Care Home: Valkyrie Lodge

What the care home does well Care plans are informative and help staff to understand the levels of assistance and support service users want and need. The staff team encourages service users to take part in activities, both in the home and around the local community. This home had a relaxed, friendly and welcoming atmosphere, and was light, bright and airy. The decoration, facilities and furnishings were of an excellent standard. What has improved since the last inspection? This was our first inspection since the home was registered with us in November 2009. What the care home could do better: Where possible, service users agreement to receiving medication support from staff should be recorded. Records should be kept to evidence that staff who administered medication to service users have been assessed for their competency to undertake this role. Evidence should be kept of issues covered in discussions at staff 1 to 1 support meetings. Key inspection report Care homes for adults (18-65 years) Name: Address: Valkyrie Lodge 27 Valkyrie Road Westcliff-On-Sea Essex SS0 8BY     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: Alan Thompson     Date: 2 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) © 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 28 Information about the care home Name of care home: Address: Valkyrie Lodge 27 Valkyrie Road Westcliff-On-Sea Essex SS0 8BY 07983459415 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): dsummun@hotmail.co.uk S B Care Ltd (Dinsesh Summun) Name of registered manager (if applicable) Mr Dinesh Summun Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following categories of service: Care Home CRH To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder - Code MD Date of last inspection Brief description of the care home Valkyrie Lodge is a two storey property that was first registered with CQC in November 2009. The home is situated in the centre of Westcliff-on-Sea close the local main high street (Hamlet Court Road), which has a range of shops and facilities available. The seafront and the Cliffs Pavillion theatre are also close by. Public transport links include Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 Brief description of the care home mainline train services from Westcliff station approximately 300 metres away, and bus services within walking distance of the home. The property was completely refurbished in 2009 before being opened as a care home for up to six people with mental health needs (Mental Disorder). The homes facilities include a large lounge dining room with an adjacent conservatory which also has dining furniture. There is a separate kitchen with an adjoining utility room. All six bedrooms are singles and all have private en-suite shower and wc. Bedrooms are located on both floors of the building. The garden was well maintained and accessible offering both lawn and patio area for service users to use. There was limited off road car parking for staff and visitors at the front. Street parking was available close by. The range of fees starts at £850 per week, but need to be discussed on an individual basis with the home as the exact amount will depend on assessed support needs. 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 unannounced key inspection commenced on Thursday 22nd April 2010 but no one was at home as people were out shopping. We therefore returned announced the next day, Friday 23rd April, to complete the process. This was our first inspection of Valkyrie Lodge since the home was registered with us on 24th November 2009. The content of this report reflects the inspectors findings on the days of the inspection along with information provided by the service and feedback by service users and staff. The manager was at the home on 23rd April and assisted us in a professional and helpful manner. The manager completed and returned their Annual Quality Assurance Assessment (AQAA) to us in time for the inspection. This is a self assessment required by law which gives homes the opportunity of recording what they do well, what they could do better and their future plans for improving the service. Some of the information and detail Care Homes for Adults (18-65 years) Page 6 of 28 provided within the AQAA has been included in this report. Discussions were entered into with service users, the manager and staff on duty. CQC survey questionnaires were also provided to service users and staff. Reference to feedback from these has been made within this report. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. All matters relating to the outcome of the inspection were discussed with the manager of the home, with full opportunity for discussion given and/or clarification where necessary. 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 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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. People considering moving into the home can be confident that the admission processes ensures that the home can meet their needs. Evidence: Service user placements are currently funded by health trusts. Records confirmed that these organisations had provided a referral and a risk profile assessment to the home before admission. In addition to this staff from the home carry out their own preadmission assessment. One service user had moved into the home since registration and admission information was looked at. The manager had completed an admission profile and risk assessment. The service user had been involved in this process and had signed to consent for this information to be recorded. There were several main headings of assessed needs which included, physical needs, social and activity needs, domestic and mobility considerations. The main headings had been further broken down into specific needs relating to eating and drinking, daily routines, washing and bathing, cultural and religious