Care Home: The Retreat

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What the care home does well Staff know people well. Staff know what people like and what they do not like. Listens to people and helps them to do the things they want to do. Looks after people`s health and cares for them well. Helps people keep in touch with their families and friends. Helps people get out and do activities that they enjoy. People have comfortable bedrooms with their own things in them. What has improved since the last inspection? There has been some redecorating. Some of the paperwork has got better. What the care home could do better: Carry on making the paperwork better. Carry on making the decorating better. Get a better cupboard to keep people`s medication safe. Key inspection report Care homes for adults (18-65 years) Name: Address: The Retreat 64 Hall Lane Walton On Naze Essex CO14 8HD     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: Louise Bushell     Date: 1 7 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Retreat 64 Hall Lane Walton On Naze Essex CO14 8HD 01255675948 01255861241 sneating@btinternet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Reverend Graham Beresford Edwards care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed four persons) Date of last inspection Brief description of the care home The Retreat is a home for up to four younger adults who have a learning disability. The home is situated close to the seaside town of Walton on the Naze. There is transport provided by the home. Each person has their own bedroom and access to kitchen, bathrooms and lounge areas. There is separate self contained accommodation for one person who needs less support from staff. 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 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: We looked at lots of different evidence for this report. We looked at paperwork like care plans, staff files and menus. The manager sent us information called an Annual Quality Assurance Assessment or AQAA. This gave us information about how they run the home. We visited the home on 17th February 2010. We looked around the home. We talked to people living in the home and staff. We looked to see if people were happy with what goes on in the home. Care Homes for Adults (18-65 years) Page 5 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 27 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 7 of 27 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 choosing to live at The Retreat can be confident they understand what the service provides and that their needs will be met. Evidence: The manager told us in the AQAA, Upon looking for a place to live a prospective resident will receive a copy of the Statement of Purpose and Aims and Objectives of The Retreat which gives a comprehensive overview of the place, the care offered, the client group, the staff and the policies of the home. There is also a Residents Guide which lays out the essentials in a more service user friendly way. This, together with a photo CD if the house, accommodation and grounds give a clear view of what the home offers. We examined the Statement of Purpose and Service Users Handbook. The Statement of Purpose clearly states the Aims and Objectives of The Retreat. The information is clearly laid out and the language used is also clear. The information in the Service Users Handbook is supported by pictures and photographs of the home and surrounding areas. Should a vacancy become available, there is appropriate Care Homes for Adults (18-65 years) Page 8 of 27 Evidence: information available should anyone choose to move in to The Retreat. The manager told us in the AQAA, The Retreat has an assessment form which we request be filled out by relatives or carers to give a wide ranging understanding of the needs of the individual. Further discussion with the Commissioning authority and family would establish if the placement was suitable and their needs could be met and We have had no new admissions to The Retreat since 1986, however should we have a new admission we will review the documentation/procedure both during and after to ensure that it is still appropriate. There have been no new admissions to The Retreat for many years. However, there is an appropriate process in place for assessing the needs of anyone wishing to move in to the home. Records examined confirm that the assessment process for people already living in the home continues to be updated to take any changing needs into account. Care Homes for Adults (18-65 years) Page 9 of 27 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 are confident that their needs are met in ways that they want. Evidence: The manager told us in the AQAA, Each resident has a Personal Care Plan which is reviewed every six months or, where progress necessitates an earlier review. These relate to the skills towards independence that are being worked on and give short and long term goals, specific tasks that are being attempted and instructions to staff on accomplishing these. We ensure that these tasks are sufficiently detailed. The care plan has been updated to reflect the needs and wishes of the residents, it includes information on their most important relationships. We examined the care plans of all three people living in The Retreat. The information in each care plan starts with a circle of people who are important to the individual. This is illustrated by a photograph of the person at the centre of the circle with people who are closest to the individual named in the closest circle (including for one person, Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: the cat) and others such as health professionals