Care Home: Westhill Care Home

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What the care home does well The home provides service users with a safe,secure,homely and comfortable environment to live in.It is very well decorated and furnished. People considering moving to the home have their needs comprehensively assessed and introductions go at the persons individual pace. Care plans are clear,person centred,up to date and contain current personalised risk assessments.Needs are reviewed by the home and with sponsoring authorities regularly. All the current staff team hold a National Vocational Qualification in care at level two or above and the home provides staff with core and specialist training. Recruitment practices are robust and protect service users. Staff are well supported and competent in their roles. What has improved since the last inspection? The premises have been considerably improved and extended and two new rooms have recently become registered.As well as the new bedrooms there is a larger dining area,larger kitchen,new office,new laundry room and a quiet seating area for service users and the garden has been improved and extended. Along with the extension there has been some redecoration and refurbishment of existing parts of the home. Some new activities for service users have been introduced. At the request of the service Deprivation of Liberty Safeguards assessments have taken place for two service users.Staff are provided with training and awareness of this process. What the care home could do better: Photographs of service users need to be added to their respective sections in the medication recording sheet folder to enhance the procedures for the administration of medication. All staff must attend food hygiene training as soon as possible after starting work at the home,one person had yet to attend the course at the time of the visit. Key inspection report Care homes for adults (18-65 years) Name: Address: 39 Westway Westhill Care Homes 39 Westway Caterham Surrey CR3 5TQ     The quality rating for this care home is:   three star excellent 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: Deborah Sullivan     Date: 3 1 0 3 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: 39 Westway Westhill Care Homes 39 Westway Caterham Surrey CR3 5TQ 01883341024 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): roshanwest@aol.com Mr Roshan Panchoo Name of registered manager (if applicable) Mr Roshan Panchoo Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: Any person accommodated within the category of sensory impairment will only have a hearing loss/deafness. The age range of the persons to be accommodated will be 35 - 65 years. The maximum number of service users to be accommodated is 9. The registered person may provide the following category/ies of service only: Care home only- (PC) to service users of the following gender: both Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Sensory inpairment (SI) Date of last inspection 9 1 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home The home is comprised of a converted semi-detached house and a two-bedroom annexe next door it has recently been extended and can now acommodate nine service users in total. The home is situated in a busy road in Caterham near to local facilities and is indistinguishable as a care home, instead blending in well with the local community.All accommodation is of a very high standard. The home is owned by Westhill Care Homes and the proprietor is also the manager of the home. The current weekly fees range between one thousand,two hundred pounds per week, to two thousand and three pounds per week.Fees are individually assessed according to the needs of the service user. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection of 39 Westway took place over nearly five hours.During the visit the registered provider/manager and the deputy manager were present . Six of the seven service users were at home for most of the time.There is an all male service user group. During the visit time was spent with service users,the provider,deputy manager and care staff.The building was toured and a range of recording and documentation including care plans,staff records and medication records were examined. Four staff members returned surveys prior to the visit and five were returned from service users who had mostly been supported to complete them by staff.One form contained a comment from a relative that the service user, Had greatly improved since being here. Service users are mainly non verbal so interaction with them was supported by the provider and staff. Care Homes for Adults (18-65 years) Page 6 of 28 The information in the surveys has been used to inform this inspection as has the AQAA(Annual Quality Assurance Assessment) completed by the registered provider as is required annually. 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. Service users and their representatives have access to up to date information about the home and visits are welcomed. The needs of prospective service users are comprehensively assessed before they are offered a place at the home to ensure that they can be fully met. Evidence: The home has a statement of purpose and service users guide,both have very recently been brought up to date to reflect that the home has been extended and two extra bedrooms added so that it can now accommodate nine people in total. Currently there are seven male service users living at the home and the provider/registered manager said there had been some interest in the new rooms. There is a comprehensive and holistic assessment procedure,the three care plans sampled each had a full pre admission assessment completed by the provider,that had involved other professionals,previous placements and relatives, and outlined the Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: service the home would provide for the person. Introductions to the home are individually tailored and can involve visits and overnight stays so that prospective service users can become familiar with staff,other service users and the environment. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user has a person centred plan that reflects their needs,goals and strengths and that is regularly reviewed. Service users are supported to make choices about their lives and take acceptable risks. Evidence: The care plans of three service users were sampled,the plans are person centred and kept in two folders.One is the daily working folder for staff and the other holds more detailed information on daily care needs,health plans,financial recording,information on activities,review notes,communication support needed and methods of communication and non current daily diary notes.All the information is confidentially stored and easily accessible for staff. The likes,dislikes,preferences and daily routines of each person were clearly recorded as were their goals and aspirations. A plan of each persons daily routine and support Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: needs is clearly laid out,and there are clear good quality individual risk assessments in place for activities at home and in the community.Examples being risk assessment for making a hot drink and for self injurious behaviour.The risk assessments read had all been reviewed within the past year. Discussion took place with the provider about service user participation in care plans.Due to the needs of the service users there is mainly participation in terms of keyworkers and other staff being aware of their needs and consulting them directly.However needs are effectively recorded and each plan gives a sense of the persons abilities,strengths and needs. Regular in house reviews take place as well as reviews by the sponsoring authority,a care manager arrived for a review during the visit and there was review recording on each care plan. Service users are given the support they need to make choices about their daily lives such as what activity they take part in,what to eat,how to decorate and furnish their rooms and what to wear.They are included in house meetings if they wish to attend and menus are developed that reflect their meal preferences. Care plans contain information on how service users communicate and staff demonstrated during the visit that they are aware of individual communication methods and how to interpret them. 