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Inspection on 30/12/09 for Radiant Care Home

Also see our care home review for Radiant Care Home for more information

This is the latest available inspection report for this service, carried out on 30th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has processes in place for assessing potential new people, with services being offered to only those individuals whose needs can be met. People who use the service are offered a good provision of health care and personal support by the home. All care is administered in a way that protects the individuals privacy and dignity. People who use the service are able to enjoy a full and stimulating programme of activities to choose from. The home provides a wide range of social, cultural and recreational facilities. People who use the service benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect individuals in the event of an allegation of abuse. The home provides accommodation for people that is odour free and well maintained. Infection control procedures are adhered to at all times. The home has a staff team that have the necessary skills, training and experience to the meet the needs of the people who use the service. The management and administration of the home is good. Quality assurance, record keeping and incident/accident reporting are satisfactory. The health, safety and welfare of staff and individuals accommodated are protected all of the time.

What has improved since the last inspection?

People`s assessments have been improved to demonstrate that there has been appropriate consultation with the person, prior to admission. Individuals care plans have been updated to include more detail about their individual preferences. The homes complaints procedure has been updated to fully embrace any negative comments made by people who use the service and to include a record of all actions taken to address issues that have been raised. Effective quality assurance and monitoring systems are in place, in order to seek the views and opinions of people using the service. Improvements have been made to ensure that CQC receive notifications of all incidents/accidents and that we receive the AQAA in the required timescales.Water testing records have been improved in order to ensure that people are not at risk of harm associated with hot water temperatures.

What the care home could do better:

All medications entered into the home are audited and accounted and a record of such is maintained. In that this will ensure that people who use the service and staff will be safeguarded from the risks associated with medications, by ensuring there is a clear audit trail of medications entering the home. All radiators must be appropriately covered or suitably risk assessed. In that this will further safeguard the health, safety and welfare of the people who use the service. Care plans should clearly record whether a person or their representative is involved in the care plan generation and review process. Care plans should be signed by the individual to show their involvement, where a person lacks capacity to sign their agreement this must also be clearly recorded. In that this will ensure that care plans are written in agreement with the individuals choice and wishes. Recommendations for good practice were also made: The service user guide should be fully up to date and without errors. People`s terms and conditions should clearly indicate what services commonly provided incur an additional charge. All staff files should be updated to include a recent photograph. That the staff training record is maintained in an up to date manner and that which is consistent with the data held on individual staff training records.

