Inspection on 06/11/09 for Holly Lodge Residential Home

This is the latest available inspection report for this service, carried out on 6th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Holly Lodge Residential Home 208 Maidstone Road Chatham Kent ME4 6HS     The quality rating for this care home is:   one star adequate 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: Anne Butts     Date: 0 9 1 1 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Holly Lodge Residential Home 208 Maidstone Road Chatham Kent ME4 6HS 01634843588 01634814817 hollylodgechat@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Imperial Care UK Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Please note the correct email address is: hollylodgechat@btconnect.com Holly Lodge is a sixteen bedded semi detached property situated on the outskirts of Chatham. It is close to local transport networks and there is limited parking available at the front of the property. Accommodation is set out over three floors. There are fourteen bedrooms, with two offering shared facilities and seven of the bedrooms offering en-suite facilities. Care Homes for Older People Page 4 of 30 Over 65 0 16 Brief description of the care home Fees are available upon request from the registered provider. These do not cover items such as toiletries and hairdressing. Full details are in the Service Users Guide and are available upon request. The home was registered with the Care Quality Commission under the present registered provider in May 2009. Care Homes for Older People 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: one star adequate 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: This was a key unannounced inspection that took place over the course of two days and was carried out by one inspector. This was the first inspection of Holly Lodge since the new owners became registered with the Care Quality Commission. Time was spent talking to people who live in the home, members of staff and the registered provider. We also spent time looking at records maintained in the home and we had a look around the building. Prior to the inspection we had requested an Annual Quality Assurance Assessment (AQAA). This is a self-assessment, required by law. This assessment focuses on how the service considers they are meeting the outcomes of the people using the service and where it feels it can make improvements. It also provides statistical information Care Homes for Older People Page 6 of 30 about the service. Information from the AQAA has been used in this report where appropriate. The AQAA was returned to us within timescales and gave us the information we asked for. We also sent out surveys to people living in the home and seven were returned to us. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the Care Quality Commission (CQC) to be able to make an informed decision about each outcome area. At the time of our visit the home did not have a manager but the deputy manager was taking the lead in the home. She told us that she was being supported by the registered provider. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 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 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 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. Prospective residents can be confident that their needs will be assessed prior to moving into the home. People are provided with information about the home. Evidence: All care homes are required to provide information about the service they provide. This is to help people decide if a particular home will meet their needs. The Service User Guide was seen and this provided information to people about the aims and objectives of the home together with details of the services and facilities available. Six out of the seven returned surveys told us that people felt they had been given enough information about the home prior to moving in. Before new people move into a home a full needs assessment should be carried out so that the home can be confident that they can meet individual needs. We looked at the Care Homes for Older People Page 10 of 30 Evidence: assessments for three people. We saw that these contained good in depth detail which explored the needs of the individual person. The pre assessment identified all areas of care and support as required by regulation. Some of the information obtained at this initial assessment had not, however, been transferred into the supporting care plan and this is discussed in more detail in the health and personal care section of this report. The home aims to obtain an assessment from the relevant placing authority and this supports their own assessment process. The registered provider has introduced a quality assurance questionnaire for people following their move into the home. This enables the home to review the experiences people have when they move in so that they can improve the process. We spoke to a relative who said that the staff had been very supportive during the assessment and moving in period and were very happy that they had chosen the home. People have the opportunity to visit the home prior to moving in. The home does not provide intermediate care. Care Homes for Older People Page 11 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to provide clearer guidance for staff so that residents needs can be fully met. Risk assessments which do not identify individual need have the potential to place people at risk. Medication records need to be maintained in line with good practice guidelines. People can be confident that they are cared for by caring staff who treat them with dignity and respect. Evidence: Each person living in the home should have an individual plan of care which clearly details how staff will support them with their assessed health, personal and social care needs. We looked at the care plans for three people. We saw that where the pre assessment process was robust and fully explored individual needs; clear guidance for staff was not always communicated into care plans. This meant that care plans did not give Care Homes for Older People Page 12 of 30 Evidence: clear guidance on how staff were to support individual people. For example a care plan stated that the person needed the assistance of one member of staff for help with personal care, but it did not identify what help was needed and give any details on how to support. There were some risk assessments in place but they did not fully support people with reducing identified areas of risk. For example we saw that one person with dementia had a tendency to wander. The care plan stated that staff should be aware of the persons whereabouts at all times and staff told us that this person would often try doors to go outside. There was, however, no risk assessment in place on how to reduce or safeguard this potential risk. There were risk assessments in place for movement and handling, medication and health and safety, for example. But these were