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. A range of activities that take place at home and in the community is available to service users to meet individual interests and abilities. The home promotes an encourages family contact. Meals are nutritious,healthy and varied. Evidence: Each person has an individual weekly activity planner,some service users attend local colleges or day centres.Other activities offered include swimming,gardening in good weather,shopping for the house or personal items,going out for meals or to the pub and helping staff in the kitchen.Service users bring their washing to the laundry and once a week are supported by staff to clean their rooms. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Service users tend to like to keep to a set daily routine and the provider said it can be difficult for them to understand why some activities are not on during holiday times,but the home does its best to offer alternatives during these times. During the visit one service user was out at a day centre,for others it was mainly an at home day,some service users enjoyed a colouring session,and spent some time watching TV.Fire training for staff took place in the afternoon and some service users were present for this as well and were watching the practical demonstration of a fire extinguisher being let off in the garden. The home encourages service users to be part of fire training if they wish as concern about fire can be an anxiety for some of them. There is an annual holiday,last year service users went to the Isle of Wight.Trips out take place and there are plenty of photos around the home of various outings such as to Legoland. There are opportunities to attend social groups or clubs but the provider said take up, especially for going out in the evening was not always good as service users prefer to keep to their normal routines.The home had a poster up for a local Easter disco and it was thought some service users may choose to attend. Contact with relatives is supported,most service users have regular family contact and a number of relatives visit weekly. There is a four week menu that reflects service users meal preferences.One person is on a restricted protein diet and there are clear guidelines in place in the kitchen for staff to follow.The menu is healthy and varied,the main meal is taken in the evening. Meals are prepared by staff and service users who wish to can assist under supervision,they also help to load and empty the dishwasher. Food is purchased locally and service users can choose to accompany staff to do the shopping. 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. The health and personal care needs of service are well met and recorded. Medication procedures are satisfactory whilst they would benefit from some enhancement for the further protection of service users. The service respects service users rights and choices and seeks specialist advice if it has concerns these may be restricted. Evidence: The care plans read held up to date information on service users individual personal care needs and preferences.The service users living at the home all require some assistance with personal care,needs vary and each plan is completed in sufficient detail to give a thorough picture of needs and guidance for staff to follow. Independence with personal care is supported and encouraged as far as possible,for instance it is recorded where prompting is needed for a person to choose clothes to Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: wear. Care is taken to respect service users personal rights and opportunities for choice, Deprivation of Liberty Safeguards assessments have taken place for two service users,the result was that restrictions in place were appropriate to keep them safe. Health needs are recorded in individual health books.Service users have a variety of complex needs in terms of learning disability,autism and self injurious behaviour.Staff receive specialist training to enable them to understand needs and referral is made to external health professionals if necessary.A service user who had moved in last year had been referred to the local health learning disability team and was awaiting allocation.Contact is maintained with health specialists such as psychologists and psychiatrists and regular routine health checks are kept up. The home demonstrates that it manages obsessive and challenging behaviour well and has strategies in place that are effective, such as for managing a persons water obsession. Medication is stored securely in the main house, and in the annexe for the two people who live there.The majority of staff are trained in the administration of medication.The list of staff who administer medication needed to be updated to show current names and signatures,this was partially rectified during the visit with signatures to be added. Medication recording sheets were correctly completed but there were no photos of service users,the provider said they would add these as soon as possible. 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. The home has policies and procedures in place to ensure the safety of service users. There is a complaints procedure and service users have representatives who are available to assist them should they wish to complain. Evidence: The home has a complaints procedure that is available to service users and others. No complaints had been recorded during the past year and there have been no safeguarding vulnerable adults alerts. Service users would need support to make a formal complaint as they have limited or no verbal communication,the majority have family involvement and all have care managers.The provider said they would make a referral for advocacy if this were necessary. Staff are familiar with individual methods of communicating and are aware if a service user is expressing discomfort or is unhappy with anything. The safeguarding procedure gives clear guidelines for staff to follow and they attend safeguarding training.All staff are fully vetted during the recruitment process and CRB(Criminal Records Bureau) disclosures are repeated three yearly. Risk assessments are in place to protect service users from harm at home,in the community and from their peers or from self harm.All the risk assessments read on Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: care plans sampled were up to date. Two service users have had D.O.L.S (Mental Capacity Act 2005 Deprivation of Liberty Safeguards )assessments at the request of the provider.This was necessary as the home has needed to restrict their liberty in certain respects,for example access to running water in their room apart from at certain times of day due to an obsession with water.One assessment was read and the decision was that the measures the home was putting in place for the persons own safety and protection were proportionate with the risks involved. 