Key inspection report Care homes for older people Name: Address: Radiant Care Home Highbury Road Bulwell Nottingham NG6 9DD     The quality rating for this care home is:   two star good 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: Rebecca Shewan     Date: 3 0 1 2 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 28 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 28 Information about the care home Name of care home: Address: Radiant Care Home Highbury Road Bulwell Nottingham NG6 9DD 01159753999 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: lota.hopewell@radianthome.co.uk Mr Derrol Paul Hopewell,Mrs Lota Hopewell care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Radiant Home cares for up to eighteen people with dementia. The home is in a residential area close to local amenities and Bulwell town centre. The home is on two floors and there is a passenger lift. There are fourteen single bedrooms, one of which has an en-suite facility, and two double bedrooms. There are three day rooms, a dining area and an easily accessible fenced garden. The fees currently charged at the home range between GBP 356 to GBP 413 per week, with additional charges made for chiropody, hairdressing, dry cleaning, newspapers and some activities. Potential new people to the home find out about the service via placing authorities, Care Managers, Health Professionals, CQC reports, word of mouth and by contacting the home direct. Care Homes for Older People Page 4 of 28 Over 65 0 18 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home 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 unannounced inspection took place during the morning and afternoon of the 30th December 2009. Incident reports and the homes Annual Quality Assurance Assessment (AQAA), held by the Care Quality Commission, were read before the inspection. The AQAA that was sent to us by the service is a self-assessment, which focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The inspection of the home took seven hours. A tour of the home was undertaken and the Registered Manager, Deputy Manager, two staff, two relatives and five people who use the service were spoken with. The main method of inspection we use is called case tracking, which involves us Care Homes for Older People Page 5 of 28 choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Records such as care plans, staff files and medication records were also viewed. Seventeen people were accommodated at the home at the time of the inspection. The Care Quality Commission (CQC), referred to as we throughout this report, also conducted surveys of staff and people who use the service. The responses received were generally positive in many of the aspects of care and provisions provided. Comments from surveys have been incorporated into the body of this report. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? Peoples assessments have been improved to demonstrate that there has been appropriate consultation with the person, prior to admission. Individuals care plans have been updated to include more detail about their individual preferences. The homes complaints procedure has been updated to fully embrace any negative comments made by people who use the service and to include a record of all actions taken to address issues that have been raised. Effective quality assurance and monitoring systems are in place, in order to seek the views and opinions of people using the service. Improvements have been made to ensure that CQC receive notifications of all incidents/accidents and that we receive the AQAA in the required timescales. Care Homes for Older People Page 7 of 28 Water testing records have been improved in order to ensure that people are not at risk of harm associated with hot water temperatures. 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 28 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 28 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. The home has processes in place for assessing potential new people, with services being offered to only those individuals whose needs can be met. Evidence: We observed that a written guide, known as the Service User, has been produced in order to ensure that potential new people have the right information about the service. We observed that this document includes all the items required under the associated Regulation, though some minor amendments are required in that the CQC contact details were incorrect and the copy of the Terms and Conditions of Residency were also in need of amending. The required amendments were discussed with the Registered Manager. We observed a Terms and Conditions of Residency. We observed that this document includes all the items required under the associated Regulation but that it does not specify the payments which are charged as extras, for example dry cleaning and Care Homes for Older People Page 10 of 28 Evidence: some activities. From the files that we sampled and from discussions with the Registered Manager, we observed that pre admission assessments are conducted by the Registered Manager. Records inspected showed that pre admission assessments are carried out on all new and potential people. Documentation relating to the most recent admissions to home were viewed and found to have been completed fully. We observed that pre admission assessment pro formas are in need of updating to include details of the involvement of the individuals representatives, in the assessment process(where applicable). The Registered Manager confirmed that copies of care management assessments from the placing authority are obtained, where these exist and she addresses any issues, which are highlighted within this assessment. Intermediate care is not provided by this service. Care Homes for Older People Page 11 of 28 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. People who use the service are offered a good provision of health care and personal support by the home. All care is administered in a way that protects the individuals privacy and dignity. Medication procedures ensure that medication are stored and administered safely. Evidence: We sampled care plans (including risk assessments) and we evidenced that they covered all aspects of the individuals needs. We observed that reviews had been conducted on all elements of the care plans sampled on a consistent monthly basis. We also evidenced that not all individuals and/or their representatives involvement in the care plan generation and review process had been documented. Of the three case tracked records we viewed, we observed that oonly one person had signed to say that they agreed their care plan. The Registered Manager confirmed that she has attended training in Person Centred Care Homes for Older People Page 12 of 28 Evidence: Planning and that she wishes to have all care plans formatted in this manner and drawn up with the involvement of the individual or their representative. We observed that a new form is being introduced called Current information. We were informed by the Deputy Manager that each person accommodated will have one of these forms on