of a generic nature and did not identify individual needs. In order to ensure that all people in the home are supported in a robust risk management framework these need to be reviewed and reflective of individual needs. We also observed that staff were not always following information in the care plans. For example we saw one member of staff assist a person to walk through the lounge. The resident was leaning backwards against the carer and was unsteady on their feet. The care plan identified that this person needed two people to mobilise. We asked the member of staff why they had assisted the person on their own and we were told that there hadnt been another member of staff available at the time. We also saw that recent significant changes to a particular person had not been reflected into the care plan. Staff told us that they were struggling to support this person as they needed a hoist and there wasnt one available in the home. The registered provider was able to demonstrate that they were taking steps to ensure the person was moved to an environment where needs could be fully met. It is, however. the registered providers responsibility to ensure that people are assisted safely particularly in relation to their movement and handling needs and are making a requirement for this to be addressed. People are supported to access healthcare support as required and are registered with a general practitioner and are supported to access the optician, dentist etc as required. As people in the home have a diagnosis of dementia, psychological health needs to be monitored and supported. We saw that although staff were aware of individual behaviours or psychological needs this was not always reflected in care plans. For example one person often expressed that they wanted to go home and as such could display challenging behaviour if they felt they were not being supported with this. Risk assessments did not identify how to support the person with this and Care Homes for Older People Page 13 of 30 Evidence: there was no clear guidance in the care plan. There were systems in place to records incidents but this was not being used in a consistent manner with information being recorded in different parts of the care plan. This does not support as how the persons needs can be kept under review and their care and support provided accordingly. People benfit from nutritional assessments and their weight is monitored with action taken if concerns are raised. The home uses a pre-dispensed system for the administration of medication. This is a system used to reduce the risk of a person receiving incorrect doses of incorrect medication. When a person moves into the home the registered provider ensures that they have details of medication at that time. However when there were prescribed changes in medication; records lacked detail of this including medication which had been prescribed for a short period of time. The registered provider needs to ensure that full and clear records are maintained of all changes and that there is an up to date list of current medication. We observed the dispensing of medication to people, however this was not in keeping with the Royal Pharmaceutical Guidelines as one member of staff took the medication from the trolley and gave this to another member of staff to administer. The member of staff who actually gave medication to the resident did not sign the medication record and the member of staff taking the medication from the cupboard did not observe who the medication was given to but was taking accountability by signing the medication records. This needs to be reviewed as to who signs the medication records. Staff rotas also showed that there were occasions that there were no medication trained staff on duty at night. This has been discussed in more detail in the staff section of this report. Observations during our visit showed that people were treated with dignity and respect. We observed staff interacting well with people living in the home and when one person was distressed they spoke to them in a calm manner. Both people living in the home and visiting relatives all confirmed that staff were polite and respectful. A returned survey stated that staff were all kind and friendly. Care Homes for Older People Page 14 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from support and care in their daily living routine that is flexible to suit their needs and preferences. People benefit from meals that support choice and offer a balanced and nutritious diet, a review of the management of the meals would further benefit people living in the home. Evidence: The Annual Quality Assurance Assessment (AQAA) identified that one of the areas that the home would like to improve upon is to expand activities. Returned surveys told us that there was room for improvement in this area. At our visit we observed that staff spent time with people and read magazines with them and arranged for a selection of games. There are also a selection of organised activities which take place. Music health also visits on a regular basis. Care plans indicated individual choices, like and dislikes and we saw that one person was encouraged to participate in light household chores, which was something that they enjoyed. Care plans also identified peoples individual preferences with getting up and going to bed and records showed that this happened. Care Homes for Older People Page 15 of 30 Evidence: At our visit we spoke to four visiting relatives. They all spoke positively about the home. They told us that they were able to visit at any reasonable time and were always made welcome. One person told us that it took them a long to time help their relative choose a home, and they were very happy with the care and support provided at Holly Lodge. We observed the lunch time meal. Seating arrangements in the dining area are not sufficient to enable all residents to eat at the same time. We spoke to the registered provider who said that there was always two sittings and it varied as to who ate at the second sitting. We observed, however on both days of our visit that there were only a maximum of two people who ate their meal at the second sitting. On both days none of these people were offered the choice of which sitting they would prefer, and on day one person kept saying to staff that they were ready for their lunch but staff had to advise them that they needed to wait. It is the registered providers responsibility to ensure that people are supported with their mealtimes in an appropriate manner. There was a choice of menu, although this was limited to a weekly cycle, we discussed this with the provider who said that they had recently introduced a new menu. In order to give people more choice and variety the home may want to consider expanding the menu over a longer period. Meals were seen to be nicely presented and people we spoke to were all complimentary about the food in the home. Care Homes for Older People Page 16 