Care Home: Windmill Lodge

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What the care home does well This small home continues to provide a very individualized caring service for the service users in a homely and safe environment. As it had been found at previous inspections it was again apparent that all the people who use the service are fully involved in making decisions as to the running of their home and that their independence is encouraged and promoted by the staff in a safe manner. There is a stable staff team who are all very experienced and well qualified. They are very well motivated and interact well with the people who use the service. The staff are enthusiastic about their work and committed to the welfare of the people who live in the home. The staff are well supported with a very good standard of training and management. What has improved since the last inspection? Since the last inspection the home has improved the person centered format of their care plans. The numbers of staff holding NVQ qualifications has increased so that it now exceeds ninety five percent.On going staff training continues to be given very good priority in the home. The home has developed its skills knowledge and ability to offer palliative and bereavement care this advancement made working in conjunction with the local hospice medical services. The home and garden have benefited from various works of refurbishment, redecoration and the provision of new equipment all these improving the overall appearance and comfort of the home for the service users. What the care home could do better: The home is well managed and there were no issues of concern at the time of this visit. The management have a clear view of where they wish to make further quality developments in the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Windmill Lodge 2 Windmill Hill Buntingford Hertfordshire SG9 9JP     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: Jan Sheppard     Date: 0 6 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 29 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 29 Information about the care home Name of care home: Address: Windmill Lodge 2 Windmill Hill Buntingford Hertfordshire SG9 9JP 01763273935 01763274303 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Mary Alcock,Miss Julie Hubbard,Mr Hedley Alcock Name of registered manager (if applicable) Miss Julie Hubbard Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Windmill Lodge was a family house that was converted into a care home in 1995. The home offers a safe, secure and caring environment for its residents who are adults with learning disabilities. It is situated at the end of a cul-de-sac in a residential area of Buntingford and is within walking distance of local amenities. Hertfordshire County Council owns the property but the home is managed by a private partnership, which is responsible for the maintenance of the building. It blends in very well with the surrounding residential properties and comprises six bedrooms, two bathrooms, a shower room, two lounges, a dining room and a goodsized kitchen. There are large gardens to the rear and side of the property and good parking to the front. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 1 5 Brief description of the care home Information concerning the current home charges can be obtained from the Manager. All the present residents are sponsored by Hertfordshire County Council. Further information can be obtained from the Statement of Purpose and the Service User Guide. Care Homes for Adults (18-65 years) Page 5 of 29 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: The last key inspection of this services was carried out on 11th April 2007 when a quality rating of 3* Excellent was awarded. Following this key inspection the Quality Rating remains at 3* Excellent. This inspection took place over six hours on a weekday. This was a key inspection that focused on the key standards of the Care Standards Act 2000 relating to adults. The report is written using accumulated evidence gathered prior to the inspection including information contained in the AQAA ( Annual Quality Assurance Assessment) completed by the Manager, information given in the pre-inspection questionnaires and also takes account of statutory notifications sent periodically to the CQC by the home. We made a tour of the building had discussions with the staff on duty and had in depth discussions with the homes manager. We met and spoke with all the service users. Spot checks were made on a number of the homes records and care plans. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 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 29 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 29 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 who use this service have a full assessment of their care needs and are able to visit and test drive the service before having to make any decision about admission. The home has a Service Users Guide and an up to date Statement of Purpose and prospective residents have all the appropriate information to enable them to make an informed choice. Evidence: The home Manager explained that there have been no changes to their procedures for the assessment of prospective new residents since the last inspection. All applicants have an assessment of their care and social needs made by the manager often accompanied by another member of the care team and that they will visit the applicant in their own home or other setting. Information from medical and social care services is also gathered so that the home can be fully informed about all aspects of the applicants needs. All prospective service users are invited to visit the home and to spend day time and an over night stay with the existing residents and thereby have Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: the opportunity to gain some understanding of the life style of the home. Their relatives are also encouraged to visit if they wish. Since the last inspection there has been only one new admission to the home and the records concerning their initial assessment evidenced that there was a prolonged assessment period during which the applicant and their family were fully involved and that many visits to the home were made during this pre admission stage. The service user