We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Venner Avenue 40 Venner Avenue, Cowes, PO31 8AG Tel: Date of Inspection: 10 October 2013 Date of Publication: November 2013 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Safeguarding people who use services from abuse Cleanliness and infection control Staffing Assessing and monitoring the quality of service provision Met this standard Met this standard Action needed Action needed Action needed Inspection Report Venner Avenue November

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Isle of Wight Council Miss Charlotte Ypres Ridett 40 Venner Avenue is registered to accommodate up to 4 people. The home provides a service to younger adults with a learning disability who do not require nursing care. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report Venner Avenue November

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 What we have told the provider to do 5 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Safeguarding people who use services from abuse 8 Cleanliness and infection control 10 Staffing 12 Assessing and monitoring the quality of service provision 14 Information primarily for the provider: Action we have told the provider to take 16 About CQC Inspections 18 How we define our judgements 19 Glossary of terms we use in this report 21 Contact us 23 Inspection Report Venner Avenue November

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 10 October 2013, observed how people were being cared for and talked with people who use the service. We talked with staff. What people told us and what we found In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. This was because they were still a registered manager on our register at the time of this inspection. We spoke with a manager from a sister home who was providing management support as the home did not have a manager. A representative of the provider also attended for part of the inspection. We met all four people who were living at the home. People appeared happy and looked well cared for. We asked two people if they were happy and they responded yes. People were relaxed and those who were able moved around the home independently. We contacted two relatives of people and spoke with one. They were concerned about the number of permanent staff who had left the home and the impact this was having on their relative. We spoke with both staff on duty and a third staff member who came to support the staff during the inspection. The permanent staff were aware of how people should be supported, their individual likes and dislikes and the help they required. However, the other staff on duty was from an agency and had not previously worked at the home. They were unaware of the individual needs or wishes of people. We spent time observing care in communal areas. We observed staff were courteous and respectful of people's views and choices were offered. The care we observed corresponded with care plans and risk assessments viewed. The home was reliant on agency staff as permanent staff who had left had not been replaced. This was restricting people's opportunities for individual social outings and meant people were being cared for by staff who did not always know them. A relative said they were "worried as staff had left and not been replaced". Staff were aware of what constituted abuse and their responsibilities to report this. People were not cared for in a clean and hygienic environment and the provider did not have quality assurance systems in place to monitor the quality of the service provided. Inspection Report Venner Avenue November

5 You can see our judgements on the front page of this report. What we have told the provider to do We have asked the provider to send us a report by 26 November 2013, setting out the action they will take to meet the standards. We will check to make sure that this action is taken. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Venner Avenue November

6 Our judgements for each standard inspected Care and welfare of people who use services Met this standard People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care and support that met their needs and protected their rights. Permanent staff were aware of people's health and care needs and how these should be met. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at two care plans and related records of care people had received. Care plans and risk assessments followed a consistent format. They included relevant individual information about what the person's health and personal care needs were and how these should be met. Risk assessments identified specific risks and action required to reduce these. We were told care plans were reviewed yearly unless there were any significant changes. We saw some amendments had been made to the care plans viewed since they were originally written. This showed care plans were updated when required to reflect people's changing needs. A relative told us they were kept informed about changes in health and medication needs. They told us they now received a monthly written update informing them of any changes and activities their relative had been doing throughout the preceding month. Records of care which had been provided including meals and personal care were seen. These showed people were receiving health and personal care as detailed in their care plans. We spoke with staff. The permanent staff member was aware of people's individual needs and how these should be met. The other staff was from an agency and had not previously worked at the home. They said they had not been able to read the care plans and were unsure about people's individual needs. They had supported three people with personal care on the morning of the inspection. The agency staff said they had not been aware of any individual needs concerning personal care and had "just got on with it". The permanent staff said they had told the agency staff "anything they needed to know". People's nutritional needs were assessed. Within care plans viewed there was information from external specialists such as speech and language therapists. Care plans provided clear information about the support people required to ensure they received a suitable diet. Inspection Report Venner Avenue November