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure with residents and relatives knowing how to complain. There are systems in place to protect people from abuse. Evidence: There is a written complaints procedure on display and this is available in the service users guide and statement of purpose. Relatives told us that they felt confident in raising any concerns about the care and support provided. Returned surveys also indicated that people would happy to raise any concerns. People we spoke to during our visit did not have any complaints about the service. The Annual Quality Assurance Assessment (AQAA) said that there had been no complaints received since the registered provider tool responsibility for the home. The registered provider told us that there is currently no one in the home subject to deprivation of liberty safeguards. We saw that there were bedrails in place for some of the people but these were not supported by an appropriate risk assessment and agreement with the individual. In some cases relatives were signing agreements for consent for particular care and support, but there was no assessment in place to show that the resident lacked capacity to make this decision for themselves. The registered provider told us that they were currently making arrangements for people to have an individual mental capacity assessment. Once this is in place the home needs to ensure that this is reflected into care plans and associated risk assessments. Care Homes for Older People Page 17 of 30 Evidence: There have been no safeguarding vulnerable adult concerns raised in relation to Holly Lodge. Staff have been trained in the safeguarding of vulnerable adult procedures. Care Homes for Older People Page 18 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, 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. People benefit from living in an environment which meets their needs. Evidence: Holly Lodge is a sixteen bedroomed semi detached property located on a main road on the outskirts of Chatham. It is close to local bus routes and there is limited parking available at the front of the premises. The Annual Quality Assurance Assessment (AQAA) identified that there was a refurbishment programme in place and we saw that some of the bedrooms had benefited from being redecorated. Individual bedrooms reflected peoples choices and were seen to be personalised with people having their own belongings. People we spoke to all said that they liked their rooms and relatives also confirmed that they were able to bring in personal possessions for people. There are sufficient bathrooms and toilets situated in the home. There is a stair lift in place and there are grab rails for people to use. As previously identified there wasnt a hoist available in the home at the time of our visit and at that time one was needed. It is the registered providers responsibility to ensure that there is suitable equipment on the premises to meet the assessed needs of the people living in the home. Care Homes for Older People Page 19 of 30 Evidence: As some people had a tendency to wander there are pressure mats in place which will alert staff to anyone wandering around the building, this ensures that they are able to respond quickly. There is a dedicated laundry area, but no allocated space for staff to do ironing and at one point there was clean laundry spread around a small landing area. This needs to be kept under review so that it is managed safely. There radiator guards in place so as to reduce the risk of people scalding themselves on hot surfaces. Communal areas were clean and smelt fresh. New televisions had been purchased for the lounge areas. People have access to well laid out gardens at the rear of the property. Care Homes for Older People Page 20 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 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor recruitment practices have the potential to place residents as risk of abuse. There is not always an appropriately trained member of staff on duty to support people with their medication and staffing levels are not always sufficient to meet the assessed needs of the people living in the home. Evidence: The provider told us that staffing levels were usually three members of care staff, supported by a cook and a cleaner. At the time of our visit the home did not have a cook and the cleaner was on annual leave. This meant that the three members of care staff also needed to prepare the meals and clean the home. This reduced the amount of care support available to the people in the home. As previously stated we observed staff assisting residents in an unsafe manner due to lack of available staff at the time. Returned surveys and conversations with people at the time of our visit also identified that there were times when staffing levels were at a minimum. Staff rotas also showed that there was not always a member of staff on duty at night who was trained and competent to administer medication. The deputy manager said that when this happened arrangements were made for a trained member of staff to come in to give out medication at night. There were, however, some gaps in the medication administration records for the night medication and staff do not sign in for this. This also means that there is no suitably trained member of staff on duty should anyone Care Homes for Older People Page 21 of 30 Evidence: require a homely remedy. It is the registered providers responsibility to ensure that there are sufficient trained and competent members of staff on duty at all times to meet the assessed needs of the people living in the home. We looked at the procedures for recruitment of new staff. The registered provider did not have a full understanding of the requirements of legislation. People do complete an application form and have an interview which is recorded and people are given letters of offer and terms and conditions. However the registered provider had failed to comply with appropriate safety checks. In that there were not two references in place and staff had started work in the home prior to the registered provider receiving appropriate criminal records bureau (CRB) and protection of vulnerable adults (POVA) checks. Gaps in employment history had not been explored and recorded. At the time of our visit records staff records we viewed did not show that there were any members of staff currerntly working in the home without a POVA. It is the registered providers responsibility to ensure that full checks are carried out in line with the Care Homes Regulations 2001, prior to a new member of staffing starting work in the home. Staff have benefited from an induction which meets the Skills for Care common induction standards and have received ongoing training. The registered provider has employed a trainer to support staff in this area. We had the opportunity to speak to the trainer who was clear about the training needs of the staff. Training included adult protection, movement and handling, health and