told us that they enjoyed living in the home I am happy here they said. The service currently has one vacancy and although a number of pre admission assessments have been carried out on new applicants referred to them none has so far wished to move into the home. The manager explained that being a very small service not only is it important that the home can meet all their needs but any new applicant must be compatible with the existing resident group and must agree themselves to move into the home. The home has a Statement of purpose and Service Users Guide which was up to date and provided clear information and a visual insight into life in the home. Care Homes for Adults (18-65 years) Page 11 of 29 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 people who use this service have person centered individually focused care plans which provide an up to date record of their needs, how these may be changing and how they will continue to be met. Risk assessments are regularly reviewed to accommodate changing ability and risk. Evidence: All the three care plans examined were found to be very detailed and to be recorded using a person centered planning format. Plans gave good detail as to service users involvement with their compiling of their plans and had been signed by them. The plans gave good detail as to the service users choices and how their preferences could best be met and how regular consultations with them were carried out. Each plan was seen to reflect the specific and changing needs of the resident, including a monthly review of their care needs and a six monthly or annual review that where possible also involved relatives, social and health care professionals. Details of each Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: residents social or family history were given, Communication charts recording behaviour patterns with improvements and changes are kept along with risk assessments which demonstrated how personal development is encouraged and risk associated with this accommodated. Care Homes for Adults (18-65 years) Page 13 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service participate in an excellent range of activities based on their individual needs and choices and they are supported appropriately by staff to use local community facilities. A healthy varied diet of freshly prepared food is provided in a manner which meets their individual needs. Evidence: All the service users have an individually planned day activity programme encompassing several weekdays as well as some regular weekend and evening activities. Local day centres clubs and educational classes are attended by service users who are able to enjoy and benefit from these whilst for the older service users a home based programme that is more suited to their interests and physical abilities is Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: organized. Programmes are planned ahead but the service users are regularly consulted about their wishes and evidence of this was witnessed during our visit. An art class was also witnessed during this visit and several of the residents told us how they enjoyed art and showed us some of their earlier art work. Younger service users who wish to develop their self care skills have chosen classes that will assist them with this cookery being a particularly popular choice. Biscuits were baked and shared by all the home during this visit. All the service users are able to take a holiday and last summer Blackpool, The Lakes and a Villa in Spain were the locations chosen. The home is fortunate in having a large people carrier van and this enables regular outings into the locality to be made, recent visits to Clacton Zoo, Hunstanton, Duxford and to Southend were mentioned. A service user told us of their visits to see a local football team, another attends the evening Gateway Social Club ,a weekend Car Boot Sale and visits to their local favorite Pub. Meals out are also enjoyed by all the residents. For the one service user who is able to go out unaccompanied the appropriate risk assessments were in place and they told us about how the arrangements for their outings are made with them by the staff. The staff assist all the service users to maintain contact with family and friends. records showed that family visits are frequently made and that where ever possible residents are assisted to make home visits to spend time with their families also. Procedures in the home ensure that residents are helped to make decisions about their daily lives for example they choose what time they go to bed and what they will eat. The staff and residents together do compile a weekly menu which was seen to be recorded. But it was explained to us that variations to this are frequently made to accommodate changes in their wishes and variations in the weather. One resident regularly helps with the weekly provision shopping at a local supermarket whilst another regularly cooks cakes and biscuits thereby practicing the cookery skills they are learning at their college class. The care records evidenced that a reducing diet had been very successfully followed by one service user who explained to us very proudly about their weight loss. Care Homes for Adults (18-65 years) Page 15 of 29 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 excellent 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 that people receive is based on their individual needs and they can expect to be treated with dignity and respect and to receive their personal care in a way they prefer and require. Evidence: All four residents were seen during this visit and they all appeared to be well cared for and to be content and happy. It was noticeable that the staff were, to meet their individually assessed needs, skillfully targeting just the right level of care and support or were encouraging residents who could do so to self care to meet these needs. The residents were seen to be supported by the staff in a very respectful manner and that their personal care was delivered to them in the way that they chose. One resident was heard to be consulted about changes to the plans for the day and their wishes about these were asked for and acted upon. Three care plans were examined and were found to be maintained with good detail and kept up to date. The information was divided into clear