on circles further away from the photograph. It was evident from discussions with the manager and deputy manager that they know the people living in The Retreat well and they are each treated and respected as individuals. Each care plan gives good detailed information about the person, starting with positive attributes and what the person is good at. Care plans then document ways in which the person may require more support or challenges they may face. The manager told us in the AQAA, High priority is given to ensuring choice in all that residents do, beginning with choosing which clothes to wear, and specific time is allotted to staff as the process of choice can be a long one otherwise there may not be sufficient time to make the choice a meaningful one. Residents have a choice of breakfast cereals and what they would like after their cereal and what they wish to drink etc. Residents are encouraged to make choices about what activities they would like to do ans what they would like to take part in. All staff seek to empower residents, although because of their level of disability, residents are on the whole unable to take a very active role in the running of the home and changing the environment. None the less they express the choice of when to go to bed, go out, have a drink, a shower or a bath for example. Care plans contain Mental Capacity Act (MCA) assessments of peoples capacity to make decisions. The manager and deputy manager explained how they support people to make decisions. On the day of the inspection we saw that one person living in the home has good verbal communication skills and is able to make their needs known. Observations of interactions between staff and people living in The Retreat confirm that staff listen to people and have a good understanding of how they communicate their needs and wishes. The manager told us in the AQAA, The Risk Assessment policy recognises that everyone has a right to take reasonable risks in their enjoyment and experience of life. Some risks are well worthwhile whilst others are too dangerous, especially when the dangers are such that the resident does not appreciate the risk. To protect the resident and the staff, risk assessments need to be completed to ensure that the risk is reasonable and the ways in which the risk can be minimised. This permits residents to go to such places as theme parks and one resident to make short journeys on [their] own. Records examined confirm that there is a robust process in place for assessing risk. Each person has a general risk assessment in place covering a range of areas of risk. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: One person has identified areas of risk in the kitchen, with personal hygiene, doing housework, electrics, general safety, outings and social activities. The positive things the person can do are identified and areas that pose a risk are documented. Information about what support is required to reduce the risk is well documented. The information in the risk assessments is written in a positive manner with the emphasis on enabling the person rather than restricting them. There are also risk assessments covering pressure sores and general hygiene. Care Homes for Adults (18-65 years) Page 12 of 27 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 living at The Retreat enjoy a lifestyle that meets their wishes. Evidence: The manager told us in the AQAA, Residents feel secure and continue to make progress in their skills except where their physical condition precludes this. They are assisted to go shopping and to use leisure and community facilities. They choose from a wide range of activities that they themselves have chosen to do, both within and outside the home. They are encouraged to participate in activities that challenge and expand their abilities. When we visited the The Retreat, the three people living there were at Peterhouse, the other home in the group. The manager explained that they go there every day and have been doing so for many years. Both the manager and deputy manager explained that all of the people from The Retreat enjoy their time at Peterhouse and are eager to Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: go every day. Should anyone not wish to go or if they were unwell staff will support them at The Retreat instead and there is no question of anyone having to go to the other home against their wishes. The manager and deputy explained that they have built up long standing friendships with people living at Peterhouse and they also enjoy socialising and the wider range of activities available. In the afternoon when they returned from Peterhouse, one person was able to tell us how they enjoyed their day. One person living at The Retreat lives a very independent lifestyle in a self-contained cottage off the main building, with their own bedroom, living room, kitchen and bathroom. Through discussions this person demonstrated how happy they are with their lifestyle and living arrangements. Care plans examined contain evidence of a range of activities that people take part in including college, pubs, church friendship club and parish lunch. People also enjoy inhouse activities both at Peterhouse and when they come home to The Retreat. One person enjoys cooking and often makes cakes. The manager explained the input people have from relatives. One person spoken with explained how they keep in touch with relatives. The manager told us in the AQAA, Residents and staff share all meals together, Fresh food is used. Residents who are unable to make suggestions as to what they wish to eat have known likes and dislikes and where this conflicts with what is being prepared they are given an alternative that they find acceptable. The small size of the home ensures the arrangements for choosing and preparing meals is homely and domestic. Staff support and encourage people to take part in shopping and menu planning. Where people are unable to communicate verbally, staff make use of other means of communication including Makaton signing and picture cards. