Inspection on 12/11/09 for The Nunnery

This is the latest available inspection report for this service, carried out on 12th 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Nunnery 19/12/07

The Nunnery 15/05/07

The Nunnery 17/01/07

The Nunnery 20/04/06

The Nunnery 23/11/05

The Nunnery 13/04/05

The Nunnery 29/10/04

The Nunnery 23/05/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Key inspection report Care homes for older people Name: Address: The Nunnery 14 Denmark Street Diss Norfolk IP22 4LE     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: Brenda Pears     Date: 1 2 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 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: The Nunnery 14 Denmark Street Diss Norfolk IP22 4LE 01379643201 01379642649 thenunnery@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jane Wentford care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Mental disorder, excluding learning disability or dementia (MD), One person (1) male, who shall be named in the records. Old age, not falling with any other category (OP), twenty two (22) of either sex. Date of last inspection Brief description of the care home The Nunnery is situated close to one of the roads leading from the market town of Diss. Gardens to the rear slope steeply down the banks of the Mere, and there are panoramic views across the water to the town. The street frontage and main building is old, and there is a newer extension to the rear. A shaft lift provides access to the first floor. There is a lower ground floor (as a result of the sloping site), which is accessible via stairs or a stair lift. The home is registered to provide care for 23 people, and three of the rooms would be double. These rooms are currently being used for single occupancy as these residents do not wish to share. The current fees charged depend on the individual support required. An up to date service user guide and fee details can Care Homes for Older People Page 4 of 28 1 3 0 1 2 0 0 9 1 0 Over 65 0 22 Brief description of the care home be obtained by contacting the home direct. Care Homes for Older People Page 5 of 28 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 an unannounced inspection undertaken on the 12th November 2009 and started at 10.00am. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information was provided to us by the home on an assessment form known as an Annual Quality Assurance Assessment (AQAA). During the visit to the home we spoke to the manager, with members of staff and also with five residents individually and other residents in a group. These methods and previous findings all inform the outcomes of this report. The home is currently not accepting any new admissions while training is accessed through the local authority and concerns are being addressed. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The current staffing levels do not allow for extra time for staff to stop and have a chat with residents, particularly during the afternoon period. One person said that apart from when staff call in on them to deal with personal care, they do not see any staff who just pop their head in on passing or come in for a short time. Staff must make sure all information is recorded and up to date on all parts of care plans, particularly when needs have changed. This full recording is to inform the staff of the current care and support needs of each individual. If this is not done, Care Homes for Older People Page 8 of 28 information will be hard for staff to find and the appropriate support may not be given. 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 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 10 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. An assessment is completed and information provided before any admission into the home is completed. Evidence: There have been no new admissions to the home recently as the provider voluntarily agreed to halt admissions following a recent strategy meeting with the local authority. Pre admission assessments and related risk assessments are completed for any new resident that moves into the home. These have been seen at previous inspections and a full summary and breakdown of needs is currently set out in care plans. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been redesigned and are now more organised and informative. However, we found that not all care plans reflected the current situation and needs of the resident. Evidence: The home has recently developed a new format for care plans that includes all areas of care into an orderly format that is clearly sectioned and labeled for ease of use. Each section has a section for identified risks and actions to be undertaken in order to reduce this risk. This is an improvement on the previous inspection that found care plans to be very muddled and disorganised. Care plans contain sections covering such areas as medical history, hobbies and interests and clear instructions for staff to remind the resident of their rights and to remind them of the information contained in the service user guide. There is a record of healthcare appointments and outcomes of visits. Information regarding a fall was tracked and full information was found on staff records, on the healthcare sheet and in the accident folder. We also noted that the choices and wishes of the resident were Care Homes for Older People Page 12 of 28 Evidence: recorded regarding such events as a review of needs and who the resident wanted to be present as their representative. However, while care plans are reviewed regularly, two care plans viewed at this inspection did not contain up to date information. For example, one resident regularly uses a wheelchair for moving around the home at certain times