Inspection on 02/10/09 for Byron Lodge Residential Nursing Home

This is the latest available inspection report for this service, carried out on 2nd October 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Byron Lodge Residential Nursing... 09/09/05

Byron Lodge Residential Nursing... 28/04/05

Byron Lodge Residential Nursing... 15/02/05

Byron Lodge Residential Nursing... 17/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Byron Lodge Residential Nursing Home 105 - 107 Rock Avenue Gillingham Kent ME7 5PX     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: Elizabeth Baker     Date: 0 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Byron Lodge Residential Nursing Home 105 - 107 Rock Avenue Gillingham Kent ME7 5PX 01634855136 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Prathap Padmanabhan Jana,Mrs Jyothi P Jana care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Byron Lodge is a privately owned, purpose built 28 bedded home, providing 24 hour nursing care to older people. Residents accommodation is situated on three floors with a passenger lift to all floors. All areas of the home used by residents are wheelchair accessible and are connected to a call alarm system. The home is situated in a residential area close to Gillingham and Chatham town centres. The home is located on a main bus route and within walking distance of shops. The home has a rear garden area and limited parking facilities. Fees currently range from £531.56 to £625 per week, including the Registered Nursing Care Contribution and depend on the assessed Care Homes for Older People Page 4 of 29 Over 65 28 0 Brief description of the care home need, funding arrangements and room occupied. Additional fees are payable for hairdressing, chiropody, newspapers, private telephone lines and toiletries. Activities include baking, bingo, music for health and motivation. External entertainers visit the home. No communal religious services currently take place. Care Homes for Older People 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: On the 2 October 2009 we the Commission carried out a key unannounced visit to the service. The visit lasted just under eight hours. At the time of the visit 22 people requiring nursing care were resident at the home. We walked around the home and talked with some residents and staff. We had conversations with six residents and three visitors. We met with two members of staff. We looked at care records, staff files, policies and procedures, minutes of meetings, comments book and the complaints book. Our visit coincided with the registered managers day off and the providers annual leave. The registered manager cancelled some appointments in order to participate in the inspection process. We appreciated this. An up to date Annual Quality Assurance Assessment was not available to support this inspection because the visit was brought forward in line with our revised programme. Care Homes for Older People Page 6 of 29 Because of time constraints we did not use surveys either. We have triangulated our evidence by conversations, observations and available records and documents. The last site visit to the service took place on 14 March 2007. Annual Service Reviews were undertaken on the service on 27 June 2008 and 23 February 2009. We have not received any complaints about the service in the last 12 months. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Regularly accessing our website would help make sure the manager is up to date on registration and regulation changes currently taking place, as well as obtaining our professional advice documents. For residents protection, new applicants references must be sought from a past care employer where stated, as well as the most recent non care employer. New care staff should be fully assisted in completing their Skills for Care Induction Programme. For residents protection, records of residents property must be kept and updated regularly. The person left in charge of the home should be able to produce documents needed for inspection purposes. All versions of the homes complaints procedure must contain our current name and contact details. To make sure the spiritual and cultural wishes and preferences of residents are met, Care Homes for Older People Page 8 of 29 end of life details must be sought and recorded. To minimise cross infection risks to residents, individual slings should be available to those residents requiring hoist transfers. Comments included Staff do not always have time to come up and spend time with me. It would be nice if they did. No requirements have been made but a number of good practice recommendations have been made throughout the body of the report. 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 Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Residents move into the home knowing their needs can be met. Evidence: The home has developed a statement of purpose and service user guide. A small colour brochure is also available. These documents inform prospective residents and or their advocates of the services and facilities provided by the home. The service user guide is in larger size print for easier reading. The documents are available in all residents bedrooms for reference purposes. This is good practice. However a review of the statement of purpose identified that it is not wholly reflective of our regulations for its content. For example reference to bedroom sizes informs the reader that they meet national care standards. However actual sizes need to be stated as the home was registered prior to 2002. The incorporating complaints procedure refers to us as the Commission for Social Care Inspection and provides out of date contact details. Residents and visitors spoken with during the visit indicated they had received enough Care Homes for Older People Page 11 of 29 Evidence: information about the service prior to moving in. Where practicably possible the registered manager, deputy matron or a registered nurse visit prospective residents in their current place of occupation to determine whether the home is suitable to meet their individual assessed needs. Information is also gathered from other agencies such as local authorities or primary care trusts, where a sponsor is involved in the placement. The information gathered helps to inform the care plan which all residents are provided with following their admission into the home. Not all prospective residents are able to visit the home prior to admission. However where this is the case their