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Inspection on 04/12/09 for The Sidcup Nursing And Residential Centre

Also see our care home review for The Sidcup Nursing And Residential Centre for more information

This is the latest available inspection report for this service, carried out on 4th December 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 4 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

Residents are provided with information on which to base their decision on whether the home is suitable for them. Generally all information was accessible and kept in an orderly fashion. Records for health and safety were well maintained and easy to extract information from.

What has improved since the last inspection?

The refurbishment has significantly improved the home all areas were clean tidy and hazard free. The appointment of a new permanent manager who is due to start January 2010 will provide a level of consistency in the management structure .

What the care home could do better:

Medications must be securely stored . Staffing levels need to be reviewed and increased to ensure there are enough staff to meet residents needs. Residents need to be appropriately supervised and assisted when required. A stable team of staff needs to be in place to ensure consistent care. Care staff need to receive supervision six times a year. Activities need to be improved up on to ensure residents social needs are met.

Key inspection report Care homes for older people Name: Address: The Sidcup Nursing And Residential Centre 2-8 Hatherley Rd Sidcup Kent DA14 4BG     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: Rosemary Blenkinsopp     Date: 0 4 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 27 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 27 Information about the care home Name of care home: Address: The Sidcup Nursing And Residential Centre 2-8 Hatherley Rd Sidcup Kent DA14 4BG 02083007711 02083007799 matthbev@bupa.com www.bupacarehomes.co.uk BUPA Care Homes (ANS) Ltd care home 100 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 100 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 90) Physical disability - Code PD (maximum number of places: 10) Date of last inspection Brief description of the care home The Sidcup Nursing and Residential Centre is owned by BUPA. The ground and first floors are for the general nursing care of 71 residents. The second floor provides care for 29 older people who have been assessed as requiring residential care as apposed to nursing. All the bedrooms in the home have en-suite facilities and there are assisted bathrooms on each floor. There are communal sitting and dining areas and an enclosed garden. The home is very close to Sidcup High Street where there are a variety of shops and access to local buses. Care Homes for Older People Page 4 of 27 Over 65 90 0 0 10 1 1 1 2 2 0 0 8 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: The inspection was conducted over a one day period by two inspectors. The acting manager facilitated the site visit, assisted by the unit managers and staff on duty. Periods of observation were undertaken in the communal areas on the nursing and residential floors. Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. The AQAA was received 18 October 2009 and contained good information regarding the service. Thirteen comment cards were received prior to the site visit, all from residents. During the visit we met with several relatives and residents. Staff were interviewed as part of the site visit. Care Homes for Older People Page 5 of 27 All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager and the regional manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. Care Homes for Older People Page 6 of 27 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 7 of 27 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 8 of 27 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 are provided with sufficient information about the home and benefit from a comprehensive pre admission assessment. From this information they can make an informed decision on whether the service is right for them. Evidence: Assessment information was viewed as part of case tracking. BUPA have standard documentation of which is comprehensive. There are some areas that must be completed as these are mandatory fields such as manual handling. BUPA use the QUEST system for care planning and assessment. There was evidence that an initial assessment had been undertaken in relation to all of the people admitted to the home. The assessment documentation included a lifestyles profile that contained good information In addition hospital transfer letters and other information from members of the multidisciplinary team were available which provided information on the persons health needs. Social Services Community Care Care Homes for Older People Page 9 of 27 Evidence: assessments are received in preparation for the admission. Relatives, and where possible residents, are invited to spend time in the home prior to admission. Over night stays can be arranged in one floor where there are vacant bedrooms. One relative with whom we met confirmed that the family had been involved in the pre-admission assessment and in the care planning, and had visited the home prior to their relatives admission. Their relative had had a trial visit to the home before deciding on moving in to it. The Service User Guide and Statement of Purpose were available in reception The AQAA said the following : Prospective residents who are unsure are given the option of a trial in the home, to ensure their happiness and wellbeing. If at all possible residents are