and this was not set out in the care plan under the mobility section. This is essential information for staff to provide appropriate and assessed support as well as giving a full picture of behaviours and routines of the individual. This particular resident does experience different levels of independence dependent on physical and mental ability at any time. This is also seen as an indicator of the actual mood of the person at certain times and again was not explained in the care plan. Another resident was having regular days with bed rest due to a current medical condition and problems with a medical aid, the district nurse is regularly attending. However, the care plan for this person did not have this up to date information or the details of the current healthcare requirements. Staff clearly explained the moods and problems this person is experiencing and staff were aware of the support this person required. This was not reflected in the notes we saw at this time on the care plan. We observed staff chatting with residents and providing support in an appropriate way with due consideration for the dignity of the person. The home keeps a record of daily notes for each client in a separate folder to provide an accessible record of daily events for the information of staff. When these sheets are full, they are transferred to the individual care plan. There is also a handover book used for all important information of events or changes in needs. The manager has a system of highlighting important information, such as any change in medication, so that it is easily seen by the staff team. Medication is dispensed by staff who have been trained to do so. Medication is appropriately stored in a secured area in a locked trolley. We reviewed a sampling of medication and found that individual medication is clearly labeled. The medical record (MAR) sheets seen were fully and clearly completed at the time of this inspection. While there are no hand washing facilities in the medication area, there is a hand washing gel available for staff to use. The manager explained that any change in medication is not accepted over the telephone. The medical practitioner writes the new instructions directly on the daily records and also on the medication administration records. Only then do staff follow any directions to adjust medication in any way. The local pharmacy has undertaken an audit of medication in the home. The manager has requested that the pharmacy Care Homes for Older People Page 13 of 28 Evidence: provide an appropriate label for eye drops externally on the box and also on the dispenser itself. This has been agreed and will be provided on all eye drops and similar bottles. A controlled drugs cabinet has been obtained since the last inspection as well as a medication fridge that allows for monitoring of temperatures at all times. 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 are able to have visitors when they wish and people are informed of any events in the home. The food is varied and special diets are catered for. Evidence: The new care plan format includes a welfare record that sets out the care required by the individual, hospital appointments and activities undertaken. The chef speaks to residents regularly and is the person who asks what each resident would like for their meal. The chef explained that this gives him an opportunity to learn what people like and also helps with the development of choices on the menu plan. There is a rolling programme of meals and we were told that the winter menu will soon be introduced. Snacks are available when needed and one person had just finished a sandwich they had requested when we viewed the kitchen area. At 8pm a hot drink and sandwiches and biscuits are available. The meal at this inspection consisted of fish with potatoes and vegetables and an alternative choice was available, plus strawberry gateau with cream or fruit and cheese for dessert. There are some specific dietary needs for certain residents and the chef showed a thorough knowledge of these by explaining the variations and requirements as well as the recording systems that are used. Care Homes for Older People Page 15 of 28 Evidence: Three residents told us that they have more than enough to eat and that meals are good and they would ask if they wanted anything different. The meal time was observed on the day of the inspection and tables had matching table clothes with serviettes and fresh flowers set at each seating place. The tables have now been joined together to allow group discussions and people appeared happy and relaxed when eating their meal that looked and smelt appetizing. There are quality surveys that cover a different area of care issued on a regular basis and the most recent was regarding meals and food in the home. This not only covered the type and variety of meals but also the times meals are served as well as suggestions for improvement. Some suggestions included more ice cream, doughnuts and spicy food. The statement that a resident is able to have a snack whenever they want had those in agreement at 88 . The response to having meals in a place of choice resulted in a score of 88 in agreement. The comment that meals are varied, appealing and wholesome resulted in 62 agreeing with this statement. Visitors are made welcome in the home and this was confirmed through discussions with residents and also on the survey resulting in 100 agreeing with the fact they are welcomed and can visit at any time. Activities are undertaken with residents and the care plans will now show who participated in each activity. There are crafting and reading materials accessible in the large lounge area for residents to work independently or with a member of staff. 