7 Permanent staff were aware of this. However, the provider may find it useful to note that the agency staff was not. For example, they had commenced work at 7.30am and at 11am they were unsure if anyone required a special diet or fluids to be thickened. One person did require thickened fluids and two people a soft diet. We spoke with an external health professional. They were said permanent staff clearly knew the people well and were able to provide all information they required. Care plans contained information about people's choices and ability to make decisions. Interactions observed between the permanent staff and people showed they were aware of people's individual communication needs. They were able to interpret responses and ask questions in a way people were able to understand and respond to. Discussions with staff showed they were aware of people's rights to make decisions and action they would take if they needed complex decisions to be made. For example, we were told they were planning to get an advocate for one person who did not have relatives to support decisions made in their best interest. We observed care in communal areas. Staff were seen providing people with good interaction. We spoke with permanent staff who were aware of the individual needs of people and how these should be met. We saw support with moving was provided as detailed in a person's care plan. People were provided with an adequate range of activities. Care plans contained information about people's interests. Daily records stated activities people had been involved in and outings undertaken. However, some of these had only been possible due to permanent staff working additional hours to ensure they occurred. For example, some people had been swimming. We were told this had only been possible as another member of staff had worked on a day off to support people at the home to enable a permanent staff and agency staff to provide the activity. Most outings were undertaken as a group with all people participating. This meant people's individual choices could not always be met. The home had access to a house car. This was suitable for all the people at the home. However, we saw people were not using this frequently due to a shortage of staff able to drive. People were supported to use public transport and all had bus passes. However, people's access to outings and individual activities was restricted due to the reliance on agency staff. This prevented individual outings when agency staff who did not work regularly at the home were on duty. Permanent staff were proactive in identifying activities for people. For example, they had requested an occupational therapist (OT) to assess two people for special hoist slings to enable them to go swimming. Therefore staff were aiming to provide a range of activities for people. However adequate staffing levels were required to ensure these occurred. Inspection Report Venner Avenue November

8 Safeguarding people who use services from abuse Met this standard People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. They were cared for by staff who were informed as to what constituted abuse and how to report any concerns. Reasons for our judgement People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw the home had a safeguarding policy in line with local authority guidance. We spoke with two members of staff who were able to describe the action they would take if they had any safeguarding concerns. Staff were aware of the opportunity to report safeguarding concerns to external professionals such as the local authority safeguarding team. We saw contact details and safeguarding information was available to staff and visitors in the home's hallway. The permanent staff members we spoke with told us they had received safeguarding training. Therefore people were cared for by staff who had received the appropriate training and understood the actions necessary to respond to people's concerns or any adverse incidents. Staff also told us they had undertaken additional relevant training such as deprivation of liberties and mental capacity awareness. They were therefore aware of issues which may occur and how people's legal rights could be protected. We saw there were appropriate systems in place to safeguard people's money. One person had an external trustee whilst the others had a representative of the local authority providing independent support and monitoring of their finances. All monies were kept individually and locked in a secure location accessible to permanent staff. All transactions were recorded in individual books and supported by receipts. We saw the process was audited on a monthly basis and a check made on remaining cash at each transaction. We viewed the financial records for two people. These recorded how money had been spent by staff on their behalf. Records showed money had been appropriately spent on personal items and activities. Care plans recorded the support each person required with their personal finances. This demonstrated there was an effective procedure in place to manage and protect people's finances. People were jointly responsible for the lease on a house car. We were told by a senior representative of the provider that people were not being charged for the car lease. This Inspection Report Venner Avenue November

9 was because there were insufficient staff who could drive so people were unable to use the car on a regular basis. We spoke with the family of one of the people using the service and a friend of another. They told us they had no concerns regarding any safeguarding issues. Inspection Report Venner Avenue November

10 Cleanliness and infection control Action needed People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was not meeting this standard. People were not protected from the risk of infection because appropriate guidance had not been followed. People were not always cared for in a clean, hygienic environment. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement We found there were systems in place to reduce the risk and spread of infection. However, these were not adhered to and there was no effective quality assurance process to identify failings. We were unable to identify who was the infection control lead for the home. This had previously been the registered manager however they were no longer employed at the home. A manager from another home owned by the provider attended for part of the inspection. They were unsure who was now the infection control lead. We asked about infection control risk assessments and audits. We were told these had not been completed. The visiting manager was unaware of an audit tool for infection control for use in residential homes. Cleaning was completed as part of the care staff's duties. We were shown the home's cleaning checklist and routine. This clearly specified what cleaning should be done daily, weekly and monthly. Staff stated cleaning was undertaken. However, they had not realised the cleaning routine specified the frequency of some cleaning activities. We were also shown a checklist of when cleaning had been completed. We asked staff on duty about this. Both staff on duty told us they had not completed cleaning tasks on the day of the inspection; however, the checklist recorded that the bathroom had been cleaned. Staff were therefore recording tasks as completed when they had not been undertaken. We visited on the 10 October The cleaning record showed some cleaning had not been completed so far on October For example, surfaces had not been dusted and polished. These had only been done once in September 2013 whereas the cleaning routine showed these should be completed at least weekly. This showed routine cleaning tasks were not being completed. We inspected the communal areas of the home, the bathroom and looked in the bedrooms. We found that although some areas of the home were clean and appropriately maintained other parts of the home were not. We looked in three of the four bedrooms. These were clean and when we checked one mattress this was also clean. However, we found the bathroom was visibly dirty. The rail supporting the shower curtain was dusty. Inspection Report Venner Avenue November