their file. We observed the form and found that it includes details of the individuals preferences, life history, important dates, people of importance, advocacy etc. Records viewed and discussions with the Registered Manager provided evidence that the service has good access to Healthcare providers. Records viewed confirmed that the people who use the service are registered with a GP of their choosing and have access to a Dentist, Optician, Audiology, Occupational Therapy, Physiotherapy and Specialist Nurses. Relatives spoken with confirmed that they are well informed of all healthcare appointments attended and any change to the health of their relative accommodated at the care home. They also confirmed that information was only shared with them in accordance with the individual choice and wishes. From records viewed we evidenced that the service has good procedures in place for the monitoring and recording of all drugs administered and those leaving the home. We observed from Medication Adminidtration Records (MAR) that precedding the 7th December, all medications entered into the home were accounted for and a record mainatined. MAR sheets viewed after this date had no evidence of medication quanitites and receipt having been recorded. Therefore an Immediate Requirement was made. Since the inspection we have received confirmation from the Registered Provider has actioned the above immediate requirement. The stores for medication were viewed and we found them to be clean and orderly manner. We audited the controlled drugs (CD) and found them to be correct. We observed that all controlled drugs are stored appropriately. We observed that daily medication fridge temperatures are maintained consistently. Staff were observed providing personal support to individuals in such a way that promoted and protected their privacy and dignity. We observed that individuals bedroom doors were knocked before staff entered them and that people were called by their preferred choice of address. Care Homes for Older People Page 13 of 28 Evidence: People who use the service told us that the staff are always friendly and helpful and that they are like friends to us!. Care Homes for Older People Page 14 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to enjoy a full and stimulating programme of activities to choose from. The home provides a wide range of social, cultural and recreational facilities. Food provision is good, with individuals choice and preferences being respected. Evidence: We observed that there is a published list of activities in place, we observed that it is based on a seven day programme of both morning and afternoon activities. We observed that activities are varied and offer a full and stimulating programme. People who use the service told us that they could pick and choose which activities they attended and that there was no pressure on them to attend all of them. On the day of the inspection a Movement activity was held, the people who use the service told us that they thought it was good fun! and that I enjoy these lessons but they leave me exhausted! We were also told in surveys that the home could arrange more outings. Care Homes for Older People Page 15 of 28 Evidence: From records viewed and discussions with the Registered Manager we noted that individuals religious wishes are observed. The management of the home believes in promoting an equal and diverse culture among staff and people who are accommodated. People accommodated and friends and family spoken with confirmed that contact with family and friends is positively encouraged, with visitors being able to attend the home at any time and in accordance with the individuals wishes. The Cook confirmed that the homes menus are devised on a two weekly basis. Menus and records viewed confirmed that all medical and therapeutic dietary needs were catered for. We observed that all meals are home cooked with an alternative available for each mealtime. The Cook confirmed that meals can be taken in their bedroom or in the communal dining room. The lunch time meal served during the inspection was ample in quantity and attractively presented. The lunchtime meal was observed and was unhurried, with those requiring assistance with feeding being treated patiently and encouragingly. We noted that drinks and snacks are available at all times. People who use the service told us that the food is always good, Tea and drinks are free flowing as are biscuits and other snacks and We can have as much tea to drink as we like! Care Homes for Older People Page 16 of 28 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. People who use the service benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect individuals in the event of an allegation of abuse. Evidence: We observed that the home has an established complaints procedure in place. Records viewed confirmed that the home has received two complaints since the previous inspection. Records viewed provided evidence that the Registered Manager and staff took appropriate action to address the issue raised. Following the inspection a concern was raised with the Commission, regarding an individual being found wandering outside of the home at night. This matter has been referred to the Provider to investigate and an outcome is awaited. From records viewed we observed that individuals voting preferences had been detailed in their care plan. We observed that individuals are able to vote by proxy, by post or to attend the local polling station. We also observed that leaflets relating to accessing advocacy services were posted on the message board. From the staff files viewed we observed that Criminal Records Bureau (CRB), Vetting and Barring Scheme checks and Protection of Vulnerable Adult (POVA) checks had been carried out on all new and existing staff. Care Homes for Older People Page 17 of 28 Evidence: Staff have attended training in the Safeguarding of Vulnerable Adults within the last twelve months. This was evident from the staff files and training matrix that were viewed. Discussions with the Registered Manager highlighted that there has been one Safeguarding Alert raised by the home in the last twelve months, however this was deemed as incident that did not require investigation by the Safeguarding Team. We observed that policies and procedures relating to Safeguarding are up to date and reflect current practice. We also observed that policies are readily accessible staff. Staff spoken with told that they would be confident in applying the procedures if an allegation of abuse was made to them. Care Homes for Older People Page 18 of 28 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. The home provides accommodation for people that is odour free and well maintained. Infection control procedures are adhered to at all times. Evidence: We observed that the size, location and layout of the home are suitable for its stated purpose. We observed that the home is well maintained and all areas of the home, including the garden, are accessible to people who use the service. The Deputy Manager reported that the home has an ongoing plan of