relatives or advocates do so on their behalf. The home is not registered for intermediate care. Standard 6 is not applicable. Care Homes for Older People Page 12 of 29 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Evidence: For case tracking purposes the care records of four residents were inspected. Records included pre admission assessments, care plans and a range of supporting clinical and safety risk assessments. The assessments covered skin integrity, moving and handling, dependency, continence and nutrition. Monthly weights are undertaken on all residents or more often where there is an identified need. Daily records are kept and provided a brief picture of the residents quality of day experiences. Although the authors had signed and dated the entries, the actual time is not always stated. This could present difficulties if an investigation into care provided needed to be carried out. Residents consent for photographs, vaccinations and the provision of bedrails is sought. The documents seen had been signed and reviewed. The home has a range of beds and bedrails in use. A supporting bedrail policy is also used and states bedrail Care Homes for Older People Page 13 of 29 Evidence: covers must be used when needed. The bedrail risk assessment for one resident indicated they are at risk of injury because of the bedrails. However bedrail covers had not been provided for this resident, potentially placing them at risk. Some residents are prescribed medications for pain relief. However where this is the case pain assessments were not seen in their corresponding care records. The purpose of these is to make sure that pain treatment plans are effective. Medication administration records (MAR) charts were inspected. The review identified a number of handwritten entries had been made on MAR charts without a signature of the person making the change or countersignature of a witness. An amendment in the controlled drugs register had also been made. The amendment had not been signed or countersigned by a witness either. Residents medications had recently been reviewed by a GP. This is good practice. The home has a clinical room in which medicines and nursing aids and sundries are safely and hygienically stored. The room is appropriately equipped. Daily temperatures of the drug fridge and room are taken and recorded. This is to make sure medicines are kept at temperatures stipulated by their manufacturers to maximise the efficacy of treatment plans. Residents were suitably dressed for the time of day and season with attention to detail where this is important to them. Hairdressing is available weekly and residents spoken with are appreciative of this service. Care records seen included comments on supporting residents in maintaining their personal hygiene care. However the level of detail does not include precise details of what a resident can do and what carers should do to assist the resident. For example the type of shave male residents prefer and whether assistance with dealing with excess facial hair is needed. For person centred care it is good practice to do so. Residents said staff assist them with their personal hygiene needs in a way that protects their dignity and privacy. Indeed screening curtains in double rooms were used when carers were providing assistance to one of the residents. However not all carers were seen to knock on bedroom doors before entering. It is polite to do so. Most of the residents living at the home will do so for the rest of their lives. Care records inspected did not include details of residents religions or specific details of their spiritual and cultural preferences and wishes in the event of death and dying. In one care record an external health professional indicated on their correspondence that the resident was not for resuscitation. However the homes actual care records did not Care Homes for Older People Page 14 of 29 Evidence: include any information on this. Whilst acknowledging that obtaining such sensitive information can be difficult, death and dying is an important aspect of care and must be addressed. Care Homes for Older People Page 15 of 29 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. Dietary needs of residents are well catered for with a balanced and varied menu that meets residents tastes and choices. The current activity changes have improved most of the residents quality of day experiences. Evidence: Arrangements are made for residents to take part in structured activities, socialise with others or to be as independent as possible. The current range of activities includes music for health, bingo, motivation and quizzes. Outside entertainers visit the home regularly providing music and singing. Following a change in the activities person, cake baking has just been introduced and residents spoken with really enjoyed this. The activities person should be congratulated. Indeed the activities person is involving residents more in reviewing the range of activities as well as the timing of these. Birthdays and special occasions are celebrated with special cakes. A greetings card is also provided. Relatives and friends are encouraged to join in with the celebrations. Although the home does not have its own transport, a special vehicle is sometimes hired so that a number of residents can have a ride out to local shopping centres. Care Homes for Older People Page 16 of 29 Evidence: The regular religious services no longer take place at the home following the departure of a local vicar. Until a permanent replacement can be identified, where spiritual support is important to residents, the home will make sure that appropriate support is sought and provided. Indeed the activities person has started to take a particular resident to a nearby church for Sunday Worship after discovering the residents special association with the church. And walks to the nearby park were introduced in the summer so residents could enjoy the good weather as well as a change of scenery. Visitors were seen coming and going throughout the inspection visit. Residents said their visitors are offered refreshments and can have a meal at the home if they wish to. This is includes Christmas Lunch. A charge is made for this. Residents are able to personalise their rooms with small pieces of furniture and special items to make them more homely. Indeed some residents have brought items with them such as special chairs and TVs. And one resident has subsequently purchased their own bed. However it has not been the homes practice to