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Retreat are confident they are supported as they would wish with their personal and healthcare needs. Evidence: The manager told us in the AQAA, Personal support is offered in a caring and respectful way, promoting choice and independence which is appreciated by the residents who show that they feel at home, relaxed and confident in the staff. Care plans examined contain information on how people like to have their personal care provided. Through discussions the manager and deputy manager were able to display a very detailed knowledge of peoples preferences around personal care. The manager told us in the AQAA, Health needs are met fully by visiting professionals or by going to medical or specialist centres. As at the last inspection, there is ample evidence in records examined to confirm that people living at The Retreat are supported appropriately with their individual healthcare needs. Records confirm that people visit the dentist and optician. They are Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: also supported to have input from their doctor or consultant and to attend hospital appointments. Records examined confirm that people are healthy. The manager told us in the AQAA, All staff are trained in administration of Medication which uses a monitored dosage system. No resident is able to administer their own medication safely, so are dependent on staff. On the day of the inspection we examined the homes processes around supporting people with their medication. Medication is currently stored in a locked bureau. The cupboard was clean, tidy and well organised, with topical medication such as ointment kept separate from oral medication. However, a piece of domestic furniture that is not of metal construction is not sufficiently secure to store medication and does not meet the guidelines set out by the Royal Pharmaceutical Society of Great Britain. The manager and deputy manager explained that they have just changed to a new supplier for their medication who will be providing a new storage cupboard. We discussed also having a small lockable drugs fridge available for the storage of any medication that needs to be stored under controlled temperatures. No-one living at the home currently takes any controlled drugs, but we discussed the need for the new cupboard to have a facility for the storage of controlled drugs should anyone be prescribed medication that requires an enhanced level of secure storage. The deputy manager demonstrated a good awareness of protocols for medication such as senna or paracetamol that are prescribed on an as required basis (sometimes referred to as PRN medication). Care Homes for Adults (18-65 years) Page 16 of 27 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 using the service are confident that any concerns they may have are listened to and acted upon. Evidence: The manager told us in the AQAA, All staff and relatives receive the complaints policy on their arrival or first visit. Records examined confirm that each persons care plan contains an personal, individualised copy of The Retreats complaints policy. Not all of the people living in the home have the ability to understand about making complaints. One persons care plan states, X is able to understand the concept of making a complaint and is able to express [themselves] and make [their] wishes known and it is the duty of staff to help X understand [their] right to complain and help [them] to do this. There have been no complaints received by us in the past year and staff spoken with said there have been no complaints. The manager told us in the AQAA, Staff also receive a Whistleblowing policy with their induction pack on the first day of work and are encouraged to use it should they find a need. Included in the induction pack are several documents that support the rights of residents including our Abuse Policy, POVA booklet, Charter of Residents Rights etc. This forms an important part of the induction process of all staff. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Records examined confirm that The Retreat has policies and procedures in place relating to safeguarding. Staff receive information in staff induction packs when they commence employment. Personnel records confirm that there is a robust recruitment process in place that ensures all the relevant checks are carried out to ensure the prospective employee is fit to work with vulnerable people. Staff training records confirm that staff have received training around safeguarding (previously referred to as Protection of Vulnerable Adults or POVA). On the day of the inspection we discussed with the manager how peoples finances are managed and records relating to individuals finances were examined. Each persons monies are kept separately with receipts and full records being maintained for any spending. Records examined were all found to be in order. Care Homes for Adults (18-65 years) Page 18 of 27 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 enjoy living in a homely environment that meets their needs. Evidence: The manager told us in the AQAA that they, Provide a homely caring atmosphere in which residents feel at home and respected and Bedrooms are individualised so they reflect the personality and interests of the residents. The Retreat is an older