beliefs, medication, behaviours, daily domestic support needed, Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: family links and any sensory needs. Risk assessments seen showed the perceived risk and what actions, if any, are needed by staff and the service user to minimise these. Overall the assessment seen contained the information needed for staff to provide the right initial support when the service user first moves in. Comments in surveys returned to us confirmed that people were asked if they wanted to move into this home and that they received enough information before making the decision to live at Valkyrie Lodge. Care Homes for Adults (18-65 years) Page 11 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. The information in care plans ensures that peoples needs could be met in a way they would wish. Evidence: We looked at service user support plans. These had risk assessments with guidelines for staff on methods to minimise risk and had been reviewed. Risks were considered by looking at the risk history hazard, the possible effects of the risk, the warning signs and showed details of the steps needed to reduce this. Files seen included a written agreement between the service user and the home on how to manage incidents and aggression. Training records showed staff had received training that included responding too and managing aggression. Care files looked at showed assessed needs under headings that included, mental state, behaviours, risk and behaviour management plan, physical health, social needs, activities of daily living and psychological considerations. Care plans showed the Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: service users perspective of their needs, the staffs perspective and the desired outcomes. They also detailed the agreed support and interventions from staff towards meeting these. Care plans are updated as and when necessary and will be regularly reviewed with evaluation dates set for at least every six months. Healthcare issues were seen recorded on the service users file, including visits to medical professionals, hospital visits, GP and consultants. The manager confirmed that house meetings are held every month so that service users views and opinions about the service are listed too. Minutes seen of a meeting held in February had included discussion on menus, fire procedures, activities, holidays, and cleaning. Service user comments were included. A service user confirmed to us that they thought they are included in day to day decision making within the home. Care Homes for Adults (18-65 years) Page 13 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 living in Valkyrie Lodge can expect to be offered a lifestyle and diet to meet their expectations. Evidence: People currently living at the home are not, due to their assessed and agreed mental health dependency levels, able to work or access the community on their own. The manager and care records seen did though confirm that staff are making progress on improving peoples wiliness to go out and make use of local facilities and amenities. The long term aim is to support people to move towards becoming independent and to make use of the opportunities available to them outside of the home. Staff encourage people to take part in activities and records kept showed that people, with staff support, go shopping, have lunch out, go for walks and take part in indoor games and activities. Service users have a weekly written plan of suggested activities Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: for them to engage in. This included swimming, arts and crafts, gardening, cooking, board games, bingo, trips out, domestic chores and trips home. Records showed that people currently at the home choose not to take part in some of these. People currently living in Valkyrie Lodge see their families every week and staff will support this contact by driving the person home if they wish. If family visit the home there is a small visitors room of the first floor which is available if people wish to meet in private. Records had been kept of contact with family and friends. The manager confirmed that staff enter bedrooms only with the individuals permission, unless the welfare or well being of the service user is in question. All service users are able to have keys to their rooms and a front door key if they wish. Written agreements are drawn up to clarify which keys people wish to hold and their undertaking to ensure keys are kept safe. At the time of our inspection no one wished to hold room keys. Throughout this inspection staff were observed to interact appropriately with people and appeared to always use the individuals preferred form of address. Discussions between the service user and staff about routines and choices were seen to take place and the atmosphere in the home was supportive and friendly. Menus were inspected and evidenced a varied and balanced diet. Menus are flexible and can be changed according to service users preferences and choices. Minutes seen of house meetings included records of discussions on menus. The current service user usually chooses to have staff prepare and cook all their meals but is encouraged to take part in this activity if they wish. People spoken with confirmed that they were satisfied with the food, which may include two main meals every day. Care Homes for Adults (18-65 years) Page 15 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 can expect to receive personal and healthcare support in an appropriate and dignified way that meets their expectations and needs. Evidence: Care records and discussion with people and staff confirm that service users are fully supported in making their own choices around clothing styles, hairstyles and general appearance. Support plans include preferences around daily routines, and details of the levels of personal and healthcare support required were also seen documented. Peoples comments to us confirmed that