Care Home: Waterfield Supported Homes Limited

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What the care home does well The home became registered with the Commission in June 2009 and by the time of this inspection had three people in residence. Our first inspection has shown that the home has made a very positive start by delivering person-centered services that ensure good outcomes for residents. The home is good at making sure prospective residents are able to make informed decisions about whether this is the right home for them to move into. Detailed written information about the home is provided, and trial visits and phased admissions are offered. Residents benefit from care plans and supporting risk assessments that reflect their needs and that are kept under review. The home works well with other agencies in ensuring residents` physical, mental and social care needs are met. The home is good at supporting residents to maintain links with their families and with the local community, and to engage in leisure activities. Residents can be confident that any concerns or complaints they raise will be taken seriously, and that there is good awareness by staff of their responsibilities with regard to protecting residents. The home offers a pleasant living environment, and residents find it is a comfortable and homely place to live. There are enough appropriately trained and qualified staff to meet the needs of the people who are currently living in the home. The skills and experience of staff members are reflected in the good quality of the services being provided. This is a well managed service, run by managers who are knowledgeable about mental health issues. People`s health and safety is promoted. Visiting health and social care professionals have confidence in the ability and commitment of the home`s managers and staff to supporting their clients. What has improved since the last inspection? This was the first key inspection of this service. What the care home could do better: They should make sure the procedure for preparing leave medication is always readily available for staff and that, whenever possible, a second person signs any handwritten addition or amendment to a medicine chart. The home has started well and now needs to sustain and build upon the good quality of support that has been delivered to its residents since it opened. Key inspection report Care homes for adults (18-65 years) Name: Address: Waterfield Supported Homes Limited 23 Broadfield Road London London SE6 1ND     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: David Lacey     Date: 2 3 1 2 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: Waterfield Supported Homes Limited 23 Broadfield Road London London SE6 1ND Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Peter Anike Type of registration: Number of places registered: care home 5 Waterfield Supported Homes Ltd 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 5 The Registered person may provide the following category of service only Care Home Code PC to service users of the following gender Either whose primary care needs on admission to the home are within the following category Mental Disorder - Code MD Mental Disorder - Code MD Date of last inspection Brief description of the care home Waterfield at Broadfield Road is a residential service for five adults with mental health problems. It is part of Waterfield Supported Homes Ltd. The home is a Victorian house in a residential area, close to local shops, public transport and GP surgery. Single bedroom accommodation and communal facilities are provided, together with staff support. Waterfield provides details of its fees on request. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 5 5 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: The quality rating for this service is two stars, which means that people using the service receive a good service. This was the first inspection of the care home since it had been registered. The unannounced site visit for this key inspection was completed over one day. Each of the three residents living in the home at the time of this inspection were spoken with and their care was looked at in detail. The registered manager was not on duty but discussions were held with the two support workers on duty and with the manager covering during the registered managers absence. The site visit included a tour of the premises and sampling of documentation such as care plans and records of care provided, and staff recruitment and training files. As part of the inspection, we carried out a survey by questionnaire of residents, staff members and visiting health or social care professionals. The responses received by Care Homes for Adults (18-65 years) Page 5 of 28 the time of writing this report have contributed to the evidence underpinning our judgements. Care Homes for Adults (18-65 years) Page 6 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 Care Homes for Adults (18-65 years) Page 7 of 28 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. The statement of purpose and service user guide contain full information, which helps people to decide whether this is the right home for them. Peoples needs are fully assessed before they move into the home, so they can be confident the home can meet them. Residents are provided with a statement of the terms and conditions of their stay. Evidence: The home has a statement of purpose and a service user guide that give full information, as required in regulation. Prospective residents are given a copy when they come to visit the home. The residents who responded to our survey stated they had received enough information about the home before they moved in so they could decide if it was the right place for them. The current residents had been encouraged to visit the home before deciding whether to move in. One explained she had moved here from the companys other care home nearby and said she had been consulted about all aspects of the move and made decisions about it. The residents who responded to our survey stated they had been Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: asked if they wanted to move into this home. The covering manager, who is the registered manager of the providers other care home nearby, said the homes registered manager and staff work closely with the agencies involved in the care of people referred for admission, and that phased admissions can be arranged if required. Each resident has a contract that sets out the terms and conditions for their placement. Discussions and examination of relevant documentation showed that a full assessment of needs is undertaken before a person moves into the home. The home uses an assessment form and staff gather information from other professionals involved in the persons care so that a full picture of that persons needs may be obtained. The visiting professionals responding to our survey stated the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned for people. 