Care Home: The Conifers

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Conifers 1 Turmer Avenue Bridlington East Riding Of Yorks YO15 2HJ three star excellent service The quality rating for this care home is: 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: Janet Lamb Date: 1 7 0 9 2 0 0 8 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 Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Conifers 1 Turmer Avenue Bridlington East Riding Of Yorks YO15 2HJ 01262606303 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Conifers Residential Home Limited Name of registered manager (if applicable) Mrs Anne Sarah Sage Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 24 0 care home 24 learning disability Additional conditions: Date of last inspection A bit about the care home The Conifers is a family-run home providing care and accommodation for up to 19 adults with a learning disability. Accommodation includes lounge/dining area, smoking lounge, single and double bedrooms and a rear garden with patio area. Four additional self-contained flats have been built, providing more independent living for people wishing to access this type of accommodation. The home is close to the centre of Bridlington with good access to local transport and amenities. The fees charged for living in the home are £360.00 per week. Information about the home can be obtained in the Statement of Purpose and the Service User Guide upon request from the home. 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: three star excellent 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 How we did our inspection: This is what the inspector did when they were at the care home The key inspection of The Conifers has taken place over a period of time. It involved electronically sending an Annual Quality Assurance Assessment or AQAA document to the home in July 2008, requesting information about people and their family members, and the healthcare professionals that have an interest in them. It also asked for numerical data in the home. We did not receive the requested information before the site visit date because of valid reasons and therefore survey questionnaires were sent out to the home in advance of the AQAA being returned. Surveys were received back at the Commission however in good time before the site visit, so they were included in the information gathering process. On 17 September 2008 a site visit was carried out to check all of the information the Commission has received since the last key inspection and the last annual service review. This information was in the form of the last key inspection report, notifications to the Commission, details of any complaints and safeguarding referrals, and details of information from other stakeholders. On the day of the site visit several people living in the home, some of the staff, the manager and deputy manager were interviewed or spoken to, and some interaction between people in the home and between people and staff was observed. Communal parts of the home were viewed, as were some bedrooms with peoples permission. Two of the adjoining flats were also viewed with permission. Care plans and some other documents relating to people, risk assessments and some records were read and staff files were seen, again with permission of the people they relate to. Safety maintenance certificates and records were also viewed. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well People are well assessed according to a specific tool, their needs are well recorded in a person centred plan of care, which is regularly reviewed for changes in need and personal development, and all needs are very well met. Care plans are supplemented by good risk assessment documents and behaviour management plans, and people also have their health care needs very well monitored and met. People are encouraged to maintain relationships with relatives, friends and acquaintances and they are expected to make informed decisions on a daily basis to maintain their independence and to reduce any risk in their lives. People say they are satisfied with the provision of meals and with the assistance some of them receive to shop, cook and prepare simple foods for themselves. People lead lifestyles of their choosing and are assisted with such as personal care and supported in their independent living in a way which they say meets their needs and suits their preferences. Healthcare needs are extremely well assessed, monitored and met with good networking relationships being in place between people and the healthcare professionals they have need to consult. Medication administration systems are robust and meets peoples needs well. They are satisfied with the support they receive to maintain a healthy lifestyle. People say they are able to make complaints openly and without fear of reprisals. They understand the procedures for making representations and for passing on information of a safeguarding nature. People are well protected and safeguarded from harm. There is an adequately clean and comfortable environment in which to live, that is improving all the time. The installation of a passenger lift in the very near future will give back their independence to those that have recently become immobile. People enjoy good staffing levels and have the support of staff that are well recruited, trained and skilled in caring for people with a learning disability. There is a very good management team in charge of the home, that operates in an open and inclusive style, and that has many years experience between them. They run the home in the best interests of the people living there, by implementing the homes policies and procedures, achieving the written aims and objectives, and maintaining a safe environment. All of the services provided in the home are monitored and improved on by implementing a quality assurance system, and the health, safety and welfare of people and staff is well promoted and protected. What has got better from the last inspection What the care home could do better The only identified improvements the home could make is to upgrade the bathrooms on first and second floors, so people have private and pleasant facilities at their disposal, and ensure a legionella water test is carried out every three years, so people are not at risk of harm from such a disease. 