Care Home: Woodlands

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What the care home does well One of the people who lives at Woodlands said " The staff are terrific, they keep their cool when we shout at them. They are fantastic, they help you out". We believe that Woodlands offers a good standard of support and care. One of the health/social care professionals we contacted commented that Woodlands, "Provides a stable and homely setting, key workers provide a sound understanding of my clients needs", and "The home support has shown itself to be flexible and responsive...". People are offered the opportunity to take part in a range of activities at home and in the local community, and are encouraged to develop new skills. Measures are taken to try and keep people safe, and where risks are identified action is taken. There is a good level of staffing in the home and staff have received training to help them do there job. What has improved since the last inspection? A number of areas in the house have been decorated or refurbished. New carpets have been fitted and some new furniture purchased. The overall effect is that the house feels more homely and comfortable. The people who live at Woodlands were involved in these changes. What the care home could do better: The way that medication is managed needs to be improved. There is no accurate record of some of the medication in the house, this means that medication could go missing and no one would know. We also believed that staff should be clearer about what medication is to be administered or returned to the pharmacy, so that medication is not left in the cupboard. Records of the recruitment of staff have to be available for inspection. We were told that the correct procedures had been followed however we were unable to check that this was the case. We also found that whilst there were some environmental risk assessments, not all of these had been reviewed and updated. It is important that such reviews are done so that people are kept safe, and free from unnecessary risk. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Woodlands Well Park Road Drakewalls Gunnislake Cornwall PL18 9ED     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 30 Information about the care home Name of care home: Address: Woodlands Well Park Road Drakewalls Gunnislake Cornwall PL18 9ED 01822832451 01822832451 woodlands@regard.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Regard Partnership Ltd care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 Service users to include up to 5 people with a learning disability (LD) aged between 16 and 25 years. Date of last inspection Brief description of the care home Woodlands is an older style detached property set in its own grounds in the rural village of Gunnislake. It is approximately 20 minutes from the nearest town at Tavistock and a further 20 minutes onto Plymouth. On the ground floor there is a lounge, kitchen/diner, a room used for hobbies and activities, an office, one bedroom, a toilet and a laundry. On the first floor there are four bedrooms, and a bathroom. On the second floor there is a study and accommodation used by staff during the night. The home is owned by The Regard Partnership and provides care and accommodation in single rooms for five younger people with a learning disability and associated syndromes. It aims to concentrate on promoting independent living & social skills that will enable the service users to ultimately move on to a more independent life, rather Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home than providing a permanent home. To this end high staffing levels are required, with frequent periods of one to one care. A copy of the Service User Guide and Statement of Purpose is available in the office, and there is a copy of the Service Users Guide in the kitchen. The fees are £1285 to £1985; the fee does not include toiletries and clothing. Service Users are encouraged to purchase and cook their own meals, this money is provided by the home. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection included two visits to Woodlands, these were on 5th May 09 ,between 11 am and 5pm, and on 11th May 09, between 1 pm and 5 pm. An expert by experience was also involved in this inspection on 5th May 09. An expert by experience is a person who, because of their shared experience of using services, and or/ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or to use a service. As part of this inspection we were shown around the house by some of the people who live at Woodlands. We looked at the support and care provided to three people, this included their care plans and any other documents. We also looked at how medication was managed. We talked with three of the staff about their work, and looked at how Care Homes for Adults (18-65 years) Page 6 of 30 staff are recruited to work at Woodlands. We received additional information about the home from the Manager in the form of an Annual Quality Assurance Assessment form. Survey forms were also sent to care staff and to the people who live at Woodlands. Five surveys were returned by staff and one was returned by someone who lives at the home. We also contacted three health/social care professionals for feedback about Woodlands. 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 set out 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 30 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 30 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 the service have the information they need to make a decision about living at Woodlands, and can be assured that their needs will be met. Evidence: One person has moved to Woodlands since the last inspection. We found that information that a pre-admission assessment had been completed, so that the staff at the home knew about the persons needs before he/she moved. We were told that the individual had visited before deciding to move to Woodlands. This is important as it give everyone concerned the opportunity to see if it is a suitable place for the individual to live. We were told in the Annual Quality Assurance Assessment (AQAA), a form filled out by the Manager, that the one of the ways that the service had improved in the last 12 months is that, The assessment process now incorporates a three stage system in that visits are made too current accommodation, to the house and a social outing in order to complete a full assessment. We also provide opportunities to form an introduction to the service in order to foster choice and self direction. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: When we looked around the house we saw that the Service User Guide, a document that provides information about the home was on the kitchen notice board. This document was written in easy to read language and with pictures, so that it might be more accessible to the people who live at Woodlands. We noted that there had been some alterations to the building, which had significantly improved the accommodation for the people who live in the house. The Statement of Purpose, a document which sets out the facilities provided needs to be amended, and agreed with the Commission. Care Homes for Adults (18-65 years) Page 11 of 30 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 live at Woodlands benefit from comprehensive care plans, which are generally put into action by staff. Risks to individuals are considered and managed. The people at Woodlands are given the opportunity to make decisions about their lives and about what happens at the home. Evidence: We looked at the care plans for three of the people who live at Woodlands, and how their care was provided. We found that there were written plans, which specified the sort of help they needed and how this was to be offered. This information had been reviewed and up dated. For some people there was additional guidance about how to manage specific difficulties or situations. This sort of guidance is very appropriate in that it helps to ensure that staff are consistent in their responses. We discussed with the Manager the records for one individual relating to their fluid intake. These records appeared to be incomplete. The Manager told us that she already planned to raise this matter at the next staff meeting. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: When we were shown around the house we saw that one person had a communication system on their wall, this was to help them plan, and understand what was expected of them. This system looked well designed and presented. We talked with a number of staff about using this system, and we got different responses. One of the staff explained that he/she did not use it, and did not believe it was in use. Other staff told us that it was. As has already been noted it is important that any plans or approaches are consistently implemented by staff. Staff told us in a survey was that one of the things that could be done better at Woodlands is, Communicate between staff about service user needs. The one person who lives at Woodlands who returned a completed survey to the Commission said that they were sometimes involved in decisions about what he/she did each day. We looked at the way help is given with money, and saw that where money was held in the home, on behalf of individuals that there were accounts of this cash. We were also told that money and benefits are paid into accounts managed on behalf of individuals by the Regard Partnership. We understand that these accounts are separate from the organisations business accounts. We were told that no statements are provided to individuals unless they ask for them. There were risk assessments that set out how risks to people are to be managed, and again these had been reduced. We saw, on our second visit to the home, that following an incident where some glass was broken in a green house, the remaining glass was removed to ensure that there was no recurrence. Over the previous 6 months the Commission has been informed of a number of incidents where an individual had been at risk because they had drunk substances that might harm them. We saw that actions had been taken to try and minimise any potential harm. We were told that that there are two meetings a week where the people who live at Woodlands can talk about issues in the house. The Manager, Dinah Newman, explained that time was set aside for these meetings even if no one chose to attend. Care Homes for Adults (18-65 years) Page 13 of 30 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. The people who live at Woodlands have the opportunity to take part in a range of activities both at home and in the community. Evidence: An expert by experience took part in this inspection and looked at outcomes in this area, for people at Woodlands. He spoke with two of the people who live at Woodlands. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Comments by the expert by experience included: The residents told me what they did during the day. These were: go for walks in and around Tavistock and Plymouth to look around the shops. They go on the bus Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: independently or go in the house car. I think it is great they go out on their own as they can meet other people. They go food shopping for the house and choose which supermarket they want to go to. I feel this is important as they are involved in the running of the house. One gentleman said he used to play for a football team but some of the team did not turn up so it got canceled. He said I would love to play for another team. One resident has had different jobs working with animals. They said I would live to have another job. I hope the home manager and staff will give them every opportunity for them to get a job. Both residents said they used to go to college and they would like to go again but they have been told independently that they were too old. I said to them to try again as I was 50 years old when I went to college. One resident said that they maybe going to Butlins Skegness. The other said they maybe going to Looe in Cornwall. I think it is good that they are going on holiday and they are able to choose their holidays. They said Its nice here but gets boring sometimes. All the residents have jobs to do in the home including washing and cleaning. The expert by experience conclusions included: From what I saw of the home it was very homely and there were pictures of residents doing activities. I felt from what I saw there was good interaction between the staff and residents. A quote from one of the residents I spoke to The staff are terrific, they keep their cool when we shout at them. They are fantastic, they help you out. I feel the residents could be helped to find paid work and helped to do college courses that they want to do. I think it is a good friendly home and if I had to choose a home to live in I would choose this one. In the office of the home there is a large white board which