they think staff treat them well and listen and act on what they say. Care files contained assessment of healthcare needs. The current service user group are offered staff support and guidance in recognition of their individual healthcare needs. Peoples ongoing healthcare needs were recorded within individual support plans, and updated in the daily care notes. People at the home regularly visit community based healthcare services including Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: community psychiatric nurses (CPNs), their psychiatrist and their GP. However because of their assessed needs they currently require staff support when they do this. People currently in the home were also receiving full staff support with their medication needs. Their files did not include their consent to this support and so we have recommended this is sought and recorded. The manager agreed that some service users may not have a full understanding or awareness of the medical reasons for medication regimes prescribed to them. The manager confirmed that if service users refused medication then advice and encouragement is offered to them to understand the reason for the prescribed dosage. If they continue to refuse their prescribed medication their psychiatrist is contacted for advice. The homes written medication procedure/policy clarified policies on homely remedies, side effects of the medicines prescribed, the storage of medicines and of administering prescribed dosages. Records were seen relating to the reordering and returns of unused medication. A random sample of medication administration records and stocks of current medication were inspected. No errors were noted. Several staff are Registered Mental Health Nurses (RMNs) and the manager is a student trainer. The manager advised that staff who are not nurses receive medication training at induction. We saw records of this training that had been provided by the manager. Unfortunately this did not include details of the areas covered, or written evidence to show that staff had undertaken an observed competency assessment before they take responsibility for administering medication to people in the home. We have recommended that this assessment is undertaken on all unqualified staff. Care Homes for Adults (18-65 years) Page 17 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. Practices in the home ensure that people are protected and that their views on the service are listened to and addressed. Evidence: The manager had a complaints procedure in place, which clarified the complaints process and the timescales that the manager should respond to the complainant. There was also guidance for staff on recording a complaint. The Service Users Guide (SUG) also included information on how to complain. The manager confirmed that a copy of this is given to all prospective new service users and is also displayed in the homes lounge. Comments made in service user surveys confirmed that if they were unhappy they would speak with staff or the manager. People currently at the home have active involvement with their respective families and with external health care professionals. These contacts offer people alternative routes for raising issues or concerns. The homes Statement of Purpose (SOP) provides advice on the use of personal representatives to support service users if they wish. Information in the AQAA shows no recorded complaints in the time from registration up to the 28th February 2010, the date the AQAA was sent to us. The manager also confirmed at the inspection that no complaints had been received but assured us that if any complaints are received records would be kept of the issues raised and of the investigation and outcome. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Seen in the home was copy of the safeguarding adults policy and procedure produced by the registered provider. This included detailed guidance for staff on the adult protection procedures to be followed and on types of abuse that may occur. Also shown was the actions staff must take if they suspect abuse had occurred. Staff had been trained on safeguarding vulnerable adults from abuse. This included in house induction training and e learning training. Staff confirmed to us that they had been trained on abuse issues and understood what was meant by safeguarding adults from harm. Also seen in the home was a whistleblowing policy which clarified staffs responsibility to report any suspected abuse. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable, clean and homely environment. Evidence: During the inspection a partial tour of the home was made accompanied by the owner/manager. The entire building had been completely internally refurbished to an impressive and high standard before being registered. All areas seen were well appointed, very clean, bright, homely and were well maintained, furnished and decorated. All of the bedrooms seen at Valkyrie Lodge have their own ensuite shower and wc. There are two bedrooms on the ground floor and four on the first floor. Private rooms had wardrobes, adequate storage facilities and were fitted with TV points. As well as having showers in all bedrooms the home also has a bathroom so that service users have the choice of taking a bath instead of a shower. This room also has a wc and there is a visitors wc on the first floor. People spoken with said their rooms were comfortable and confirmed that they were satisfied with the facilities in the home. They also confirmed that staff supported them to keep their room clean. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The manager confirmed that service users are provided opportunities to personalise their rooms to their own tastes and requirements, and some rooms inspected included various items of personal possessions according to individual choices. The laundry facilities were in the utility room which is off the kitchen. The equipment in place looked suitable for the size of the home. The home has a garden which could be accessed from the utility room and from the conservatory. The garden looked well maintained and had seating and a wooden garden room which is designated for use as a smokers room. There is a driveway at the front of the property which provides limited car parking for staff and visitors. 