refurbishment in place. From a tour of the premises we observed that two newly redecorated bathrooms had towel warmers fitted. These were observed to be thermostatically controlled but were uncovered and had hot surface temperatures, therefore an Immediate Requirement was was made. Since the inspection we have received confirmation from the Registered Provider has actioned the above immediate requirement. We observed from staff records that staff are trained in infection control procedures. We observed that there is a daily cleaning schedule in place and that the home was fresh and clean, whilst no malodours were noted. Care Homes for Older People Page 19 of 28 Evidence: People who use the service and their relatives told us that this is a home from home, the home never smells and always looks lovely and clean and the home is always clean and tidy. Care Homes for Older People Page 20 of 28 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. The home has a staff team that have the necessary skills, training and experience to the meet the needs of the people who use the service. Evidence: From records viewed we observed that a competent staff team meets the needs of the individuals accommodated. We observed that there is a staff rota in place, which details staff hours of working and staff job designations. Records viewed confirmed that the home has a permanent staff team of the Registered Manager, Deputy Manager, three Senior Cares, seven Carers, a Cook and a Maintenance person. We observed from discussions with the Appointed Manager and from staff files viewed that all care staff are National Vocational Qualification (NVQ), level 2 or 3, trained in care or equivalent. Staff recruitment files were viewed and we evidenced that these files contain all of the items required under the Care Homes Regulations 2001. We observed that Criminal Record Bureau (CRB) checks have been carried out on all staff. We observed that the home has an Equal Opportunities policy in place and is an equal opportunities employer. Care Homes for Older People Page 21 of 28 Evidence: Training records were observed and we evidenced that staff receive effective induction training. All staff providing care have received up to date training in mandatory courses including moving and handling, fire safety, first aid, safeguarding adults and infection control. Discussions with the Registered Manager were held, in relation to the training matrix being kept up to date to reflect dates of training. The matrix viewed gave the impression that some training had not occurred, though individual training records showed that training in key subjects had been completed by staff. Staff told us that they felt the received the right amount of training in orsder to conduct their roles effectively. Care Homes for Older People Page 22 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is good. Quality assurance, record keeping and incident/accident reporting are satisfactory. The health, safety and welfare of staff and individuals accommodated are protected all of the time. Evidence: The Registered Manager is also the Registered Provider and has owned and operated the home for many years. She is a qualified Registered General Nurse with a current PIN number. The Statement of purpose and discussions held with The Registered Manager confirmed that she has a Higher National Certificate in business and finance, a Social Science degree, a dementia care mapping certificate, an NVQ level 2 in Palliative care and Health and Safety and has achieved the ENB (English Nursing Board) Care of the Elderly in the Community (ENB 994). Care Homes for Older People Page 23 of 28 Evidence: She confirmed that she has also completed a two year ageing and mental health course and keeps up to date in Tissue Viability, dementia care and health management by attending annual congress/conferences and that she has received training in Person Centred Planning, supported living, Deprivation of liberties and Safeguarding Vulnerable Adults. People, relatives and spoken with said that the Registered Manager is friendly, approachable, supportive, runs a tight ship and the home appears well managed. We observed that Regulation 26 visits are not conducted by the Registered Provider, as she is in the home almost everyday of the week. We observed that staff meetings and meetings involving the people who use the service are held. Minutes of these meetings were viewed. The Registered Manager reported that the home does not take any responsibility for any of the finances of the people accommodated. The Registered Manager confirmed that all individuals accommodated have family, friends or representatives who protect their financial affairs. Personal Allowance accounts held for individuals and with clear accounts maintained. We observed that a system of regular checks on fire systems and equipment is in place. We observed that there is a fire risk assessment in place, which is current. From the tour of the premises we observed that all chemicals are securely stored and chemicals in use are not left unattended. From the AQAA and records viewed we observed that all necessary Health and Safety checks are conducted and recorded, water temperature checks and Portable Appliance Testing are also conducted and recorded. Care Homes for Older People Page 24 of 28 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 28 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 1 9 13 All medications entered into the home are audited and accounted and a record of such is maintained. In that this will ensure that people who use the service and staff will be safeguarded from the risks associted with medications, by ensuring there is a clear audit trail of medications entering the home. 30/12/2009 2 25 13 All radiators must be appropriately covered or suitably risk assessed. In that this will further safeguard the health, safety and welfare of the people who use the service. 31/12/2009 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 15 Care plans should clearly record whether a person or thier representative is involved in the care plan generation and review process. Care plans should be signed by the individual to show their involvement, where a person lacks 30/03/2010 Care Homes for Older People Page 26 of 28 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 capacity to sign their agreement this must also be clearly recorded. In that this will enure that care plans are written in agreement with the individuals choice and wishes. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 1 2 29 30 The service user guide should be fully up to date and without errors. Peoples terms and conditions should clearly indicate what services commonly provided incur an additional charge. All staff files should be updated to include a recent photograph. That the staff training record is maintained in an up to date manner and that which is consistent with the data held on individual staff training records. Care Homes for Older People Page 27 of 28 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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