11 The underneath of the shower chair was dirty as was the underneath of the bath. This also contained a range of odd items of equipment and bath aids which were covered in dust and debris. The air ventilation filter intake was covered in cobwebs and dust. Staff stated this did not work which was confirmed when we tried to turn it on. There was a cracked mirror with sharp edges and the cistern top had been glued together. Staff stated this had occurred about three years previously. The bathroom also contained a crate of yellow clinical waste bags and various items of clothing and shoes. The bathroom was not clean, hygienic or pleasant and homely. When we arrived at the home we were aware of water running out of the garage door and down the drive past the home's front door. We were told this was coming from the washing machine which was leaking but still in use. We asked to see the laundry room and identified this was located in the garage. We saw the garage floor was wet from the leaking washing machine. A non-washable mat had been placed on the tiled washable floor. This was also wet. There were three red bags lying on the mat in front of the washing machine. We were told they contained soiled laundry. We saw mops were not stored dry and a bucket holding a mop also contained a tea towel. Also in the garage, opposite the washing machine and positioned on top of a wooden storage unit we saw a cardboard box. This contained potatoes and onions. Located beside the leaking washing machine was a fridge, containing vegetables and a chest freezer containing meat products. People were therefore at risk as food had been stored in an area which also contained soiled laundry. This meant people using the service, staff and visitors were at risk of the spread of infection. We spoke with two members of staff. They told us they had received infection control training. However, the environment and practices in place did not follow good infection control procedures. Therefore, people were not protected from the risk of infection because they were cared for by staff who had received appropriate training, but did not always put it into practice. Providers are required to have regard to the Department of Health Code of Practice on the prevention and control of infections and related guidance. The Code of Practice sets out the basic steps to ensure compliance with the infection control requirements of the Health and Social Care Act, We found the provider had not taken the steps necessary to meet the requirements of this standard. Inspection Report Venner Avenue November

12 Staffing Action needed There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was not meeting this standard. There were insufficient qualified, skilled and experienced staff to meet people's needs. The provider had failed to replace permanent staff when they had left employment at the home. There was a reliance on agency staff who did not always know the people they were caring for. We have judged that this has a moderate impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement There were insufficient qualified, skilled and experienced staff to meet people's needs. We were told three permanent staff and the registered manager had all left the home's employment and not been replaced since July We were told another staff member was due to leave by the end of the month we were undertaking our inspection. This left four permanent staff to cover the home. We were shown a copy of the home's duty roster. This showed staffing levels of two staff during the day and one sleeping at night were provided. However, this was only being achieved due to staff working excessive numbers of hours. For example, one staff had worked a full day (7.30am to 10pm) Wednesday, the same Thursday, a sleeping night shift Thursday night and then 7.30 to 3pm on the Friday. The rosters showed the staff member was working similar shift patterns and excessive hours on other weeks. There were therefore insufficient staff available to cover the duty roster in a sustainable way. The duty roster showed agency staff were frequently being used. On the day of our inspection an agency staff was on duty in the morning. They had never previously worked at the home and did not know the people or their needs. In the afternoon another agency staff was working. They had previously worked at the home and had a better knowledge of people and their needs. The duty roster showed agency staff were being used every day. The duty roster for the week prior to and following our inspection were similar, with a high reliance on permanent staff working excessive hours and agency staff. Staff told us when new agency staff worked at the home people were unable to go out individually. This was because the agency staff could not take them out or remain at home with the other people unless a permanent staff member was with them. The duty roster showed one person should be receiving 12 hours of individual staffing per week. They were not receiving this. The person required this time to provide them with individual activities and outings. We were told they would not be paying for the individual time they were not receiving. However, the lack of staff meant they were not receiving care Inspection Report Venner Avenue November

13 as detailed in their care plan to meet their needs. We spoke with a relative who said they were concerned about the staffing numbers at the home. They said a number of staff had left and when they visited they did not always recognise staff. They were concerned about the effect this would have on their relative who had particular needs in relation to eating and drinking. We spoke with staff who felt under pressure to do additional hours to ensure at least one of the permanent staff was on duty at all times. Staff were trying hard to ensure people continued to enjoy a range of outings. However, they all recognised they were getting tired and could not continue this indefinitely. Staff told us they had completed a range of relevant training. They told us they were now having to cancel training to ensure adequate staff at the home. The duty roster recorded that three training sessions had been cancelled the week of our inspection and the week following for one staff member. Therefore, there were insufficient staff both day to day and on-going to ensure people had their needs met in a consistent and sustainable manner. Inspection Report Venner Avenue November

