had the effect of the service focussing on maintaining Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: previous activity timetables and managing challenging behaviours as they arose. Since the end of May the reorganisation of staff into 4 teams linked to the units has resulted in staff being able to focus on individual needs and aspirations. It is acknowledged that these changes are still at an early stage but there is strong evidence that this will continue to strengthen and provide better outcomes for service users. One service user had successfully applied for a part time kitchen assistant post and was being paid for this work. During the course of the inspection staff were obtaining money for individual service users to carry out a range of activities including shopping and eating out. Of those staff spoken to, obtaining money on behalf of service users had proved so problematic prior to the current manager coming to the home that outings had been extremely restricted. The kitchen and food preparation areas were seen and were clean and well organised. The main kitchen is of an industrial style and currently all main meals are prepared here and transferred to the units in heated trolleys. A recent environmental food safety inspection resulted in a 4 star rating which is very good. There are plans to review how the evening meal is prepared as there are kitchen facilities within the units where service users can be supported to prepare their own food. These plans are ongoing and will involve some reorganisation of the available space within some units. It was apparent from those plans of care seen that food preferences are recorded and any specific dietary requirements are clearly documented. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of service users are met. The arrangements for medication are improving in order to ensure the protection of service users. Evidence: The health and personal care needs of service users are documented in their plans of care. The range of health care professionals called upon to assist with meeting individual health care needs was provided within information made available by the service prior to the visit and included a wide range of health care professionals. The home utilises the services of the onsite Psychology team to assess and implement specific guidelines for staff. This information was in evidence from examination of 4 plans of care seen. The plans detailed individual needs and recorded most health care contacts. The medication storage facilities were seen in the form of locked metal cabinets. An audit of the medication system was not undertaken. Discussion with the temporary manager indicated that prior to her appointment no comprehensive or robust administration system had been implemented. This had resulted in wide spread confusion on the part of staff where minor errors in recording had taken place. The Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: organisation had commissioned a thorough audit of the arrangements for medication within the home and this had been undertaken by a highly experienced manager from another home in the village. The report was extensive and very detailed. There were plans to completely review the current system of centralised storage and possibly replace this with individual locked cabinets within individual service users bedrooms. It was hoped that this would support a more person centred approach to care and would enable service users to be more actively involved with their medication. All staff undertake medication training and are subjected to tests of their competence within the home. Staff spoken to confirmed that they had received training. In view of the problems encountered by the home in relation to the lack of systems for the administration of medication staff were being retrained in the newly implemented procedures. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that their views and concerns will be listened to and acted upon and that they are protected from abuse and neglect. Evidence: Information provided by the service prior to the visit confirmed that no complaints had been made about the service since its registration. The Commission has received no complaints or concerns about the service. There is a robust complaints procedure that is made known to the representatives of service users and is available to service users in a range of formats to meet their particular communication needs. Pictorial formats were in evidence within those plans of care seen. There are plans to make these formats more individual to meet specific communication needs. The temporary manager confirmed that all staff had received instruction in the safeguarding of adults. This was confirmed by the two staff spoken to in private who demonstrated a sound understanding of the principles of safeguarding and the potential for abuse. The inter-agency policy on safeguarding adults was available in the home and the temporary manager was clear about the action that needed to be taken should an allegation or suspicion of abuse come to her attention. The village as a whole has now removed the previous internal panel, which was set up to decide if concerns expressed by staff or managers was sufficiently serious to make a referral to Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: the Local Authority safeguarding service. This was confirmed by the business manager spoken to during the course of the inspection and the temporary manager confirmed that it was her understanding that as manager she could make a referral direct to Social Services if she felt that was appropriate. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well maintained and comfortable environment that is safe, clean and hygienic. Evidence: The building has been purpose built and opened in January 2009. Currently most areas are still rather bare and stark. Plans are in place to provide more homely fittings such as curtains and pictures. One area has been personalised with carpeting, curtains and frosted glass to an outside door to provide privacy and already feels more homely and comfortable. All service users have their own rooms and each has a private outdoor space and en suite facilities. Now that key workers have been allocated to individual service users plans for incorporating enhancements to the bedrooms based upon individual need and preferences can get underway. Each of the four units has a dining room and lounge. Some pictures and curtains have been purchased to soften these areas and further purchases are planned. There are bathrooms and separate toilets situated in each unit and a central office is located in the middle of the building on the ground floor. There is additional office and meeting space situated on the first floor. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The service employs cleaning staff and throughout the home was clean, tidy and fresh smelling. There are dedicated laundry facilities to which service users have access to wash their laundry with support. There are policies and procedures in place for the control of infection and for the control of substances hazardous to health. As with many other areas of the home these systems are subject to review to ensure the most efficient and effective use of the available resources. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good 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 the support of well trained and competent staff and are protected by the organisations policies and procedures on recruitment. Evidence: Information provided by the service indicated that all staff are subject to an extensive recruitment programme that complies with the regulations. All prospective staff must complete an application form and are subject to written references and formal interview. The inspector is familiar with the organisations recruitment arrangements, which have always been found to be robust and effective. The temporary manager confirmed that recruitment to this service had been particularly robust in relation to its specialist status for providing a high quality service for people with autism. Prospective staff had to demonstrate very specific skills and attributes in order to be considered suitable for the service. Staff spoken to were now clear about their roles but reported that during the period of the opening of the home in January and the departure of the registered manager, roles were very unclear and expectations and responsibilities were confused and unsettling for the whole staff group. There is an extensive training programme provided by the organisation and all staff Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: have regular access to updates and specialist courses. All current staff within the service have either gained National Vocational Qualifications or are in the process of obtaining them. Many have undertaken specialist training in learning disability and autism. Both staff spoken to provided information about the range of training and courses that they had attended and both confirmed that in their view the training offered by the organisation was extensive and of good quality. Evidence seen and provided indicated that the majority of staff had received very few one to one supervision sessions prior to the appointment of the temporary manager. Since the end of May and the re-organisation of the staff teams all senior staff had been charged with responsibility for drawing up a programme of one to ones for all staff within their teams. In addition, all senior staff had either been provided with supervision or were due to have one imminently. Staff meetings organised since May had initially commenced with a whole team meeting to provide staff with reassurance about the absence of their manager and the planned changes. Additional unit team meetings had commenced and staff spoken to reported that these were very useful and provided staff with much needed structure and direction. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users now benefit from a well run home where they can be sure their views will be taken into account with regard to the development of the service. Service users are protected by the homes policies and procedures for health and safety. Evidence: There was considerable evidence to support the view that the registered manager had been struggling to cope with managing and running the home effectively since it first opened in January 2009. This situation only came to the notice of the organisation during an unannounced visit conducted at the beginning of May by a senior manager. During the time the home was opening a complete change of senior management at the village was being undertaken. There was only one record of a Proprietor visit (Regulation 26) available and further suggests that the manager was left unsupported during a difficult and demanding phase for the home. Staff were left with little direction and a failure to implement suitable operating systems resulted in a lack of structure where staff felt unsupported and vulnerable. However, the organisation did act swiftly when the full scale of the difficulties were Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: uncovered. The temporary manager was assigned to oversee the running of the home and has been assisted by a senior member of staff from her original service. This has proved extremely positive and there was considerable evidence to indicate that already the home is running with structure, purpose and clearly defined policies and procedures. Staff were feeling much better supported and described the temporary manager and her assistant as competent, professional and approachable. It was acknowledged that considerable work still needed to be undertaken but the management team were in no doubt as to where weaknesses still remained and what needed to be implemented to bring standards up to ensure good outcomes for service users. The organisation has comprehensive quality assurance systems but due to the short duration the service has been in operation and the recent need to improve basic practices as a priority within the home, a full scale quality assurance exercise has not been undertaken. Part of the feedback for how well the service is meeting needs is obtained from individual service user reviews and these have now commenced and will be undertaken for all service users. It is clear that records as a whole prior to the temporary manager overseeing the service were disorganised and not easily accessible. The manager confirmed that although extensive review of all documentation had been undertaken with the assistance of the part time administrator, important paperwork was still being found misfiled or not filed at all. Some work had been undertaken on locating health and safety documentation and a member of staff has been designated as the health and safety co-ordinator for the home. It was clear from the file seen that there were apparent omissions in relation to fire safety drills, although it was noted that due to a faulty call bell a full evacuation had occurred recently and this had been documented. Other checks were in evidence but a full audit was not possible due to the lack of comprehensive information. It was noted from a gas safety report undertaken in December 2008 that a piece of faulty equipment rendered the use of the gas equipment in the main kitchen as potentially dangerous. Documentation confirming that remedial work had been undertaken could not be located at the time of the inspection and the temporary manager undertook to ensure that this documentation was found to provide evidence that the work was completed. The organisation ensures that full liability insurance is in place for the service and this was confirmed in information supplied prior to the visit. The temporary manager was aware of the need to implement a business plan and arrangements were underway to Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: ensure that this work was completed. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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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