Care Home: The Paddock

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What the care home does well Residents are encouraged and supported to make choices about their daily routines and what they want to do with their lives. They are helped to develop their daily living skills and social skills, so that they can live their lives as independently as they want, knowing that staff are there to offer encouragement and support when they need it. They have the opportunity to have time with their key worker. That is a staff member that they have been linked to that they can rely on to provide support. This helps to make sure that they can talk about their worries. Staff are good listeners and make sure that any thing raised is acted upon. Some service users go out into the community and pursue their own chosen leisure activities. Others are supported by staff to go out to lots of different places of interest. Staff make sure that residents receive good healthcare. The home is well managed with residents best interests at the heart of whatever they do. Staff said that they felt the home works well because the staff team has a good mix of youth and experience. What has improved since the last inspection? Staff training this year has included Person Centred Planning to help staff develop more informed, and informative, support plans. Staff have undertaken medication training. The storage of medication is now in service user rooms. This increases privacy and service user involvement and potentially offers more control by the service user. Increased access to the kitchen offers service users the opportunity to make their own snacks and drinks. The home has secured the use of a hall in the community which it uses for activities and has potential for more integration with local people. What the care home could do better: To continue the training programme for manager and staff to develop skills that are specific to the service user support needs. This includes Autism, Aspergers Syndrome, Learning Disability and Non verbal communication. The working party need to finalise and produce written information about the home in a format that is appropriate and meaningful to the service user group. Continue to develop the activity programme and record a weekly planner. This is so that service users and staff know who is doing what and when, and what levels of support are required. Key inspection report Care homes for adults (18-65 years) Name: Address: The Paddock The Paddock 80 High Street Lydd Kent TN29 9AN     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: Geoffrey Senior     Date: 1 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: The Paddock The Paddock 80 High Street Lydd Kent TN29 9AN 01797321292 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Laurence John Waitt,Mr Shaun Rigby Waitt care home 19 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 19 The registered person may provide the following category of service only:Care home only (PC) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category : Learning disability (LD) Date of last inspection Brief description of the care home The Paddock provides personal care and support for 19 service users with a learning disability. It is a large detached house set in pleasant gardens. It is situated in the small coastal town of Lydd and the local shops, church and public houses are all within walking distance. The larger towns of Ashford, Folkestone and Hythe are all within easy driving distance and the home provides transport in order to access the available educational, recreational and cultural facilities. In the gardens surrounding the home there is a vegetable plot where the service users are supported to grow some of the fresh produce for the home. Bedrooms are single and there are spacious communcal areas. There is parking at the front of the house. The fee range for this service is Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 19 0 9 0 1 2 0 0 9 Brief description of the care home about £476.79 - £1281.35 per week. For more information about the fees and services please contact the provider. Care Homes for Adults (18-65 years) Page 5 of 28 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 report takes into account information gathered since the last key inspection on 09.01.2009 and includes a visit to the home. The visit to the service was an unannounced Key Inspection which took place over one day. We arrived at 11.45 am on 19.09.2009 and stayed for about five hours. The homes Registered Manager, four members of staff and several of the service users were involved in the inspection. We received the homes annual quality assurance assessment, known as an AQAA for short. This is a document that all homes have to send us once a year to tell us how they think they are meeting the national standards, how they have improved in the previous year, what they aim to do and lets us know when they have completed important environmental safety checks. Prior to the visit we sent survey questionnaires to the home to be distributed to the 16 service users, 10 members of staff and 5 care professionals. Most were completed and returned to us. The responses were noted and contribute to this report. At the time of the visit there were 16 service users living at the home. We spoke with several of them and had discussions with the manager and Care Homes for Adults (18-65 years) Page 6 of 28 the staff on duty. We observed how staff interacted with service users during the day when offering care support. We looked at some of the service users individual support plans and risk assessments. We also looked at and discussed the training records and quality assurance arrangements. Care Homes for Adults (18-65 years) Page 7 of 28 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 Care Homes for Adults (18-65 years) Page 8 of 28 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 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 10 of 28 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. Written information is made available to people interested in living at The Paddocks. There