record details of such property. It is important do so. The home has a dining room where residents may choose to eat their meals. Although meals were not sampled on this visit, an appetising and well presented lunchtime meal was seen. Special diets are catered for and care records evidenced residents are regularly weighed. Indeed the home has two devices to do this, including sit on scales. However at the time of the visit a large box was stored on the seat of the sit on scales. Improper use of weighing devices is not good practice and may affect the accuracy of residents weights. The scales are calibrated annually. Care Homes for Older People Page 17 of 29 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their advocates can be satisfied their concerns and complaints are listened to and acted upon. Evidence: Up to date information is displayed in the reception hall informing members of the public of the homes complaints procedure. A complaints procedure is also included in information provided to prospective and existing residents. However details on this procedure were not up to date in that our name and contact details are not current. The complaints procedures are in normal type print and do not indicate whether they are available in other formats and or versions. For equality and diversity it is good practice to do so. Residents and visitors spoken with during the visit indicated they knew what to do if they were unhappy about anything. The home maintains a complaints book and records the last complaint having been made in July 2008. However during our visit we were informed of a situation which constituted a complaint. Indeed the matter was dealt with to the persons satisfaction. However there was no indication this had been recorded. For quality assurance purposes it is good practice to record all types of adverse comments and niggles. Staff interviewed described appropriately the action they would take if they suspected abuse had taken place. Training details provided at the visit indicated all staff have Care Homes for Older People Page 18 of 29 Evidence: received adult protection training. The home has a whistle blowing policy. However discussions with staff highlighted the need for some training in this respect as one member of staff appeared not to know what it stood for and another member staff had heard of it but not from this employment. The home generally lets us know of incidents which have happened that may have affected residents wellbeing. The home has safeguarding policies provided by local authority. However last year the home did not follow the process in a timely manner following three theft allegations. This resulted in only one of three allegations being investigated. So residents can participate in local and general elections, arrangements are made to make sure that their names are on the current electoral register. This is good practice. Care Homes for Older People 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and homely environment Evidence: Areas visited were fresh, clean, warm and odour free. Indeed residents and visitors spoken with indicated the home is always kept in a clean, fresh and warm condition. Since the last visit the home has repainted a number of bedrooms and a new wide screen TV has been installed in the lounge. The last environmental health inspection of the homes kitchen found standards were satisfactory. The kitchen was clean and tidy on our visit. The home has a range of moving and transferring equipment so staff can assist residents in a safe manner. However it was identified on this visit that hoist slings are not available for residents individual use. To minimise cross infection risks, it is best practice to provide each resident requiring sling transfer with their individual one. Guidelines for Infection Prevention and Control in the Community published by Kent Health Protection Unit provide information in this respect. The home has a copy of this. Corridors are wide and handrails are fitted. This helps mobile and wheelchair users move safely and independently around the home. However the decorative state of Care Homes for Older People Page 20 of 29 Evidence: corridors was reduced because of contact damage to doors and walls. Indeed one door has a hole above the metal kick plate. The home provides a range of beds and residents spoken with said their beds are comfortable. Residents linen and personal clothes are laundered on site. The laundry is appropriately equipped and a laundry operative is employed. Residents spoken with indicated the laundry offers a good service. However during one conversation it transpired the service had not been so good of late because one of the dryers has broken down. Indeed an out of order notice was seen affixed the machine dated 27 August 2009. A replacement dryer has been ordered. Some doors are required to be kept shut or locked for fire safety purposes. These include residents bedrooms. So residents can choose to keep their doors wide open magnetic closures have been fitted. This is good practice. A small room on the second floor has a door sign stating fire door keep shut. However a used wooden wedge was seen in the room indicating the door is sometimes wedged open. It is the providers responsibility to make sure only approved devices are used for propping open all doors which for fire safety purposes are designated to be kept shut. As is expected of homes providing nursing care, separate sluice rooms are provided for the safe disposal of clinical waste and bodily fluids. However it was identified on this visit the doors were not lockable thereby preventing unauthorised access. The door handle was broken and could not be properly closed. The external fire safety notice sign for this room states Fire door keep shut. Care Homes for Older People 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Staff morale is good resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Evidence: As well as care staff, staff are employed for cooking, cleaning, laundry and activities. Maintenance, gardening and decorating is provided on a contractual basis as and when required. As expected of a care home providing nursing care, the home is staffed 24 hours a day. The registered manager is supported with her administration duties by one of the providers. Staff were seen carrying out their duties in an unhurried manner and being attentive to residents. Residents spoken with indicated staff are generally around when they need them, although sometimes they have to wait