Care Home: The Coach House

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What the care home does well People who live at he Coach House have their needs assessed in a person centred way and comprehensive support plans ensure that their needs are met in away that considers their choices and aspirations. People are supported to undertake activities of their choice both within the service and the community and staff encourage people to be independent. What has improved since the last inspection? This was the first key inspection of this service, which opened May 2009. What the care home could do better: This first key inspection has not identified any major areas that would benefit from improvement at this stage. However there are some areas of good practice recommendations. The temperature of the room where medication is stored needs to be better monitored to ensure it does not go above 25oC. Handwritten entries on medication administration sheets should be signed and countersigned to minimise any risk of error. Where medication is not given and coded as `O` staff could make a not on the reverse of the record sheet to indicate why this has happened. Key inspection report Care homes for adults (18-65 years) Name: Address: The Coach House The Coach House 9 Radcliffe Mount West Bridgeford Nottinham NG2 5FY 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: Susan Lewis Date: 2 9 1 0 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: The Coach House The Coach House 9 Radcliffe Mount West Bridgeford Nottinham NG2 5FY 01159861555 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sarahhardy@becausewecare.org.uk Mr John Riley, Mr John Pownall trading as Because We Care Name of registered manager (if applicable) Miss Sarah Hardy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: The maximum number of service users who can be accommodated is 4 The registered persons may provide the following category of service only Care home code PC To service users of the following gender Both Whose primary care needs on admission to the home are within the following category Learning Disability code LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home The Coach House is a recently converted building. It comprises of two floors and has four bedrooms. It was purchased and modernised by the current proprietors for the sole purpose of providing residential care for a small group of people with learning disabilities. The Coach House is in walking distance of Nottingham city centre and West Bridgford. This makes easy access to local amenities including shops, cinemas, bowling and other public facilities such as libraries. 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 The focus of Inspections undertaken by the Care Quality Commission is upon outcomes for people who use the services and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire called an Annual Quality Assurance Assessment, which tells us about how well their service provides for the needs of the people who use it and how they intend to improve their service. We received this back from the manager within the required timescale and the form was completed in a satisfactory manner, providing us with information to assist in planning our visit and deciding what areas to look at. We also reviewed all the information we have received about the service since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of Inspection we use is called case tracking which involves us selecting a number of people who use the service and looking at the quality of the care they receive by speaking with them, observation, reading Care Homes for Adults (18-65 years) Page 7 of 30 their records and asking staff about their needs. We also sent Have Your Say questionnaires to a random selection of people who use the service, some relatives and some staff members. The information provided in the replies we received, was also a contributory factor in the focus of our inspection visit. We spoke with one member of staff and three people who use the service to form an opinion about the quality of the service being provided. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who use the service. The fees range from £1,100 to £2,500 per week. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the care home does well People who live at he Coach House have their needs assessed in a person centred way and comprehensive support plans ensure that their needs are met in away that considers their choices and aspirations. People are supported to undertake activities of their choice both within the service and the community and staff encourage people to be independent. Care Homes for Adults (18-65 years) Page 8 of 30 What has got better from the last inspection What the care home could do better This first key inspection has not identified any major areas that would benefit from improvement at this stage. However there are some areas of good practice recommendations. The temperature of the room where medication is stored needs to be better monitored to ensure it does not go above 25oC. Handwritten entries on medication administration sheets should be signed and countersigned to minimise any risk of error. Where medication is not given and coded as O staff could make a not on the reverse of the record sheet to indicate why this has happened. Care Homes for Adults (18-65 years) Page 9 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 Susan Lewis CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 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 10 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 11 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. Everyone who wants to use the service will have their needs assessed prior to moving to the home. Evidence: The manager told us in pre inspection information that We have an experienced well trained staff team. We looked at the records for three people living in the home and saw that all of them had been assessed prior