are plans to make this easier to read and understand and be more meaningful to the individual. Evidence: We talked to the manager about what happens when she is contacted by, or on behalf of, people who are interested in living at The Paddocks. She told us that although they have not had any new placements in recent years there is a clear admissions procedure that is followed. Upon receipt of an enquiry the prospective service users and their current carers are provided with the homes statement of purpose, a brochure and the service users guide. In the survey questionnaire we sent to the home before our visit we asked service users if they had been asked if they wanted to move to the home. Eleven said yes and four said no. All but one of the fifteen who replied said that they had been given enough information about the home to decide if it was the right place for them. We were told that there is a group of service users and staff that is currently working on making improvements to the information, to make it easier to read and understand Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: and more meaningful to the individual. People may visit the home before moving in, to meet the service users who already live there and the staff. They may also have a look around the house and find out about the lifestyle and routines they can expect to experience at the Paddocks. We saw in a number of service users files that care managers are asked to provide profiles and assessments of the service user which, together with the homes own assessments, help to form the homes plan of care and support. We spoke with four of the service users who all said that they were happy living at the home. One said that he had lived there a long time and did not feel there was anything that could be improved. Another indicated in the survey form that we sent out before the visit, that he was unhappy and felt that a move might make him feel better. We understand that a review meeting has been arranged to look at the situation and he would be helped to move if it was in his best interests and he still wanted to change. Care Homes for Adults (18-65 years) Page 12 of 28 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. Service users benefit from having their own plan of care that shows their assessed needs and wishes. Staff and service users work together to make sure these are met. Service users are encouraged and supported to make their own choices and decisions. They are supported to take reasonable risks and develop their life experiences. Evidence: Each person has their own support plan file that tells staff about them, what support they need and how they like to receive it. We were told that staff have had training in how to help people express their personal goals and aspirations and put support plans together in a way that reflects this. One of the service users we spoke with told us that he had talked with his keyworker about becoming more independent and what sort of support he needs to achieve this. He said that he had been able to say the things he wanted and the things he did not need or want and this had been written in his support plan. We looked at three of the service user files and saw that they contain a lot of information that is important to the individual and for the staff to know about. These Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: include the individuals daily routines, what they need reminding about, where they need encouragement and what they need support with. The manager showed us that they now have individual health action plans to monitor, record and review the persons well being. The manager also gave us an example of how the home has used an independent advocate to ensure a service users best interest was being served and appropriate health care support offered. The support plans also cover culture and religion so that any related things are known and plans put in place to make sure that persons wishes are respected. We were given an example of one service user being supported to attend a church group when he wishes. The support plans record where service users have made decisions about their lives and what has been agreed to keep them safe. Risk assessments have been undertaken and recorded. The manager told us that risk assessments are in place to support people to do things rather than as a reason to stop them. She told us that, as a result of reviewing some assessments, a number of restrictions that were in place have now been removed. These include, access to the kitchen, service users preparing their own food and support to manage more of their own monies. When asked in our surveys, Do you make decisions each day, six said always, four said usually and five said sometimes. Care Homes for Adults (18-65 years) Page 14 of 28 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 can do occupational and social things that interest them However some might like to do more outings. People are helped to keep in touch with family and friends. They can spend their days as they wish. People have a choice of good quality meals. Evidence: People are free to do things they want and that interest them. Some of the things involve helping out in their own way to keep their rooms and some of the communal areas looking tidy. They also now help make up the menus and shopping list. Some told us they enjoy going to the supermarket to fetch the shopping. Fourteen of the fifteen service user surveys that were returned said that they can do what they want during the day, evenings and at weekends. Two said that they would like more trips out in the minibus. People have, over time, developed their own things they like to do Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: each week. This includes going to a local resource centre where they can do various activities. We were told that the home has recently accessed a local community hall where they have introduced line dancing and arts and crafts. They are trying to encourage more community participation through coffee mornings and indoor boot fairs. Service users had gained