longer than they would normally like when they need assistance with getting washed and dressed in the morning. Sixty seven percent of unregistered care staff are now trained to NVQ 2 care or equivalent and four more are currently undertaking the course. This is good practice and should provide care assistants with the skills and knowledge they need to perform their roles. New staff are required to complete an initial induction programme and this varies according to their role and previous experience. Since the last visit the providers have Care Homes for Older People Page 22 of 29 Evidence: acquired the Skills for Care induction programme model. New carers are now expected to complete this after their initial brief induction programme. However during a conversation with a carer it was reported that although they have been given their programme book to complete they were a little confused how to do this due because of insufficient guidance and support. Despite this the carer is enthusiastic about their role and is eager to commence NVQ training. Staff receive initial and refresher mandatory training covering fire, moving and handling, infection control and basic food hygiene. In addition to this, registered nurses also receive training in clinical subjects. However it was difficult to actually establish full details of such training in the last 12 months as this information is not held centrally. The staff files of two members of staff were inspected. As part of the homes vetting practice, references are sought and obtained, POVAFirst is accessed and Criminal Record Bureau (CRB) checks are undertaken. Both applicants had provided accompanying CVs. In one case two care employment episodes were recorded, although neither was the latest employment. However no reference had been sought from either care employer. Our regulations require that where a person has previously worked with vulnerable adults or children for a period of not less than three months duration, a reference relating to this employment must be sought. Care Homes for Older People Page 23 of 29 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Residents benefit from a well run home. Evidence: The registered manager is a registered nurse, is experienced in working with elderly people. She has been the home manager for 10 years and been registered with us since 2003. The registered manager endeavours to keep her knowledge and skills up to date and over the last 12 months has attended training and or retraining for subjects including the Mental Capacity Act, Deprivation of Liberty Safeguards, Dementia, Catheterisation, Venepuncture, Liverpool Care Pathway and Medicine Administration. Residents, visitors and staff spoken with all indicated how approachable and helpful the registered manager and deputy manager are. An open door policy is promoted and this is much appreciated. One of the registered providers provides administrative support to this and two other Care Homes for Older People Page 24 of 29 Evidence: associated care homes on a week day basis. The registered manager attempts to have three mornings every two weeks supernumerary time to carry out some administrative responsibilities. However the staff rotas in support of this visit do not clearly record this. Following the introduction of the Deprivation of Liberty Safeguards in April of this year, the registered manager and registered nurses have received some training on this. It is intended that this training will be made available to all carers when it becomes available in the area. The home has acquired policies and procedures on this important aspect of care. The home has not made any safeguarding referrals. Not all records required to support the homes performance for inspection purposes were actually available to us as the registered nurse on duty at the end of our visit could not access them. This included maintenance records and the fire safety book. The person left in charge of a care home should be able to provide them. The home has developed its own quality assurance programme. This includes carrying out annual surveys and facilitating meetings for residents, visitors and staff. The results of surveys are analysed and are available for information purposes. The home is in the process of updating and reviewing its policies and procedures. This is to make sure that staff have ready access to current regulation and best practice. During our visit we established that the registered manager has not been able to obtain the professional guidance our legacy organisations have published to support registered managers and providers. Subjects include medicine management and staff recruitment. This professional guidance may assist the registered manager in the review and development of the homes policies and procedures and is still available on our website. During the review of care records a bedrail policy was seen to accompany consent forms for the provision of bedrails. However the policy was undated and did not indicate whether it had been regularly reviewed to reflect information sent to services from the Medicines and Healthcare products Regulatory Agency as and when necessary. For residents safety it is good practice to do so. Although the home has computer equipment and internet access, it is not yet the registered managers practice to access our website to obtain up to date guidance, as well as information about the future of regulation and inspection. With the changes in frequencies of inspections it is important and expected that care services regularly access our website and assimilate the information on a need to know basis. Care Homes for Older People Page 25 of 29 Evidence: The home is responsible for maintaining small amounts of residents monies. This is used for purchases made or services provided on their behalf. Records and receipt are maintained and balances checked. Visitors confirmed they are provided with receipts. As previously stated, the home does not keep details of residents property or indeed items of furniture they may bring with them into the home. This is despite a number of theft allegations being made about the home last year. For residents protection it is important records are maintained and available for our inspection purposes. Care Homes for Older People 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 Older People 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 Older People 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. 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