safety and staff are completing a dementia course. There is an ongoing training and development plan in place. Staff we spoke to confirmed that they received training and that it was to a standard that they felt met the needs of the residents. Staff are also supported with gaining a National Vocational Qualification in care. Care Homes for Older People Page 22 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents can be confident that their care is promoted by the philosophies of the home. Peoples interests would be better promoted through more robust management and quality assurance arrangements for the safe and efficient running of the home. Evidence: At the time of our visit the home did not have a manager and it was being managed on a day to day basis by the deputy manager with support from the registered provider. The deputy manager said that she felt well supported, however she also had full time care duty responsibilities which meant that she did not have the time to manage the home on a full time basis. We spoke to the registered provider, who although was able to demonstrate that there was an awareness of some key principles such as staff training and supporting people in the home with promoting choice and respecting their privacy and dignity had not recognised other areas of shortfalls. These have been reflected throughout this report. Care Homes for Older People Page 23 of 30 Evidence: It is apparent that the registered provider to keen to ensure that the best outcomes are promoted to support people living in the home but a lack of clear understanding of the Care Homes regulations 2001 is not supporting this. It is the registered providers responsibility to ensure that the home is managed and run in a manner that safeguards and protects people living in the home and ensure that they are aware of the requirements of regulation. It is also the registered providers responsibility to ensure that there is a robust management structure within the home. The registered provider has started to implement quality assurance processes which involves speaking and listening to residents and relatives in order to address day to day issues. This needs to be expanded upon to ensure that there are systems in place to ensure that key points of regulation are adhered to. There are systems in place to safeguard people with their personal money. There are systems in place to maintain health and safety within the home; for example electrical items were checked, hot water temperatures and fridge and freezer temperatures were maintained. The Annual Quality Assurance Assessment (AQAA) stated that all equipment had been checked. We did see some potential health and safety risks at the time of our visit; for example in one bathroom there was an open bottle of shampoo left in the sink and in another there was a bottle of dettol left on the windowsill. As people in the home have a diagnosis of dementia this has the potential to cause risk of harm should it be swallowed. We also saw that an electrical cupboard was unlocked and many of the bedroom doors were propped open with items of furniture. The registered provider must ensure that the environment protects the people living in the home. Records are maintained of accidents and incidents, but there was not always evidence to show that appropriate follow up action had been taken to identify how to reduce a risk. For example an accident record would identify only identify that a person had fallen with no other recorded information available. Improved records in the home will further support the health, safety and welfare of the residents. Care Homes for Older People Page 24 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 Older People Page 25 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 7 13 The registered person shall ensure that unnecessary risks to health or safety of service users are identified and as far as possible eliminated. These must be kept under review. This is so risk assessments identify all individual risks, give clear guidance to staff and are kept up to date. 31/01/2010 2 7 15 The registered person shall 31/01/2010 prepare a written plan in respect as to how service users needs in respect of their health, safety and welfare are to be met. These must be kept under review. This is so that care plans are individualised, specific to the person and give clear guidance to staff and are kept up to date. 3 9 13 The registered person shall make arrangements for the 15/01/2010 Care Homes for Older People Page 26 of 30 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 recording, handling safekeeping and safe administration of medication. So that full records are maintained of peoples current medication and MAR sheets are signed in accordance with the Royal Pharmaceutical Guidelines. This is people are fully safeguarded with their medication. 4 15 16 It is the registered providers 15/01/2010 responsibility to provide meals which is available to service users as such time that may be reasonably required. This is so that service users do not have to wait for their meals. 5 27 18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users to ensure that staffing levels are in such numbers are as appropriate to meet the health and welfare of the service users. This is so that there are sufficient and appropriately trained staff on duty at all 15/01/2010 Care Homes for Older People Page 27 of 30 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 times to meet the needs of all service users. Including supporting people with the adminstration of medication. 6 29 19 The registered person shall only employ a person to work at the care home in line with regulation 19 and Schedule 2 of the Care Home regulations. This is so that service users can be confident that they will be cared for by people who have been properly checked. 7 38 13 The registered person shall 15/01/2010 make suitable arrangements to provide a safe system for moving and handling service users. This must include appropriate risk assessments and equipment which will meet the needs of the service users. This is so service users will be in safe hands at all time. 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 08/01/2010 1 7 It is recommended that records for service users are maintained in a robust manner which clearly records how Care Homes for Older People Page 28 of 30 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 the care and support is delivered. 2 18 It is recommended that following individual mental capacity assessments then the registered provider ensures that there are clear recorded agreements with people in relation individual needs. For example agreements for bed rails. The registered provider needs to ensure that all parts of the home are free from risk and ensure staff do not leave unattended open household substances in areas which service users can access. 3 37 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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