permission to pick fruit in local residents gardens and we saw the chutney being made and bottled as a result. We saw that there is a full programme of social and recreational events and service users are encouraged to participate. Three service users were keen to show their medals, received as a result of their efforts at the Special Olympics. People are supported to maintain contact with family and friends. Visitors are welcome to call at the home as long as service users are happy with the arrangements. Keyworkers keep in touch with family members to tell tem how things are going. The manager told us how they are supporting one service user with his desire for a more independent lifestyle. He already goes out on his own to various places but is being helped to develop travel skills so he can safely go further afield and independently visit his family. People said that they have good quality meals and that they have enough to eat. People have access to the kitchen. Some make their own drinks and breakfast. We were told that there is no set menu each day. Several dishes are prepared by the cook and we saw service users choosing what they wanted at the serving hatch. The cook also showed us the picture cards she uses to help people make choices when planning the shopping and letting them know what is available. We asked staff members whether things have changed much in the home since the last inspection, as peoples lifestyle was an area identified as needing development. They felt that there are now more opportunities for integrating people into the local community, the home is less institutionalised, there are more examples of service users choice and being supported to do things for themselves rather than the staff doing it for them. Care Homes for Adults (18-65 years) Page 16 of 28 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. Service users are supported and encouraged by staff to make sure that their personal and health care needs are met. They can be confident that staff will listen and try to understand their needs, however diverse, and that everything will be done to make sure they are met. They benefit from a safe system of medication administration and storage Evidence: Each personal file includes details about the individuals health needs and the support they require. Since the last inspection the home has introduced health action plans to record and monitor the persons health and well being. Information and monitoring charts are in place for the people who have specific conditions so that details are available if the GP or specialist needs them. People are supported to access community and specialist health care services and appointments. Staff were able to able to talk in detail about the current health of the individuals and where progress had been made. Peoples health is also monitored as part of the support plan review process so that any changes can be acted upon with Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: minimum delay. Fourteen of fifteen service users said in the questionnaires that they feel well supported and well treated by staff who listen to what they have to say and are attentive to their needs. Medication is now stored in a locked cupboard in each persons room. This was done with a view to administering medication in the privacy of their room, increasing their involvement and to offer more control to those who may be able to manage their own. The records relating to medication administration were seen to be complete and up to date. There is information about what each person is taking and possible side effects to be aware of. The manager said that all staff who are involved in medication have received an appropriate level of training and she is satisfied with their competency. Care Homes for Adults (18-65 years) Page 18 of 28 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 are supported and enabled to make complaints. The management and staff make sure that complaints are listened to and sorted out. The homes recruitment procedure checks people who come to work at the home to make sure service users are protected from the risk of harm. Evidence: The home has revised its written complaints procedure to now include pictures and symbols to make it more meaningful to everybody. Each service user has a copy of it in their room. This is discussed with them when they first come to live at the home and a general copy is on display for visitors to the home. In the survey questionairres, all but one of the service users said they knew who to speak to if they were unhappy and eleven said they knew how to make a complaint. One service user spoken with summed up the general mood when he said that support workers are very good, they sort out my problems. All six staff who answered said that they knew about the complaint procedure and how to raise a concern if they were not happy. Staff said that they would seek to resolve any thing that caused distress to the service user and try to reassure them. Staff have received training in the protection of vulnerable adults and were clear in their explanation of what they would do if they had any cause for complaint or concern. The AQAA told us there have been no complaints or safeguarding issues in the last 12 months. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People said that they enjoy living in a home which is well maintained, clean and comfortably furnished. The home is arranged in a way that suits their individual and collective needs. Evidence: The manager told us that a programme of decoration and improvement is in place and in the past 12 months they have changed the floorcoverings in several areas and also replaced all the dining chairs. We saw, as we looked round the home, where improvements had been made and were told about the forthcoming works, such as addressing the need for a ramp in the car park to meet someones mobility needs and the foundations laid for a training kitchen in the grounds. This is intended to encourage and support service users to develop their daily living skills and move toward a more independent lifestyle. We spoke to some service users who said that they liked their surroundings, and having their own rooms that they can personalize with their own bits and pieces. We saw that there are a number of communal spaces in the home that people moved freely between. There is a wide entrance hall with easy chairs and settees that people congregate in, particularly when incoming staff arrive or when the door bell rings. Externally the grounds are well kept by staff and service users. Some areas are being developed as vegetable plots, for interest and to supply the kitchen, and other areas Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: have chairs and benches for just sitting and enjoying the surroundings. Care Homes for Adults (18-65 years) Page 21 of 28 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. Recruitment procedures are sound and protect service users. Staff receive induction and training to help them do their job properly. There are sufficient staff on duty to support service users with their daily care and recreational needs Evidence: We talked to the manager about staffing in the home and looked at the staff duty rotas. We were told that there is an average of four support workers on duty, plus the manager on weekdays. We saw that rotas are worked out to cover for staff training and residents activities. Staff were seen listening to service users and appeared well motivated to support them. One service user said that the staff are nice and helpful and encourage him to do lots of new things. Another said that he felt he could talk to staff if he felt upset about anything. There is a Commitment to staff development. Staff were asked in our surveys if they were being given training that is, relevant to their role, helps them understand and meet the needs of people, keeps them up to date with new ways of working and gives them enough knowledge about healthcare and medication. Six completed the question and said ,yes they were. The AQAA told us that 15 staff have attained NVQ level 2 or above. All new staff have to complete initial training, to acquaint themselves with the home and residents and things to ensure safety. We spoke to a staff member about the induction training, and they said Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: that this is linked to the Learning Disability Award and helped to give them the skills and confidence to do their job properly. There are a number of training courses that staff attend following their introductory training, these are called mandatory courses and include things like, food, diet and nutrition, first aid, safe moving and handling, fire safety, health and safety and infection control. Once these are completed all staff should have opportunities to attend other courses that are specific to caring for people with learning disabilities, such as, autism, Aspergers syndrome, and epilepsy. We talked to the manager and looked at staff files and saw that the organisation has robust recruitment procedures in place to protect residents. A number of security checks are completed before new staff start working at the home. These include written references and a criminal records check to make sure that they are trustworthy and safe to be around the residents. We also saw from staff records that they receive individual supervision with the management at least six times per year. This is to monitor performance and discuss training and development needs and achievements. Care Homes for Adults (18-65 years) Page 23 of 28 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. Residents benefit from living in a well managed home where their best interests are safeguarded and their health, safety and welfare are promoted and protected. Residents can be confident that their views are listened to and affect any changes introduced in the home for their benefit. Evidence: The manager has several years experience of working in the care sector. She is registered with us. This means that we think she has the right qualifications, experience and necessary skills to run the home. We saw that the open management approach of the home makes sure there is good communication between staff and between residents and staff. This means that residents are consulted and involved in the daily running of the home and in planning their own individual lifestyles. They have regular residents meetings and staff meetings. Residents have their regular one to one meetings with their key worker and staff have regular supervision meetings with the manager. There is ongoing quality monitoring that includes monthly visits by a representative of the owning organization. Since the last inspection the home has Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: arranged for all service users to have their own bank accounts and a number are supported to manage their own monies. The AQAA indicates that they utilise review meetings, family visits and residents feedback on the home to assess how well they are doing and identify areas for future development. They encourage people to respond to the relatives and residents satisfaction questionnaire and to make written suggestions for change and improvement. Staff members spoken with said that they felt valued and that they have a voice in the home. In response to our survey questions, two care professionals commented that the manager appears committed to providing the service users with an active programme and as much independence as possible. They also said that the Manager is always open to ideas and ways to improve the service, keeps them informed and up to date with developments. The AQAA indicates that safety checks are up to date. There is some remedial work required following the most recent electrical inspection but the Manager said that this is in hand and will be rectified within days. The manager said that regular health and safety audits are carried out so that anything identified can be quickly remedied. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 27 of 28 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). 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