sections making this easily assessable.Since the last inspection the home has worked on developing these plans Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: into a more person centered format. It could be evidenced throughout by their signatures or marks that the residents were fully involved with the compiling of their plans. The home continues to use a dosset box system for storage and administration of medication which is supplied from a local chemist. The administration records MAR sheets examined were found to be accurately completed with no signature omissions and good explanations including identification codes written on the reverse of the sheet when required. Adequate arrangements are in place to prompt the one service user who is working towards self administration of their medication but more attention should be given to compiling risk assessments concerning the arrangements for medication administration when they spend time staying away from the home. Since the last inspection the service had occasion to administer a controlled medication for the first time since the home opened. It was seen that the home had the required storage facilities and that the process of signing for controlled medication was understood by the staff.Since the last inspection all the staff had attended refresher medication training. The home has very good support from local health care professionals including GPs, District and Community Nurses and from the local Mental Health Services. Since the last inspection the home for some months worked closely with the local Palliative Care services and together they were able to enable a resident with a terminal condition to be supported in the home until the end of their life. The staff of Windmill Lodge are to be congratulated on the professional way they developed these close working relationships and the manner in which this benefited not only the individual service user but also the other residents staff and relatives as well. Comments received by the Commission from other Professionals prior to this inspection gave evidence to this. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to express their concerns, have access to an effective complaints procedure and they are protected from abuse. Evidence: An easy read complaints procedure is included in the Service User Guide and the one service user asked said that they would know what to do if they ever had to make a complaint. The home holds regular residents meetings and minutes of these are kept and were available for inspection. It was seen that all the residents participate in these meetings and that they are encouraged to do so by the staff. Since the last inspection the home has received one complaint which did not relate to the care of the residents or the running of the home.The records evidenced that this complaint had been dealt with within the prescribed time frames and that the appropriate legal services had been involved in the resolution of the problem. All the staff spoken with and those who replied in the pre- inspection questionnaires all evidenced a good awareness of the homes policy and procedure on safeguarding issues and the whistle blowing policy. The home follows Hertfordshires multi-agency Safeguarding Procedures and since the last inspection the homes records evidenced that these had been correctly followed for the one safeguarding investigation that had arisen. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: Staff in the home have received training concerning the Mental Capacity Act and its implications for the care of the service users at Windmill Lodge. The records relating to one incident concerning the consent to treatment evidenced that appropriate multidisciplinary meetings had been held and the correct procedures followed to ensure the proper safety and care for the service user. Care Homes for Adults (18-65 years) Page 19 of 29 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 physical layout and design of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: Since the last inspection routine works of maintenance and improvements to the home have been carried out and on the day of this unannounced inspection Windmill Lodge was found to be clean and tidy with a well kept appearance and homely feel to it. Improvement works have included redecorations, new furnishings and carpeting in bedrooms where residents were supported by the staff to choose and purchase new furniture and bedding of their own choice. Two residents had also purchased their own new televisions which had been wall hung. All the bedrooms were seen to be very well personalized to meet individual tastes and to provide very comfortable sleeping and sitting areas. Two residents showed us their bedrooms during this visit and spoke happily of the plans that they had for further purchases. Works have been carried out to the bathrooms where a new shower and a wet room have been provided. Refurbishment of the third bathroom is scheduled for the next phase. The laundry room and the kitchen have all the required equipment maintained in sound working order. A recent Environmental Health Inspection had been carried Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: out and found that these areas were compliant. An additional garden room has been built in the garden where areas for planting could be evidenced along with a patio and bar-b-que area. The spacious communal and individual spaces and the facilities provided in the home give a good environment where the service users can live comfortable lives and where their independence can be encouraged and maximized. Care Homes for Adults (18-65 years) Page 21 of 29 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. People who use this service benefit from receiving support from a consistent and well trained group of staff who know them and understand their needs very well. The home recruitment procedures are robust and ensure that residents are protected from abuse. Evidence: The home is fortunate in being able to retain a very stable care team many have worked at the home for many years and all very experienced at working with these residents and understand their needs and how to interpret their communication very well. All the staff except one who is working towards this, hold NVQ qualifications at either levels 2 or 3. During