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 benefit from living in an environment that is clean,comfortable,very well presented and homely. Evidence: The home has recently been extended and now offers accommodation for up to nine people.As well as providing two more en suite bedrooms,one with a wet room,the dining room is now extended,there is a new laundry room,a new small first floor seating area to provide additional seating to the main lounge,more office space and a larger very well equipped kitchen. There has been some refurbishment alongside the extension, and the home was very well presented and clean throughout,care staff are responsible for cleaning and laundry.The provider is hoping to add a conservatory to allow for an additional relaxation area in coming months. Part of the building is an annexe which two service users occupy,it has its own kitchen,lounge,and small garden.The two service users in the annexe mix with others in the main building, whilst preferring to be supported individually much of the time. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The main garden is large, safe and secure, attractive and well maintained.There is a patio area with patio furniture,flower beds and lawn and an area where it is intended service users can grow vegetables this year.The provider said service users enjoy gardening when it is fine. Vacant and occupied bedrooms were visited,those occupied were all of different colour schemes and furniture,choice of bed covering and personal items in the rooms reflected service users individual personalities. Rooms had pictures,photos,TVs,cuddly toys,puzzles,postcards and other personal items.One service user had a lot of pottery and some sugarcraft items he had made on display in their room.Service users all have keys to their rooms and can choose to lock them if they wish. The en suite toilet and bathroom in one service users room had areas of damp on the woodwork surrounds and walls,the provider explained this is due to the service users personal needs which include the need to interact with water.The home manages this by allowing the service user an agreed amount of time to use water each day in their own bathroom and as a consequence the damp occurs.Redecoration of the room is ongoing and this is well managed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a team of staff who are well trained and supported and knowledgeable about their individual needs. The homes recruitment procedures are thorough and they protect service users. There are sufficient staff on duty to meet service users needs. Evidence: The home was fully staffed at the time of the visit,during the morning four staff,two female and two male were on duty including the deputy manager and a senior carer.There are slightly more male than female staff employed overall which reflects the gender of the current service users.The staff group is diverse in terms of age,ethnicity and experience. The home does not employ any domestic staff and carers are responsible for cleaning,laundry and preparing meals. The majority of staff have gained a National Vocational Qualification at level two or above.Core training that is updated at required intervals is provided.External trainers are used and the training certificates seen on three staff files confirmed this. One staff member had not done food safety training,the provider said it had been planned but the person had been unable to attend, it was being rescheduled shortly. Specialist Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: training and training relevant to the service users needs that is provided includes,epilepsy,autism,dementia and Deprivation of Liberty Safeguards. The provider has a training plan and tracks training for all staff. Three staff files were sampled,two were of carers who joined the home last year and one was that of carer who had been employed for several years.The files were well ordered and information easy to find.Recruitment documents required were all in place including application forms with full employment histories,references and evidence of Criminal Records Bureau checks,these are repeated every three years. Staff supervisions are held regularly and recorded.The deputy manager currently does the majority of the supervision.A member of staff stated they were very well supported and the provider and deputy could be consulted freely for advice. Staff spoken with and observed showed a good awareness of service users needs and the ways they communicate and service users were comfortable with them. Four members of staff returned surveys to us,the information in the surveys told us that staff had been vetted before they started work,had received induction,feel well supported and that they have training that equips them to meet service users needs. Additional comments from staff included, The home always has good team work---the service users are always happy Ensures all service users are cared for to a high standard Ensures that at all times the client/staff ratio are adequate Management endeavour to make sure that staff receive all training necessary. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of service users and staff and is welcoming and friendly. Service users are projected from harm by the use of safe working practices. Internal quality assurance takes place which includes seeking the views of service users. Evidence: The home is well managed by the registered provider who is also the registered manager,he is experienced and well qualified for the role. The manager is supported by a deputy manager and there are senior carers.The deputy manager who is registered manager of another of the providers services hopes to soon move there full time when service users are in residence. As the deputy manager provides supervision for most staff the provider will then take on this role and said they were considering offering supervision training to senior staff. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The home undertakes internal quality assurance,regular house meetings are held that service users are welcome to attend.Minutes of the meetings show that a range of issues are fully discussed. Annual quality assurance surveys are sent to stakeholders by the home and as well as attending house meetings the views of service users are gained through individual discussion and at reviews. The home has a welcoming,homely atmosphere and service users appeared comfortable with their surroundings and staff.The feeling is that of a family home and the two people who live in the annexe join others for some meals,support and activities. Health and safety is promoted,policies and procedures are in place to ensure that safe working practices are used and the home is very clean.As recorded earlier fire safety seen as highly important and service users included in fire training if they wish to attend. All the documents and records examined during the visit were up to date,kept in good order,stored securely and confidentially and completed to a good standard. Considerable investment has been made during the past year in extending and improving the home.This has benefited service users as they have more space indoors and outdoors, including the additional quiet seating area and larger dining room. Further improvement to the main building and garden is being considered. The home send in notifications to us of matters that we need to know about and the provider returned the Annual Quality Assurance Assessment document within the timescale given for its return. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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