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 Janet Lamb St Pauls House 23 Park Square (South) Leeds LS1 2ND 011 3220 4600 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 have their individual diverse needs well assessed and risk managed, so they are confident they are met. Evidence: The service obtains placing local authority community care assessment documents for prospective people before they become resident in the home and carries out its own assessment of need covering eleven specific areas. These include physical, social, emotional, cultural and religious needs, and therefore a comprehensive assessment of a persons needs is completed in readiness for their admission and to inform the care plan of the action needed to meet them. There are risk assessment documents also in place that help reduce risks identified in assessing individual and diverse needs of people. Documents are signed and dated and show that people are fully involved in the process, with support from family members or appointed advocates. People spoken to remember the assessment process even though for some it was many years ago. Some of them are aware of the documentation in place and are consenting to it being looked at. Standards 1, 4 and 5 were not assessed on this inspection, but they were met at the last inspection. It is understood the statement of purpose and service user guide are kept up to date and provided to everyone in the format they require them to be in. Introductory visits were only discussed in relation to specific people in the home, but evidence was not explored. Contracts of residence and contracts between the provider Evidence: and the placing authorities are held at the providers private address for easy access when dealing with financial and contractual arrangements. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have good care plans that enable them to be independent and to make choices, and people enjoy making their own decisions in life, with good risk assessments being put into place where necessary, so they are confident their lifestyles meet their expectations. Evidence: The service has individual care plans in place for people that reflect their diverse assessed needs and, which show what the needs are, what services and tasks are required to meet them, who is responsible to meet them and what is the frequency of care required to meet them. There is evidence of two monthly reviewing of care plans in the homes amendment sheets, as well as evidence of six monthly full reviews of care in fairer access to care services review minutes. This evidence was seen for three people with their permission, and these people spoke in interview of their understanding of care plans, reviews of care and of allocated key workers. Care plans also contain recording documents of such as diary notes, health checks and consultations, and for personal care and monitoring provided on such as checking weight, giving assistance with hygiene or mobility and so on. Again documents are signed and dated and show evidence people are consulted and included in the process. Daily diary notes record peoples decisions and day to day choices. Observation of their activities evidence that people are able to come and go freely, control their own finances if able, and make choices on a daily basis. One person freely uses the trains to and from Hull, while another holds down a job and occupation at a local charity shop. Several others attend local pubs, shops, centres and the cinema, or engage in Evidence: pastimes within the home, such as knitting, painting and listening to music. All decisions people make are their own, but sometimes with information or guidance supplied by staff and professionals. People talk about taking risks in life and staff often need to support and direct them in making choices about risks. People talk about their outings and activities and the relationships they may form, and of the difficulties they sometimes experience in everyday life. Generally they enjoy a good level of freedom, where risks are reduced and choices are encouraged. Where people find it difficult to relate to others behaviour management plans are in place and accompanied with support from staff to help them manage their behaviour. Any limitations on choice and freedom imposed by a specialist programme are clearly recorded and agreed under a multi-disciplinary approach of those professionals and stakeholders concerned and only in the best interests of the people they refer to. Care plans are now recorded in written and pictorial formats as suggested at the last key inspection. 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 lead and enjoy appropriate, inclusive, healthy and fulfilling lifestyles in the home and within the local community, so their quality of life is good. They enjoy good food provision so they are confident they have a healthy lifestyle. Evidence: There are several people in the home that are encouraged to think and act as independently as possible and to undertake as much activity as they can, engage in developing their living skills and maintaining relationships. Some people go to college classes, or to centre events in the community, may live more independently in the adjoining flats, and may even have unpaid work placements. They tend to be more able and lead lifestyles of their choosing and making. They only require guidance and a little support on occasion from staff, for such as health care issues and in respect of their safety. These people also handle their own finances on a daily basis, have keys to their room or flat, handle their own post and enjoy various activities in the local community. They may also develop relationships of their choosing and have friends and acquaintances round to visit. They speak freely and openly of their routines of daily living and take pride in the efforts they make to keep their rooms and flats tidy. Most of them enjoy food provided in the main house but those in the flats do have some personal stores for breakfast and evening snacks. These people shop for such items on a small budget and are encouraged to learn new living skills whenever possible. Everyone confirms in interview all of the activity they are involved in and further evidence is in files and Evidence: records. Others are more dependent and rely on greater staff support and advice and may only go on outings accompanied, but they do still enjoy a variety of activity and frequent different places in the community. These people need more prompting and a higher level of support with such as personal hygiene and with their health care. They also have more complex communication needs, which are clearly recorded and strategies put in place to meet them. Everyone is assisted to maintain good communication and contact with family and friends through letter writing, speaking on the telephone or visiting on a regular basis, transport being provided or arranged. Everyone is assisted with entertainment and patimes in the community or in the home, and these may include going to Gateway Club, bingo, restaurants, pubs and cafes, or doing such as horse riding, writing and sewing courses at college, or just listening to music, knitting, watching television, and joining in conversation in the home. They may also include a holiday away for a few days. People have individual weekly activity plans and there are records in diary notes and in outing records that evidence what actually takes place, where people go etc. There are no issues with food provision, and people spoken to are satisfied with the arrangements for meals and with the actual food they are given. Menus are on a four weekly rotation and there are usually two sititngs per meal in the dining room. The lunch time meal observed on the day of the site visit was a choice of egg mayo or tuna and sweetcorn sandwiches and salad, with dinner planned as beef stew and dumplings with vegetables, or jacket potatoes and coleslaw, and pudding of cherry sponge and custard or yoghurt and fruit. There are limitations placed on everyone in the home on going into the dining room in that no one has access without staff being present. This is because of the differing needs of people and the need to maintain high standards of hygiene and consistency for everyone. The door has a key pad lock and is always kept locked until meal time. People are able to access drinks from the drink station in another part of the home at any time, however. There is a designated cook employed to prepare the eveing meal each day, but care staff provide breakfast and lunch. 