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. People who use this service are supported by staff who have been properly recruited and are trained for their roles. Evidence: We looked at the staff rota. One service user was living at the home when we visited, and there was one support worker on duty and the manager. The manager confirmed that whilst there is only one person in the home normal daytime staffing is one of duty with another person on call outside the home. The manager also said that staffing levels will be increased to two support workers as more people move in. Night time staffing is currently one on waking duties. This will also be increased as more people move in to include one on sleeping in duty. Two staff recruitment files were looked at. Evidence was seen to confirm that staff had been properly recruited with application forms completed, written references obtained and criminal records checks undertaken. Copies of proof of ID and photographs were also on files. New staff undergo initial induction training suitable for their role. Records looked at showed that this covered the premises, communication, fire safety, first aid, moving and handling, service user care, respecting privacy and dignity and polices and Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: procedures in the home. Induction records included the manager and staff members signatures to confirm completion. After this staff move on to full induction based on the Sector Skills induction for the service type. Staff confirmed that they received induction training and that this covered what they needed to know when they started their jobs at the home. Staff training records had been kept. Records and certificates seen along with feedback from staff evidenced to us that staff have been trained for their roles. Qualifications held and training provided to staff includes mental health nursing, NVQ, infection control, health and safety, first aid, fire safety, adult protection, challenging behaviour, food hygiene, medication and equality and diversity awareness. Staff confirmed they were supported by the manager, and records at the home showed that regular house meetings take place to enable all to be involved in the service provision. Most staff indicated that they received training opportunities appropriate to their roles, and all thought that the training provided helped them understand and meet the needs of service users. Staff we met were open and friendly, and the observed rapport between staff and service users was supportive and relaxed. Records were seen to confirm that regular 1 to 1 staff supervision and support had been held, and staff had confirmed that they are supported in their roles. However records had not been kept of the content of discussions at 1 to 1 meetings and we have recommended evidence of this is kept for us to see at future inspections. 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. Service users live in a well run home that is managed in their best interests. Evidence: The manager at Valkyrie Lodge is experienced and competent. The manager is a trained nurse in mental health, has twenty years experience of working in a hospital setting, and is a student trainer. In addition to this experience the manager has also been the registered manager since 2006, of a care home in Wickford that is linked to Valkyrie Lodge. At the time of this inspection the home had only been open for five months and this is insufficient time for the full quality monitoring process to be implemented. The manager confirmed that an annual quality monitoring exercise will take place and that this will include gathering the views of service users, healthcare professionals involved in the service and peoples relatives. Records will be kept of this process, along with the feedback received and of any actions taken. We did see evidence to show that on a day to day basis service users views on the support they receive are sought at house meetings held in the home. Comments in surveys returned to us also confirmed Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: that service users thought staff listened and acted on what they said and that they could make decisions about what they did each day. Random samples of records required to be kept by regulation were inspected. These included the staff rota, visitor book, menus, assessments, care plans, staff recruitment, medication records, service user monies held for safekeeping, fire procedures and fire drills. All seen were acceptably maintained. Records seen and feedback from staff confirmed that staff had received training in first aid, fire safety, health and safety and food safety. Service records were also looked at and showed that the homes fire alarms, fire equipment, emergency lights, gas systems, electrical installation supply and portable electrical appliances had all been tested/serviced when the home opened. The manager also confirmed that hot water supply is regulated for delivery at or near 43 degress celcuis to try to minimise the risk of scalding. 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 1 20 Records should be kept to evidence that staff who administered medication to service users have been assessed for their competency to undertake this role. Where possible, service users agreement to receiving medication support from staff should be recorded. Evidence should be kept of issues covered in discussions at staff 1 to 1 support meetings. 2 3 20 36 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. 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