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. Residents benefit from having care plans that reflect their assessed needs and from the supporting risk assessments. Residents are encouraged to take decisions about their lives and benefit from the support provided by the staff team to enable them to exercise their choices. Evidence: Each of the three residents had care plans with supporting risk assessments. Care plans were detailed and addressed the totality of residents needs. The plans were personalised and tailored according to each individuals needs. Risks had been assessed before admission to the home in accordance with health and social services protocols. Plans and risk assessments were being kept under review, with the involvement of the individual resident being encouraged. The three staff members responding to our survey confirmed they are always given up to date information about residents needs, for example in the care plan. Each of the current residents was receiving enhanced Care Programme Approach Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: (CPA) support and CPA meetings are held every six months. Staff members keep daily records of the progress and welfare of each individual resident, which confirm the support provided. Records seen were of a good standard, with information given about peoples mood, mental state and activities they had undertaken. One of the residents who responded to our survey commented that something the home does well is that it looks after peoples needs. The three staff members responding to our survey stated they have enough support, experience and knowledge to meet residents different needs, including needs relating to disability, gender, age , race and ethnicity, sexual orientation and faith. The visiting professionals responding to our survey stated peoples health and social care needs are always properly monitored, reviewed and met by the home. They also confirmed the home always seeks advice and acts on it to meet peoples health and social care needs and improve their well-being. One professional commented that the service users needs are well met socially, emotionally, culturally, and religiously and that I feel confident that the people I placed there their needs are being met. The other professional commented that the home had been proactive in providing a specially tailored service to the needs of my client. The home had gained access to an interpreter for a resident whose first language is not English. Although the resident speaks some English, she benefits from using her first language in situations such as hospital appointments or when she is feeling unwell. One of the residents who responded to our survey stated she always makes decisions about what to do each day and one stated this is sometimes the case. They stated they can do as they wish during the day, in the evening and at weekends. The visiting professionals responding to our survey stated that the home always supports people to live the life they choose wherever possible. 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. Residents are encouraged with opportunities for personal development. Residents are supported to ensure that their rights and responsibilities are recognised. They are supported to maintain links with family, friends and the local community, where this is their choice. Residents know they are able to have a healthy and nutritious diet. Evidence: The home supports residents to maintain contact with their families and friends, where this is the residents choice. This includes supporting visits to families, within a risk assessment framework. Discussions and examination of records showed relationships with family members and friends are encouraged and supported. Residents feel free to use the homes facilities and all residents are offered keys to the home and to their rooms. Informal house meetings are held to discuss issues such as menus, outings and holidays. Individuals are supported to take part in age and peer Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: appropriate activities, attend events and enjoy leisure pursuits both in the home and in the community. On the day of inspection, residents were looking forward to being driven to central London to see the Christmas lights. It was understood that, wherever possible, the home tries to ensure that any interests and activities that residents had been pursuing before their admission to the home remain as part of their programme. Staff support residents with cooking, shopping, cleaning and laundry as part of their rehabilitation programmes. One of the visiting professionals responding to our survey commented that the home has been excellent in trying to engage my client in activities/opportunities within the local community such as day centres and community opportunity services, also providing trips out to other places of interest. Nutritional needs are monitored on an ongoing basis, and special diets are catered for. For example, there was evidence of how a resident is supported to manage her diabetes with an appropriate diet. Residents said they like the food provided. 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. Residents are supported with personal care as appropriate to their needs and preferences, and their physical and emotional needs are met. Residents know their progress and well-being is monitored and that any changes or concerns are addressed promptly. The homes management of medication is good. Evidence: The people living in the home at the time of inspection were able to manage their own personal care, though sometimes need prompting and encouragement from staff members. It was evident from discussions and from examination of residents care files that they are supported to access the health and social care they need. For example, residents are supported to visit the GP as they need and they have regular contact with community mental health teams. One of the visiting professionals responding to our survey commented that the home had built up very good links with the local GP surgery. Medication is supplied by a local pharmacy in blister packs and stored safely. The receiving pharmacist stamps the homes returns book when unwanted medication is returned. There were no controlled drugs being stored in the home. Leave medications Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: are secondarily dispensed into a dossette box that the resident can take with them. The covering manager stated either the registered manager, herself or another registered nurse carry out this secondary dispensing, as this is not done by support workers. The medication policy on file dated August 2008 did not have a section about secondary dispensing. The covering manager stated this was kept elsewhere in a procedure bundle. It should be more readily available to staff to help to ensure safe practice (see recommendations). Two of the three medication administration charts seen had handwrittten additions, which the covering manager said she had written. It was recommended that wherever possible two people sign handwritten amendments, as this reduces the possibility of any errors being made (see recommendations). The three staff members responding to our survey confirmed they are being given training that gives them enough knowledge about health care and medication. One staff member commented that medication training is always updated. Staff do not give the insulin and depot injections which were being prescribed for one resident, as these are given by the district nurse and community psychiatric nurse respectively. The visiting professionals responding to our survey stated the home either supports people to administer their own medication or manage it correctly where this is not possible. At the time of this inspection, none of the residents were self-medicating but there is lockable storage in their rooms if they do keep their own medicines and the homes policy states that self-medication is promoted whenever possible, within a risk assessment framework. 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. Residents can be confident that any concerns, complaints or allegations they raise will be taken seriously. The home operates policies and procedures that protect residents from abuse, and staff receive relevant training in this respect. Evidence: The residents who responded to our survey stated they know who to speak with if they are not happy and that they know how to make a complaint. Residents are given copies of the complaints procedure which they have in their bedrooms. The visiting professionals responding to our survey stated the home always responds appropriately to any concerns raised. Staff members know the importance of taking the views of residents seriously, and of listening to and responding to issues raised. Each of the three staff members responding to our survey stated they knew what to do if someone has concerns about the home. Observation during the inspection showed relaxed and positive interactions between residents and staff. One of the residents who responded to our survey stated the care staff and managers always treat her well and always listen and act on what she says. The other resident who responded stated she is usually treated well and that staff sometimes listen and act on what she says. There was no evidence seen or heard during the inspection visit that staff were not listening to residents or treating them well but the home will wish to take these responses into account in assuring the quality of care provided. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The home has policies and procedures in place that safeguard vulnerable adults. All staff receive suitable training about safeguarding and those interviewed during the inspection had good awareness about protecting the people using the homes services. The commission has not received any concerns, complaints or allegations about this home since it opened. 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. The home offers its residents a clean and safe living environment. The communal areas are well equipped and furnished, and residents bedrooms suit their needs. Evidence: The home is set in a Victorian house, in a residential area near local shops and other community facilities. The environmental standards of the communal areas and the bedrooms were assessed as part of the commissions registration process for the home earlier this year. The home was clean and tidy on the day of inspection, with appropriate standards of hygiene. One of the residents who responded to our survey stated the home is always fresh and clean, with the other resident stating this is usually the case. The residents bedrooms seen during the inspection were well equipped and furnished, and had their personal items to make the rooms feel homely. Residents were satisfied with their rooms and with the communal space available. All of the current residents were independently mobile. The home has a television in the communal sitting area, which two residents were watching when the inspector arrived, and an online computer in the activities room so residents can send or receive emails. There is a notice board with information for Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: residents and a pay phone in the hall. It was said residents can use the office phone if they need privacy while making a call. 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. There are sufficient staff to meet residents needs, and they are appropriately trained for their work in the home. The homes recruitment procedures are robust, supporting and protecting residents. Evidence: The three staff members responding to our survey confirmed their employer had carried out checks, such as CRB disclosures and references, before they started work in the home. They stated their induction programmes had covered very well what they needed to know to do the job when they started. The two staff members interviewed during the inspection spoke about their recruitment and selection processes, which they thought had been thorough and fair. The files of three staff members were selected for inspection and found to contain the recruitment information needed to support and protect residents. Some information was being held at the companys other care home nearby, and this information was also made available for inspection. The staff members responding to our survey confirmed they are being given training that is relevant to their role, helps them understand and meet peoples individual needs, and keeps them up to date with new ways of working. One commented, The manager always tries to keep training up to date, like health and safety, food hygiene, medication training. Another staff member commented that training is always up to Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: date and that staff are trained to support individuals to do as much for themselves as possible. There was evidence from staff files of training completed by staff and evidence from feedback of positive outcomes from training. The visiting professionals responding to our survey stated the homes managers and staff members have the right skills and experience to support peoples health and social care needs. One commented that their knowledge and skills are at a very high level. Another stated I have found the staff at Waterfield very approachable with good communication skills, and commented that my client is quite challenging but staff have always maintained a very professional approach and attitude. Staff members interviewed during the inspection were able to describe how they had applied the induction and further training they had undertaken to their work in the home. When the inspector arrived for this unannounced inspection visit there were two support workers on duty, providing care to the three residents who currently live in the home. The three staff members responding to our survey stated there are always enough staff on duty to meet residents individual needs. Rotas and discussions with residents, staff members and the covering manager confirmed there are always at least two staff on duty for day shifts and one at night, with the manager being supernumerary. The covering manager confirmed that a manager is on-call at all times should staff need advice or support. 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 run home that focuses on supporting them to achieve good outcomes. Equality and diversity, human rights and person centred approaches to care are given priority. The health and safety of residents, staff and visitors is promoted at this home. Evidence: The manager has been registered by the commission as the manager of the home, following a process of assessment. He was not on duty at the time of this unnannounced inspection but it was evident there were effective arrangements to cover the management of the home in his absence. There was evidence to show that the home is being run well. Equality and diversity, and person-centered services are given priority. The organisation has quality assurance strategies, which incorporate the views of residents, relatives and health and social care professionals to ensure that the standard of service is maintained. Residents are supported and encouraged to give their views about the running of the home. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The home has good health and safety procedures and practices, and documentation sampled for inspection was up to date and within the appropriate timeframes. Fire prevention equipment is checked regularly and a fire risk assessment was available. Staff follow the food hygiene policy and procedures, for example, they were using colour-coded chopping boards in the kitchen, and making sure that fridge and freezer temperatures were maintained within safe limits. At the time of our visit, the home had not yet had its first environmental health inspection. Staff make a weekly check of all sharp items in the kitchen and COSHH products were being stored in a locked cupboard in the kitchen, to which staff hold the keys. The covering manager stated there were no residents living in the home at the present time who were subject to deprivation of liberty safeguards. 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 The registered person should ensure the procedure for preparing leave medication is always readily available for staff. The registered person should ensure that whenever possible a second person signs a handwritten addition or amendment to a medicine chart. 2 20 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). 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. 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