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. The manager does inform residents of their rights, staff are prompted to refer residents to the information in the service user guide and a complaints policy is on display in the home. Evidence: The home does have a complaints policy and procedure that is on display. While records were seen of a complaint received by the manager and the actions taken, this information was very scant and kept in a loose leaf file. Discussions were undertaken with the manager regarding this documentation and record keeping as a bound book is required with full time scales and outcomes to be recorded. The home uses a work book regarding the safeguarding of adults that is developed by the local authority. Staff training for the protection of vulnerable adults is now due to be refreshed. Staff confirmed they have training regarding recognising various forms of abuse and that they would have no problem with talking to the manager if they had any concerns about the welfare of residents. Care Homes for Older People Page 17 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 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 been improved in various areas through decoration and refurbishment, however, some areas still have an unpleasant odour. Evidence: There have been some improvements made to the internal environment that include the renewal of carpets in some rooms and communal areas around the home, the rewiring of electrical systems, two rooms and the front hall have been redecorated, the small lounge area known as the snug has been redecorated and lighting has been improved in the areas identified as needing thisin the previous report. We spoke to five residents individually and also to a group of residents in the home. One person told us that they are waiting for a new carpet to be put into an empty room before they move from their current room. This room was chosen by the resident because they wish to be nearer to the busy part of the home. During discussions with the resident we heard that the maintenance person has been working closely with family members to ensure the new room has appropriate shelving and storage. The resident said they are happy to be moving rooms and that the home has consulted with them throughout to support choice and provide a suitable environment. The entrance hall has been repainted and all doors leading off this area have also been painted white along with the ceiling. This does improve this area as it was very dull Care Homes for Older People Page 18 of 28 Evidence: and poor lighting was also found at the previous inspection. The lighting has been improved and helps to provide a brighter environment. However, the entrance hall has not yet been re carpeted and the manager explained that this carpet has currently been down for some considerable time. There is an offensive odour that permeates in this area and although housekeeping staff do work hard and continually wash carpets in various areas on a regular basis, this area remains odorous. There is also a badly stained area of the carpet in front of the doorway leading to the kitchen area. One other area of the home also has strong odour that can be strong and offensive at times. This was discussed at this time as the routines and medical condition of one person does affect the atmosphere in this area of the home. Discussions have been undertaken and a review of needs has resulted in the decision to alter the flooring where necessary to support the dignity and comfort of this particular resident and also for other residents in the immediate area. One room was being decorated for respite stays and new carpeting was seen on the adjacent stairs leading to the lower ground floor. The home is currently waiting for a new carpet to be fitted in the large lounge area that will provide a cleaner environment. This carpet has been chosen by the residents in the home who wanted something bright and colourful for their lounge. It is noted that the stairs with new carpeting also have rubber edges for the safety of people in the home. One bathroom has been painted and also has new flooring. Outside each bathroom apron and glove dispensers are now in place. The external area of the home has been made safe with a new fence and gate preventing direct access to the lake that backs onto ground at the back of the home. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate care staffing levels in the home do not reflect the current needs of residents, potentially leaving areas of the home unattended at certain times of the day. Evidence: The staff on duty at this time consisted of the manager, three care staff, two housekeepers and one cook. We were informed that there is usually a laundry person on duty during the week and also at weekends. There are two waking night staff on duty and two care staff on duty during the afternoon plus the manager. The chef works through until 5.30pm to provide a meal at teatime. Discussions were undertaken regarding the needs of residents and the manager stated she does assist with care when necessary. However, there are currently 18 residents in the home and three need the use of a hoist for transferring. The reason for this is that one person permanently needs this support, one person is a wheelchair user and another currently has a leg in plaster. The manager stated that she felt staff managed to support residents and have a timed routine when assisting with individual care. With three people currently needing two members of staff to move them, this means that during the morning there is one additional member of care staff on duty and during the afternoon there is no additional member of care staff on duty. Residents were found to be in bed or in their rooms as they had chosen and they got up for