14 Assessing and monitoring the quality of service provision Action needed The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was not meeting this standard. The provider did not have systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. The provider was unaware of a number of concerns we identified during this inspection. We have judged that this has a moderate impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement The provider did not have systems to regularly assess and monitor the quality of service people received. We spoke with a manager from a sister home who was supporting staff as the home's registered manager had recently left the provider's employment. We also spoke with a senior representative of the provider. The home had transferred to the current provider in June We were told there were no formal quality assurance systems yet in place to monitor the service provided to people. We were told the managers of the eight learning disability homes owned by the provider were planning to work together to develop a quality assurance system. The representative of the provider told us they visited the home monthly. However they had not completed any formal audits or reports of the service provided. They were unaware of the infection control concerns identified around the laundry and food storage or cleanliness of the bathroom. When we visited the home there was a problem with the hot water tank and central heating for the home. Staff told us this had been a concern for over two years and one bedroom did not receive adequate heating via the central heating system. A portable heater had been placed in this room, but could not be used when the person was in the room due a risk they would fall against it. We were told a gas fire in the lounge was never used as staff had been concerned about it two years previously. Although it had been made safe by a qualified technician no action had been taken to replace or remove it. We were told damage to fixtures in the bathroom had occurred up to three years previously and had not been adequately repaired or replaced. In the garage we identified substances which could be hazardous to health in an unlocked cupboard accessible by people. Also in this cupboard we found three folders of care records and personal information relating to one of the people who lived in the home. The provider's representative had been unaware of the environmental concerns which we identified during out inspection visit. People had therefore been placed at risk by the provider's failure to have a system of quality assurance and monitoring for the home. Inspection Report Venner Avenue November

15 We asked about audits which were being completed to monitor the service provided. Care staff told us they completed a monthly review of the activities and any significant events which had occurred for each person. Copies of these were sent to relatives. A relative confirmed they received them. However, no other audits were being completed. The manager from another home was unaware of infection control audit tools. Staff were checking each other to confirm medication had been given. However there was no formal auditing of medication or record keeping. We asked how accidents and incidents were managed. Staff said these would be reviewed and if necessary care plans and risk assessments would be updated. There was no system for these to be monitored by a manager or senior person. Staff told us they had recently held a staff meeting. Minutes were not available. However, they were able to tell us about some changes they were implementing. These included providing a more substantial supper for people. They reported people were now remaining in bed longer in the morning (by about half an hour) and felt this was due to them not getting up so early due to feeling hungry. This showed staff were considering how they provided the service to meet people's needs. Staff told us there was no system for their supervision and they were unsure what the new provider's system for annual appraisals was. This meant staff performance could not be monitored and support, if required, provided. The provider's representative was unaware staff were cancelling training to ensure people were cared for. Staff also did not have a formal route for raising concerns or alerting the providers of issues or concerns. The provider was therefore unaware of how the service was meeting people's needs or if this was safe and effective. Inspection Report Venner Avenue November

16 This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Cleanliness and infection control How the regulation was not being met: The registered person has failed to ensure, as far as reasonably practicable, that service users, staff and visitors are protected against identifiable risks of acquiring an infection. The provider has failed to operate effective systems designed to assess the risk of, and to prevent, detect and control the spread of a health care associated infection. The provider has failed to ensure the maintenance of appropriate standards of cleanliness and hygiene in relation to the premises occupied for the purposes of carrying on the regulated activity. Regulation 12 (1)(a)(b)(c) (2)(a)(c) Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010 Staffing How the regulation was not being met: The registered provider has failed to safeguard the health, safety and welfare of service users, as they have failed to take appropriate action to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons Inspection Report Venner Avenue November

17 This section is primarily information for the provider employed for the purposes of caring on the regulated activity. Regulation 22 Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service provision How the regulation was not being met: The registered person has failed to protect service users, and others who may be at risk, against the risks of inappropriate or unsafe care and treatment, because they did not have effective systems designed to enable them to regularly assess and monitor the quality of the service provided in carrying on the regulated activity. The registered person has failed to identify, assess and manage risks relating to the health, welfare and safety of service users and others who may be at risk from the carrying on of the regulated activity. Regulation 10 (1)(a)(b) This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent to us by 26 November CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report Venner Avenue November

18 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Venner Avenue November

19 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Venner Avenue November

20 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Venner Avenue November

21 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Venner Avenue November

22 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Venner Avenue November

23 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Venner Avenue November

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