to moving to the service. Copies of assessments carried out by the care manager were also obtained before the person moved in. This ensures that staff receive all the information about the persons needs and whether they have the skills and abilities to meet those needs. Staff we spoke with understood each persons individual needs and aspirations and how to meet those needs. The assessment was detailed and covered all aspects of a persons daily life and how they wanted to spend their time as well as what and who was important to them. It also Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: showed where a person may have any restrictions on their movements and why. People we spoke with said that they felt involved in choosing to move to the home. One person told us I chose my bedroom when I visited and I really like it. Care Homes for Adults (18-65 years) Page 13 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 using the service make their own informed decisions and have the right to take risks in their daily lives. Evidence: The manager told us in pre inspection information that The Coach House promotes independence, person centred planning, involvement from outside agencies, we constantly carry out risk assessments, we hold bi-monthly service user meetings. A key worker system is in place. We looked at the care files for three of the four people living at the service. Each one contained a very thorough pre-admission assessment and detailed support plans, as well as appropriate risk assessments. We saw that the plans for each person had been developed with the involvement of the person and any changes were clearly documented through the evaluation of the plan. Staff told us that the service operated a key worker system and a member of staff helped Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: provide individual support for people who lived at the service. People we spoke with knew who their key workers were and one person said that they like their key worker and they get to know them well , they told us I can talk to them if there is anything I am unhappy about. Staff told us that they knew each persons needs and had received lots of training before the home opened so that they could support people in the best way. Staff were aware of peoples long term aims and knew what to do to help people meet those aims. One member of staff told us The Coach House has trained staff to meet the needs of service users and to provide good care. On the day of the inspection as it was half term and usual college activities were suspended people were choosing how to spend their day. Some people were going to visit family and friends and others were going to play bingo. People are supported to do the activities they want to do within a risk assessment framework ensuring they are safe yet still able to live full and active lives. People spoken with said that they were able to go out and do a variety of things such as go into town by themselves or visit family. People had bus passes to enable them to travel independently. We observed staff and people living at the service and the interactions were very positive. People were spoken to and treated in a respectful manner. Staff only entered peoples rooms with their consent. Care Homes for Adults (18-65 years) Page 15 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. The service actively supports people to be independent and involved in all areas of daily living in the home. Evidence: The manager told us in pre inspection information that The Coach House promotes personal development, support to access the community and facilities, for service users to be able to acheive their personal goals, family and friend contact will be encouraged if appropriate, support given to access outside agencies, spiritual and cultural needs are met, daily activity plans in place and are individual to the service user and promote independence and choice whilst risk assessment is taken into consideration. We provide a wide range of meals and ensure that these are nutritious and well balanced. Service users have a choice of where to eat their meals and meal times are flexible. We spoke with people who live at the service and they told us that they are involved in Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: developing their care plans and can choose where to go and when they want to go out. One person told us I see my mum often and go out when I want to. Staff told us that they support people to access the community following their risk assessments and ensure that they have the support they need to do this. We spent time in the home observing staff with people who use the service, it was relaxed and pleasant. Staff chatted pleasantly with people and there was a gentle banter taking place as staff asked people what they wanted to do during the day. Staff told us that people who use the service are asked each week what they want to eat and a menu and shopping list is prepared from this. People who live at the home told us that they decide what they want to eat and they help prepare a shopping list. Some people help in meal preparation where it is appropriate and they make drinks when they want them. There was a large bowl of fresh fruit for people to help themselves and staff said that they had sufficient money to ensure people had a healthy and nutritious diet. People we spoke with said that they were involved in a variety of activities including college, voluntary work, shopping, cinema and various trips out organised by staff. Staff told us that people can do what they want during the day and they will support them as required and although each person has a timetable this remains flexible to reflect what people want to do each day. We saw photographs around the home of different activities that people had been involved in, including a holiday. People told us about their holiday and that they had enjoyed themselves. The people who live at the home have regular meetings we