this visit it was seen that staff work very well together as a team and clearly have meeting the needs of the service users as their top priority. The service users spoken with said that they felt themselves to be very well supported by the staff.They spoke of the staff helping them both inside the home and accompanying them also on journeys outside of the home. The recruitment records of the last appointed staff member were examined and were found to contain all the required checks and references which should give proper protection to the service users. The home is fully staffed and never has to use the services of agency staff. Staff spoken with all said that they were very well supported by the managers and Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: that they had good training and personal development opportunities.One told us I am very lucky to work here its a pleasure to come to work. Care Homes for Adults (18-65 years) Page 23 of 29 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. People who use this service benefit from living in a well run home where their views are listened to and acted on and where the welfare of both residents and staff are promoted. Evidence: Since the last inspection there have been no changes in the management team which has remained consistent since the home was initially registered. The Manager has the required qualifications, ( NVQ Level 4 Registered Managers Award) and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service and an open door approach to management. Her aim is to continually improve the quality of life for the service users and to enable them to maintain their independence and this aim has become part of the homes ethos and is embraced by all the staff. She has a calm and open management style and supports and encourages her staff very well. One staff member told us we have very good team working here and the managers are fully involved with every aspect. The manager continues to update her training and to keep abreast with changes and Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: developments in the social care field. Since the last inspection she has attained the Assessors Award teaching certificate , undertaken a course on Dementia Care for service users with learning disability and another on the implications of the Mental Capacity Act. The home compiles an annual training needs plan and it could be seen that the individual training requirements of all the staff had been incorporated into this. Staff spoken with confirmed that training is given a high priority in the home even though all the staff except one already hold professional NVQ qualifications. The homes records evidenced that all staff have regular supervision and an annual appraisal. Staff reported that they were well supported by the manager and the two other providers and that being a small home there was always someone to consult if they were ever in any doubt. The home has appropriate systems in place to enable good communication between the various staff something that the manager recognizes as being very important to ensure the smooth running of even a small home like Windmill Lodge. Staff meetings are planned ahead and were seen to be well recorded and to have good staff involvement. A daily communications book completed at the end of each shift was seen to be being well used. The home gives good priority to promoting the health safety and welfare of the service users and staff through the regular maintenance of safety checks, training and record keeping. The records relating to Health and Safety checks, Fire Alarm testing and Evacuations practices, the monitoring of the hot water temperatures and the servicing and safety checks of the homes equipment were found to be well maintained. Risk assessments for the environment were seen to be compiled and periodically updated. The home has a policy and procedures to ensure the protection of the service users finances and three spot checks made on these found that the amounts and the records and receipts kept did all tally.All the service users have their own bank accounts and paper records of these accounts are kept. The records of the fire alarm testing evidenced that this is carried out regularly and that the service users respond positively to it. A full evacuation of the home is carried out periodically to include both the day and night hours; plans are in place to ensure that the service users would be kept both safe and warm after evacuation and the home has a contingency plan as to where service users may go if ever Windmill Lodge became uninhabitable. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The home carries out a regular Quality Assurance Audit with surveys being sent out periodically to service users, relatives and other professional stakeholders in the home and the results from these form part of the homes Annual Report. A very good response was made to the surveys sent out by the Commission before this inspection visit. A total of eighteen surveys were returned, nine from staff, two from related social care professionals , four from service users and three from relatives.Without exception all the comments were very positive about the care given the manner in which that care was delivered the quality of communication between the home and all interested parties. One relative said I am very very happy with the care my relatives receives, and another I feel the service is doing all it can and I am satisfied that my relative is very well looked after.There is no other place I would rather they be accommodated and looked after. Comments from a social service and a nursing colleague were equally positive one said the home provides good care to its service users and when appropriate to their relatives also, they have developed a good local network and integration of their service users within the community. One nursing colleague commented the home offers exceptional care they work well with us and it was a privilege to work together with them as a team. The service users all commented on the activities they could do and those who could do so were able to write their replies themselves. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 28 of 29 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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