style property with a small cottage adjacent to the main building. One person lives in the cottage and manages much of the activities of daily living with a degree of Independence but supported where necessary by staff. The cottage reflects the persons tastes. There is ample evidence of personal possessions, including photographs, pictures, ornaments, music and DVDs. Peoples bedrooms in the main house are also comfortable and reflect their personality. One person chooses by their behaviour not to have items in their room and can be intolerant of clutter. However, the room is bright, pleasant and clean with pictures on the walls to make it more homely. The manager told us in the AQAA, The resident who has consistently chosen to reject personal items from [their] room has been part of a programme to seek to encourage [them] to tolerate such items. There has been some success in this and this programme continues. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: Since the last inspection some areas of the home have been re-decorated and overall, taking into account the older style of the property, The Retreat is comfortable and homely. The Retreat was clean and there were appropriate facilities for handwashing, including liquid soap and paper towels. The manager told us in the AQAA, There is a good awareness of health and safety issues among the staff. Care Homes for Adults (18-65 years) Page 20 of 27 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 living in The Retreat are confident that staff support them as they would wish by meeting their needs and keeping them safe. Evidence: The manager told us in the AQAA, There is a low turnover of staff and that they, Provide long service staff that the residents are familiar and secure with. The manager also told us, Residents enjoy staff and show pleasure when they come on duty, greeting them with enthusiasm and asking about them when they are not there. We discussed staff qualifications with the manager and deputy manager. They explained that most staff have completed a National Vocational Qualification (NVQ) at level 2. The deputy manager has also completed level 3 and 4 and has the Registered Managers Award (RMA). The AQAA dataset confirms that 5 out of 6 care staff working at The Retreat have an NVQ qualification. The manager told us in the AQAA, Appointment of staff is a careful process to procure staff capable of working to a high standard and having a commitment to caring for the needs of the residents. This has produced a highly motivated staff with great commitment and interest in the residents. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: During the inspection we examined a sample of two personnel files. The files had a checklist on the front displaying the contents and were well organised. All the documentation required by regulation was in place in the records examined. We discussed the recruitment process with the manager and deputy manager and they explained how one of the people living in the home was involved in recruitment and interviewing of prospective employees. We examined the staff training matrix for 2009-10. Training that has already taken place includes Fire Safety, Deprivation of Liberty Safeguards, Medication and first Aid. Staff spoken with on the day of the inspection displayed a good knowledge of the needs of the people living in The Retreat and spoke confidently of how they support people. These discussions demonstrated a good understanding of good care practices. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in The Retreat are confident that the service is managed in their best interests. Evidence: The manager of The Retreat is suitably qualified and, through discussions, was able to demonstrate a good awareness of his responsibilities around managing the home. The manager was also able to demonstrate an in depth knowledge of the people living in the home, including their needs, wishes, preferences, what they dislike and their individual behaviours. The manager is ably supported by the deputy manager, who also works at the other home in the group, Peterhouse. This ensures continuity of care for the people living in The Retreat both when they are at home and when they are visiting Peterhouse. The manager told us in the AQAA, An annual QA [Quality Assurance] programme seeks the views of residents, relatives, friends, staff and professionals on the services quality. All comments are considered, appreciated and answered. The views and responses of the residents (though often non-verbal) are taken as a priority for Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: analysis and action. Throughout the day the manager was able to explain how they monitor the quality of the service and get the views of people living there. The abilities and behaviours of the people living in the home mean that formal meetings are not appropriate. However, as it is a small home there is ample evidence that staff give people one-to-one support and listen to their views. On the day of the inspection we observed very good interactions between staff and people living in the home. A sample of documentation relating to health and safety was examined and found to be in order. This included fire testing, evidence of electrical re-wiring and maintenance of the heating system. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 1 20 So that peoples prescribed medication is stored securely, the provider should ensure an appropriate drugs cupboard is installed (as planned) that meets the guidelines drawn up by the Royal Pharmaceutical Society of Great Britain. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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