saw minutes of these meetings. The meetings look at things that are important to people who live at the service and show what action staff need to take to support them. Care Homes for Adults (18-65 years) Page 17 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. Practices in the home reflect peoples needs and they receive effective personal and health care support using a person centred approach. Evidence: The manager told us in the pre inspection information that Medication training is provided twice a year and medication audits carried out by the local pharmacy. Medication is stored and administered as per policy and legislation. We looked at peoples care plans and spoke with them about the care they received and found that staff provide the support they need in a way they want. Each care plan contained detailed information that ensured staff had the information they needed to support people in the way they wanted whilst maintaining a persons independence as far as possible. We saw in peoples plans that they see other professionals when they need to, including Doctor, dentist, optician and psychologist. Support is provided to each person on an individual basis and is based on the assessment. People spoken with told us I am able to do what I want, the staff help me if I need it, Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: they are really kind. We observed staff during the day supporting people with a person centred approach and speaking to them in a respectful manner. We looked at the storage of medication and saw that it was in a locked filing cabinet. The service only stores medication for four people and have been told this is a safe method of storage by the pharmacist. The temperature of the room was not being taken to ensure it remained below 25oC the safe storage temperature for most medication. All medication administration records were completed and accurate, however where people did not receive medication and staff had used a code O or other to indicate it had not been given they had not explained why it had not been given. Also where staff had handwritten medication details on the administration sheets they were not signed and countersigned to minimise any errors. The service has a reliable system for ordering medicines and disposing of any unused items. We looked at training records and these showed us that all staff who handle medication have had training to do so. We spoke with staff and they confirmed that they had received training and felt safe and competent to give out medication. Risk assessments had been completed for each person to see if self-administration of medication would be possible. Only one person self medicates and we saw evidence that staff monitor this to ensure the person remains safe. Care Homes for Adults (18-65 years) Page 19 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 who live at the service say that they are extremely satisfied with the service, feel safe and well supported. The home has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Evidence: The manager told us that The Coach House holds bimonthly supervisions and staff meetings. Correct procedures are followed for the recruitment of staff to ensure safety of all. Staff training is provided to include safeguarding adults, whistle blowing, Mental Capacity Act, Deprivation of liberty and NAPPI.(Non-aversive physical and psychological intervention.) We looked at records of any complaints and the service has not received any. We have not received any complaints about this service since it was first registered in May 2009. Safeguarding Adults is a process of identifying and reporting suspected or potential abuse of vulnerable people and provides a framework of consistency to protect those individuals at risk. Whistle Blowing is a means for staff to feel supported to report anything of concern that they may witness. We spoke with people who live at the service and they told us that they know who to complain to if they are unhappy about anything. They also told us that they feel safe Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: living at The Coach House and that the staff are kind and helpful. The surveys we received showed that staff understood how to support people in making a complaint and were aware of the policies and procedures within the organisation to make complaints and take them further if they were not happy. We spoke with staff and they had a clear understanding of how the safeguarding procedures worked and what their responsibility was if they believed that any abuse was taking place. The training records showed that all staff had undertaken training that would help their understanding of abuse and what to do about it. Staff also told us that they felt management welcomed suggestions on how to improve the service and that they were open and supportive to them as a staff group. Care Homes for Adults (18-65 years) Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to see the home as their own. It is a very well maintained, attractive home. Evidence: The manager told us in the written information she provided A maintenance log is held in the office for staff to report any faults or necessary repairs. These are seen to within a practical timescale depending on severity. The home is kept clean and tidy and a cleaning rota is in place. The home has laundry and hand washing facilities. There is a COSHH policy in place which is reviewed regularly. All bedrooms have high quality furniture and are equipped and adapted to the needs of the service user. We looked at parts of the building as part of the inspection. The communal area is open plan living, dining and kitchen. It is domestic in nature and is clean, bright and airy. We looked at a selection of bedrooms and saw that these had been personalised and people told us that they liked their bedrooms and they told us that they were involved in choosing the colours and decoration for their rooms. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: One person said I like my room I could choose what I had in it and all the colours. I love my bedroom. Staff also felt that people were able to live in a pleasant environment and several staff who responded to the pre inspection surveys when asked what they felt the service does well commented on the good quality environment. There are two bathrooms providing people with a choice of a bath or a shower, these are well equipped and spacious. The laundry room is outside the main home, this means staff do not have to take soiled laundry into areas where food may be prepared or consumed. Training records showed that staff had received infection control training and the service had a suitable infection control policy ensuring people are protected from potential infections. Staff spoken with said they understood how to support people and minimise any risk from infection. 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. Management priorities training and facilitate staff members to undertake external qualifications beyond basic requirements. Staffing levels reflect the needs of the people using the service. Evidence: The manager told us in the written information she provided All requirements are met and Criminal Records Bureau checks are carried out prior to commencement of employment. Staff are recruited on their skills and experience set by Sector skills council workforce. Staff hold mandatory training; all have completed their Learning Disability Qualification and have commenced National Vocational Qualifications. We looked at three staff records and we saw that all staff had two references and a Criminal Records Bureau check prior to them starting work, staff spoken with confirmed that they had filled out application and had been interviewed for the post. Records also indicated that a thorough training regime was in place to ensure that staff received the training they needed to carry out their role. The records indicated that staff received an induction training and this was confirmed by staff spoken with. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Staff told us that management were very supportive regarding attending training courses. Staff also commented on the surveys that they have received on going training and the training is excellent. The staff rota showed that there were sufficient staff available during each shift to support the people who lived at the home. Management told us that there is always an experienced person on each shift, this was confirmed by staff spoken with. We observed staff to be communicating respectfully with the people they were supporting and with each other. Staff told us This is a good place to work there is a good rapport between staff and service users. I can honestly say its the nicest residential home I have worked at the staff are great with the service users. People living at the service told us that staff are kind and helpful. 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. The service is run in the best interests of the people living there. The health, safety and well being of the staff and those living there are promoted and protected. Evidence: The written information provided to us told us The manager of the Coach House is a registered mental health nurse and has many years experience of working in the care sector and is currently completing National Vocational Qualification 4 in Leadership and Management. The manager is approachable and creates a positive and inclusive atmosphere. Quality assurance monitoring is in place. The home holds written policies and procedures. The manager ensures that the health and safety of all is maintained. The manager ensures compliance with all relevant legislation and the overall management of the service ensures the effectiveness of financial viability. Staff we spoke with all said that they enjoy working at the service and feel supported and listened to by management. One person told us that Staff ideas are listened to and if worthwhile implemented. People who live at the service said that they liked the manager and she is very nice. I Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: can talk to her. A quality assurance system has been developed by the service and this looks at the views of the people who use the service and others linked to it such as relatives and health care staff or social workers. As the service is still very new the manager is still in the process of collecting this information. However there are other methods in place to help look at the opinions of people who use the service. Regular residents meetings are held and minutes of these were looked at and showed that people are encouraged to be open and honest in how they feel about living in the home. We looked at the arrangements for supporting people with their finances and saw that the system is safe and all transactions are carefully documented. We looked at the records of accidents and incidents. These were recorded in detail in each persons file and included any actions and outcomes. We also looked at the records of regulation 26 visits (these are visits that a registered provider must do where they are not in day to day management of a service). These are carried out monthly but they did lack detail as to what they had discovered during the visit. We looked at the maintenance records for the home and these showed that all action has been taken by the manager to make the service safe and protect people who use the service. 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 20 20 Where staff have entered O in the records they could clarify what this means Where entries on the medication record have to be handwritten staff should sign and someone countersign to say they are correct. Ensure that the storage of medication meets regulations. Where the provider carries out unannounced visits it would be beneficial if the were recorded in more detail. 3 4 20 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!