Care Homes for Older People Page 20 of 28 Evidence: meals when they wished at this time. Discussions with residents confirmed this is usually the case. The manager informed us that the home is currently waiting for contact from the local authority as up to date training regarding catheter care is being accessed. Staff have individual supervision every other month and this was confirmed by the members of staff we spoke to at this time. Staff have a two monthly meeting that allows staff to discuss how they are getting on every month supervision is not undertaken. The manager does not attend these meetings as staff can then discuss things together and raise any matters with the manager collectively. We were provided with a copy of the training schedule and told that all staff undertake training to provide them with knowledge of how to support residents. This has been the case since the outbreak of swine flu as a contingency plan is needed and staff training supports this plan. The training schedule shows dates that each area of training was last undertaken, except where training is due to be booked the comment in this box only shows that training is due and is shaded red to allow for easy identification. Those areas of training identified as due for the majority of staff include health and safety, COSHH, mental capacity act and dementia care. The previous survey issued to residents were relating to questions about staff in the home. The results show 80 stating they can speak freely to any member of staff and management. A question of trusting the staff and do they appear clean and well presented had a result of 60 for both these questions. However, the question of feeling that the opinion of the resident does count resulted in a score of 40 , clearly presenting an area that needs further discussion with residents on an individual basis to find why this outcome is so low. It is noted that following the change over of staff shifts a call bell was sounding for some considerable time. When the manager checked, she explained that this call had been answered but as the person had been taken to the bathroom, the buzzer had not been cancelled. Staff were spoken to collectively and also three were spoken to individually. They all confirmed they have supervision and that they feel they can discuss any matters with the manager. They also felt confident that they have training that supports them to fulfill their roles and that if they felt they needed any different training they would ask. Care Homes for Older People Page 21 of 28 Evidence: 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider continues to improve areas of the environment along with the recording and monitoring systems. However, this improvement must continue until all areas are at a required level. Evidence: Quality monitoring surveys are issued regularly and cover a different area of care and life in the home each time. The most recent survey was regarding meals and snacks in the home and some of the results can be found under the relevant heading in this report. Fire drills are undertaken by staff in the home and the most recent included staff practising the actual use of a fire extinguisher. The staff that participate in the fire drill have this recorded in their staff file. A new panel has recently been installed for the fire alarm and this has been fully tested along with the smoke detectors. Equipment is serviced and these include hoists, the call bell and regular checks on Care Homes for Older People Page 23 of 28 Evidence: wheelchairs. A checklist is completed every six months on areas relating to health and safety throughout the home. The manager works in an inclusive manner and families and friends are included welcomed at any time into the home if the resident chooses. Three staff files were seen at this time and while information regarding interviews and scoring were evidenced, the safety checks were not on all files. One person has had an initial check but there was no criminal record check on file and one reference had not been received. The manager was following this up at the inspection and she stated that this person is supervised. Another member of staff had undergone a check by the manager regarding home office letters of authority but a copy of the permission to work in this country had not been obtained. Files contain a list for checking off when the full recruitment process is completed, however, where documents remain outstanding, no further follow up was evidenced. 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 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 14 The assessment of the 18/12/2009 needs of the service user are revised at any time when it is necessary. That any change in the needs of a resident are identified and clearly set out in the care plan when these changes occur. 2 27 18 The registered person shall 31/12/2009 ensure that at all times experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staffing levels must ensure needs can be met at all times, particularly at busy periods of the day when two staff are needed for one resident. An assessment plan must clearly set out how the safety and welfare 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 of residents is being supported at all times. 3 36 19 That the registered person 31/12/2009 obtains appropriate documentation that complies with the recruitment of staff and schedule 2 of the relevant regulations. That all recruitment documentation is completed on staff files. To evidence that the member of staff is suitable in experience and character to legally work in the home. 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 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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