identifies the activities that people will be involved in each day. We asked one of the staff about the activities for one person, and she explained that they had not happened for some months. We spoke to the Manager, Dinah Newman, about this and she explained that such activities were options, and that some of the activities described would be starting again in the near future. We looked at the individuals plan of activities in their file. This was the same as the notice board. The Manager said in the AQAA that a wide range of activities is offered however, this is also dependent on house mates engage in independent living skills throughout the week in order to accrue credits for other leisure activities. The Manager explained that this system had been implemented following discussions with the people who live at the house, and with support from a visiting psychologist. We were told everyone who lives at the house must participate in this system, and that they must sign up to it before they move in. We were told that each individual can earn credits by completing various tasks. The individual can then accrue credits and use them for additional activities. The large notice board in the office showed that one individual had to complete certain cleaning tasks to accrue credits. However when we looked at the Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: recording for this system, the tasks to be completed were different. We talked with a psychologist about the appropriateness of such a system for all of the people in the home, and was told that it would not be suited to all of the individuals. We discussed this with the Manager, who considered that it the system did suit all of the individuals at Woodlands. We understand that people are encouraged to be independent at Woodlands and to develop their skills. We saw that each person had their own food cupboard, and were told that each person is given a sum of money to buy food and that they are given support to shop and cook. We asked one of staff about how they develop the skills of individuals, for example in planning budgeting, planning a menu, shopping and cooking. The staff member explained that they supported individuals with these tasks and this is how they learned, there was no structured method of teaching. Care Homes for Adults (18-65 years) Page 16 of 30 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 people who live at Woodlands are provided with support they need to ensure that their health and personal support needs are met. Medication is generally well managed however the records of what medication is actually kept in the home are inadequate, and this means that it would not be clear if medication went missing. Evidence: We spoke with two of the people who live at Woodlands they told us that they were happy with the help that they received. We saw that staff treated individuals with respect and listened to what they said. Information in the plans of care indicated that people were treated as individuals. Four of the five staff who responded to a survey told us that they feel they always have the right support, experience and knowledge to meet the different needs of people who use the service. One staff member commented It is very person centred, the service users are involved in what they do. We saw that referrals had been made to other health care professionals where appropriate and we were told by a Social Services Care Manager, that she was kept up to date with any issues she needed to be told about. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: We looked at the medication system. We found that staff who were involved in administering medication had all received theoretical training, and that they had been observed to check their competence. Much of the medication is in blister packs that are prepared by the pharmacist. We did find that some medication was in the cupboard was not on a record sheet to show it had been received, and there was no guidance on whether it was to be administered. We also found that there was no record of opening for some medication that would have a limited shelf life once opened. There was good clear guidance on administering as required medication to an individual. However when we checked how much of this as required medication was in the cupboard, we found that there was far more than might ever be used, and that there was no record of the amount in stock. It would therefore be difficult to audit whether the correct amount was in the building. A recommendation was made at the last inspection in relation to keeping a tally of as required medications. Care Homes for Adults (18-65 years) Page 18 of 30 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 the service are able to express their concerns, have access to a complaints procedure and are protected from abuse. Evidence: We were told that there are two meeting every week for the people at Woodlands to talk about how things are going, and therefore raise any issues or concerns. We also saw records of reflective meetings between individuals and their key workers, and we understand that these could be a time when an individual could raise an issue that was worrying them. There is a copy of the Service User Guide in the kitchen, and this contains a copy of the complaints procedure. All five of the staff who returned a survey said that they knew what to do if someone raised a concern about the home. The Manager told us in the AQAA that no complaints had been received. We discussed with the Manager that in the AQAA it states that two referrals had been made to Safeguarding adults process. The Commission has no record of being informed of these referrals, although the Manager advised us that appropriate notifications had been made. We spoke with staff about safeguarding people and they confirmed that they had received training and knew what actions to take. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: We spoke with the Manager about the Mental Capacity Act, and she confirmed that this legislation is being implemented, and that the service is aware of the issues relating to the Deprivation of Liberty, and would take action if appropriate. Care Homes for Adults (18-65 years) Page 20 of 30 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 people at Woodlands benefit from spacious and comfortable accommodation. Evidence: One of the people who lives at Woodlands showed us around much of the house. We found that there had been significant improvements since the last inspection visit. The house has been redecorated and new carpets have been fitted. We are told that the people who live at Woodlands were involved in making the decisions about the choice of colours. The walls were decorated with pictures of people who live in the house, or their art work. The people who lived in the house confirmed our view that the house was generally well decorated and comfortable. We saw that improvements had been made to the layout of the house, so that the office had moved downstairs to the conservatory, and changes had been made to the staff sleep in room, one of the bathrooms and a bedroom. These changes had improved the accommodation. However we were concerned that their appears to have been no discussion with the Commission about these changes, and the Statement of Purpose had not been updated to reflect this. We noted that one of the bedrooms, that had an en-suite shower and toilet, had an Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: odour. We discussed this with staff who said that the floor was cleaned every day, however the individual did not like the noise made by the extractor fan. We discussed with the staff whether other options had been considered for ventilating this room. We also noted that there was a strong and unpleasant smell of oil in one of lounges. The Manager told us that they had had this matter looked into and had been informed that the room was safe, however she confirmed that the smell was unpleasant that she was looking into this issue. Care Homes for Adults (18-65 years) Page 22 of 30 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. The people who live at Woodlands are supported by well trained and competent staff. The records which provide evidence of a robust recruitment procedure are lacking. Evidence: We received surveys from five of the staff who work at Woodlands. All five people told us that the employer carried out checks and took up references before they started work. We looked at the files of three individuals recently recruited to confirm this. Information about individual checks is kept at the head office of the Regard Partnership. There were forms that should show give the dates when checks have been made. We found that the forms were incomplete on two peoples files, and did not exist for the third person. There must be evidence of proper recruitment checks in the home. We saw that there were induction records for staff who are new to the home, and there that staff had received training in a range of area including person centred planning. Staff told us that much of the training now was done on line. We asked staff about supervision, some staff said that they had received supervision others said that they had not. We raised this with the Manager who said that this may Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: be because new staff had an opportunity to meet with their manager during their induction, but this is not recorded as supervision. Care Homes for Adults (18-65 years) Page 24 of 30 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. Woodlands is well managed and whilst there are no concerns about safety in the home, not all the necessary checks of safety are being carried out. Evidence: The Registered Manager, Dinah Newman, has worked at Woodlands for a number of years. We spoke to two care managers and a visiting health care professional about the quality of the service. The overall opinion of the service was very high. One person described the service as excellent and said that the service was very pro-active in management. One professional said that the service had managed a number of difficult episodes very well and that the management were aware of the need to balance risk and choices. We were told during this inspection that the Manager was spending one day per week managing another service. The Commission needs to be informed of any significant changes to the management of the home, which might affect the well being of service users, or mean that the manager is not in full time day to day control of the home. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: The Managers shifts are not recorded on the rota. A record must be kept of the hours all staff work in a care home. We asked about quality assurance system and was told that the head office sent out forms and collated the results. In consequence it was not possible to see what feedback related to Woodlands and what feedback related to other services run by the Regard Partnership. We looked at various risk assessments for the home, and found that whilst a Fire Risk Assessment had been carried out in December 08, other risk assessments had been last reviewed in January 06. Whilst we were not aware of any significant risks that were not being dealt with, we were concerned that the risk assessments had not been reviewed. We looked at records of visits by a representative of the Regard Partnership, to check on the running of the home. We found that such visits were being conducted, but that these are not unannounced as is required in the regulations. Care Homes for Adults (18-65 years) Page 26 of 30 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 30 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 1 1 4 The Statement of Purpose 01/08/2009 must be amended to reflect the accommodation provided and a copy of this sent to the Commission to be agreed. The Commission needs to know and agreed the facilities provided at Woodlands. 2 20 13 A record of all medication in the home must be kept. Records of medication help ensure that medication does not go missing. 16/07/2009 3 34 18 There must be evidence of pre-employment checks on staff, in the home. The Commission needs to be confident that only people who are suited to the work are employed. 01/08/2009 4 41 12 Risk assessments must be reviewed, updated and implemented. 01/08/2009 Care Homes for Adults (18-65 years) Page 28 of 30 The people at Woodlands need to be confident that they are safe and free from avoidable risk. 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 39 The quality assurance system should ensure that the views of the people at Woodlands are taken into account, and contribute toward an annual development plan. Visits by representatives of the Registered Provider, to check on the smooth running of the home,should be unannounced. 2 43 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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