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 excellent 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 receive good assistance and support to maintain their personal and health care, so they are confident their needs are met. Not everyone experiences the opportunity to self-medicate, because of risk, but their levels of choice and independence are good in other areas. Medication management systems are good in respect of handling, storage and administering of drugs, so peoples needs are met. Evidence: People spoken to about the care and support they receive say they are satisfied it is given when and how they need it. Care plans are in use and show what personal needs people have and who actually needs support with hygiene or health care etc. There is an element to the care plans that covers health care and issues, and there are records in place that show when GPs or hospital consultants were visited. Staff identify health issues very well from their observation of peoples demeanour and the changes they exhibit or from the verbal information people give them. Staff respond quickly and access all necessary health support and treatment required. There have been several health issues over the past two years for people and these have been very stressful to the person concerned, the management team and the staff, but everyone has coped extremely well. All health support has been accessed and treatments have been provided to the extent people are now recovered and leading busy lives again. Case files show the levels of health care needed over the past two years and that people have received a very good service of monitoring and support to attend appointments and to receive treatment. The medication systems within the home are satisfactorily managed. There are policies and procedures to follow, a good audit trail is in evidence, storage and handling of medicines is good and administration of it is according to safe practice in line with the Evidence: applicable legislation stated in standard 20.6. One person self-medicates insulin from measured dosages put up by the District Nurse. There are no controlled drugs used in the home at the moment. The manager, deputy and four senior staff are trained in medication administration, last done on 24 April 2008, and have been competence checked by the trainers, Lloyds Chemist, who also provide a medication checking service on a regular basis. This was last done on 1 August 2008. 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 confident their concerns and complaints are listened to and acted on, and they are safeguarded against harm or injury, so people are properly protected. Evidence: There are both complaint and safeguarding adults procedures held within the homes four procedures manuals, and people spoken to are well aware of how to make representations, either formally or on a daily basis. They say their relatives also know how to complain. Details on making complaints or passing on safeguarding information are listed in the homes statement of purpose and service user guide and there is a complaint procedure pinned on the notice board in the entrance hall. Details are also listed in pictorial format as well as written. The management style within the home is open and inclusive, yet confidentiality is maintained, and is such that people are confident about coming forward with any issues they may have. Usually the staff respond well and quickly to any changes in peoples behaviour or demeanour, and to any direct information they receive, and therefore they are able to deal with simple problems before they become complicated ones. People talk on a daily basis to staff and managers and have their worries or complaints brought out in the open and resolved in a very timely manner. Because of this formal complaints do not manifest and therefore the complaint record is blank for the period since the last key inspection. Safeguarding adults issues would be dealt with in the same way should there be any identified. There have been no safeguarding issues raised within the home or by people or their relatives, or any other stakeholder, but one has been identified through the Protection Of Vulnerable Adults office for the local area. This was dealt with entirely appropriately by the provider and did not result in anyone in the home being put at risk of harm or abuse. The provider has shown they are responsible and handle issues well and according to the requirements of procedure and legislation. Evidence: Staff files and interviews with staff reveal they have completed safeguarding adults training via a variety of ways. The manager and deputy and four senior staff have completed the Hull and East Riding Safeguarding Adults Board training, while all other staff have done an in-house course with Nexus Training Company and which involved the viewing of a DVD and the completing of a questionnaire to determine their level of understanding. All safeguarding training has been done within the last two years. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service enjoy a clean, homely and comfortable environment, suited to its stated purpose. This could be much better if the bathrooms are attended to. Evidence: The home is suitable for its stated purpose of providing care and accommodation to people with a learning disability, though at the present time there are no facilities for people with a physical disability. This is to change, however, as the provider is soon to have a passenger lift installed, and work will begin in the next few weeks. Viewing of the communal areas of the home and some bedrooms with permission from people and discussion with them about their impressions of the facilities they have, reveals the home is generally well maintained in most areas, but requires a small amount of work in other areas. Bedrooms are personalised and mostly of a satisfactory standard of decoration and furnishing. Not all rooms were viewed, but those seen appear homely, very personalised and adequately furnished. One room does require some redecoration, a new carpet and an audit of the furniture and fittings available ought to be done. The provider is aware of this and has plans to complete the work within the next round of redecoration. There is an urgent need to review the facilities within two bathrooms, one on the first floor and one on the second floor. These require redecoration, the fitting of tiling around the baths and washbasins and toilets, and the fitting of new floor surfaces, in order to bring the bathrooms up to required standard. These bathrooms could also be made more pleasant to use by fitting such as shelves and pictures, or by supplying suitable bathroom furniture and storage for towels, soaps, and so on. There should also be a safe facility, that can be overridden in an emergency, to lock the bathrooms for when a person needs privacy. Evidence: The rest of the house is clean and comfortable and people have full access to all parts except the kitchen and dining room for safety reasons. There is no garden to the home, as much of the rear of the property has been used for the flat extensions. 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 who use the service benefit from appropriately recruited and well-trained staff in sufficient numbers to meet their needs, so they are confident their lifestyles are respected. Evidence: The staffing team consists of people of different ages and experiences, but many have acquired the necessary qualifications they need to carry out a caring role supporting young adults with a learning disability. Ten from fourteen care staff now hold a recognised qualification giving the home a 72 percent success rate with an award. There are usually three care staff employed each shift throughout the day time and two care staff employed to work waking nights. Staff confirm this in interview and rosters seen also show this to be so. Staffing levels are considered to be appropriate at the present time as people say they are supported to go out and to undertake activities within the home as they require. Diary notes and records show people receive the support they need to maintain their personal care and their health care. There is good evidence in staff recruitment and training files, seen with their permission, which is backed up in staff interview to show that staff are recruited according to sound policies and procedures and in line with the requirements of regulation 19 and schedule 2. Required application and reference forms are in place, required security checks are carried out in a timely manner and proof of identity is pursued and evidenced. Staff complete induction and foundation training to specified Skills For Care standards. There is also good evidence that staff complete mandatory training on such as fire safety, safeguarding adults, infection control, medication administration and so on. Staff also confirm this in interview. All standards in this section are met. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from having a registered manager and a deputy manager in post that are competent and maintain a consitent service. People benefit from a quality assurance system that is effective in demonstrating their individual development in relation to their care plans. They enjoy good protection from harm under the health and safety measures in place and the practice carried out, so people are confident their health, safety and welfare are well promoted and protected. Evidence: The home is well managed and run by one of the providers who is also the registered manager, and a deputy manager. Both have the required qualifications and both have many years experience working with people with a learning disability. They make sure the home is run in the best interests of the people living there and make sure the aims and objectives of the home are followed, that policies and procedures are implemented, budgets are well managed, certificates and licences are obtained and displayed, people have contracts of residence and these are fulfilled, and the Care Standards Act 2000 requirements are complied with. There is a quality assurance system in place that meets the requirements of the standard and, which consults people in the home and other stakeholders regularly. These documents are maintained as evidence of the consultations made about the service and come from people in the home, relatives, social services officers, community psychiatric nurses and such as project workers at facilities in the community. Everyone gives testament that the home is very good, has helped people to develop and improve their skills and offers a very good level of support and advice to the people living there. The home also has achieved the East Riding of Yorkshires Quality Development Scheme parts 1 and 2. The home produces an annual report and Evidence: business plan to show performance and future plans. Meetings are held by people in the home, their review meetings of the care they receive and general discussion and solving of daily problems all contribute to the methods of seeking peoples views and meeting their needs. People spoken to say they are very satisfied with the service of care, the help and support they receive and some even say they have achieved a lifestyle that suits them very well and offers them independence and fulfilment. Certain areas were sampled under standard 42 to evidence that the service provided is safe and follows the requirements of health and safety legislation. Areas include the fire safety systems, some of the premises checks, accident reporting, use of cleaning products, water bacteria checks and hot water controls and staff guidelines for good practice. All of these areas are satisfactorily managed by the management of the home. The only recommendation to make is that the hot water storage tank needs to be checked three yearly for legionella bacteria. All three standards in this section are well met. 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 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 27 The registered provider should make sure all bathroom facilities are maintained to a required standard, so that people have sufficinet privacy and so their individual needs are met. This means bathrooms on the first and second floor should be redecorated, have new floor covering fitted, have tiling fitted around the bath, sink and toilet, and be made pleasant with the introduction of appropriate bathroom furniture, fittings and storage. The registered provider should make sure a three yearly legionella bacteria test is carried out on the hot water storage system, so people know they are protected from the risk of harm from this disease. 2 42 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.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 © (2008) 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. 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