encouraged to visit and have lunch with us before making any decision. Regular mystery shops are conducted to ensure the home is providing the correct information to enquirer. We actively encourage enquirers to look at other homes so an informed decision can be made. Care Homes for Older People Page 10 of 27 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 and risk assessments are in place to provide staff with guidance on how to meet care needs. There are insufficient staff to meet the full care needs of residents . The storage of medications introduces a risk to residents Evidence: Observations were undertaken on the first floor, it was extremely busy. Call bells were going off frequently and there was a long time before some were answered. Staff were addressing personal care, medications etc. During the time we spent on this floor, the lounge area, which had several residents in it, was unmanned - occasionally staff would pass it, or pop in, although for the majority of the time residents were unsupervised. One resident needed to use the toilet we rang the call bell for him, as he was unable to reach it and it was some five minutes before it was answered. The lack of staff had been referred to in the comment cards we received, and without exception staff spoken to, felt there was insufficient staff to fully address care. Dependency was very high, many residents remained in bed and there was a lot of Care Homes for Older People Page 11 of 27 Evidence: equipment in use. Staff said they had enough equipment provided although dependency made the unit busy and sometimes corners were cut when delivering care. Care plans were examined across two units. The format is comprehensive. There was evidence that risk assessments are completed in relation to manual handling, falls and pressure sore development. These are reviewed regularly. Generally care plans showed how risks were to be managed and care needs met. Care plans have supporting records such as turn charts, food and fluid intake, and wound care management. Some of these charts were not well completed with gaps and omissions in entries, particularly the food and fluid intake charts. It is important that when residents need this level of monitoring charts are accurately completed to ensure they are receiving sufficient food and fluid. One resident who we interviewed was extremely confused, their care plan referred to mild memory loss the interventions to address this issue were very limited. The resident was disorientated in time and place and was very confused generally. There was no attempt to engage with this residents who spent time in a drowsy state in the lounge. The care plan of a resident who had been admitted the day previously had all of the mandatory sections completed. Records of multidisciplinary health professionals visits are retained on separate sheets those viewed showed details of the visit with brief notes. On the residential unit care plans identified specific needs and these were personalised to the person living in the home. One resident had hearing difficulties and had a detailed care plan on how this was to be managed. Two residents recently admitted to the home said that they had been involved in stating how they wanted to be looked after and what they wanted to do. The medications were inspected. Records were kept for receipt, administration and disposal of medicines. Pre-printed administration charts were used and these were completed with the allergies and photographs of residents. Hand transcriptions had two staff signatures to confirm accuracy of the information recorded. Medications were dated on opening although one container of eye drops, which was in use, had expired some time ago. This was referred to the Registered Nurse. A tour was undertaken and in the bathroom of the first floor, which was accessible, as the door was unlocked, was a large supply of medication. Some of the medications in this room were easily Care Homes for Older People Page 12 of 27 Evidence: accessible. It is of particular concern as this floor had residents who were confused and were wandering, who could have easily entered the vicinity without staff knowing. At the point we discovered the medications there were no staff in the vicinity. Immediate requirements were left as follows : All medications must be safely and securely stored. Care Homes for Older People Page 13 of 27 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. There are insufficient staff to supervise residents, engage with them or undertake activities. There is little in the way of structured activities to entertain residents. Evidence: Observations were undertaken on two floors the nursing unit and residential unit. During the course of the morning there were no activities in the first floor lounge area which is the nursing wing. The TV was playing although there was little interest in it , many residents seemed sleepy. There were two jugs of fluids in the lounge, but no glasses, after a considerable time we pointed this out to staff who brought them, although did not attempt to offer a drink to any one, nor were residents able to get drinks. The mid morning tea was served at almost 12 midday, which means there was long gap between the drinks. On the residential unit whilst chatting to a resident, a visitor from the local Catholic Church arrived, who stated that she visits regularly and is always made welcome. They said that their friend had improved physically and that they really enjoyed living there, and has made friends. Another visitor arrived who was visiting their mother. They had some concerns about Care Homes for Older People Page 14 of 27 Evidence: medication and levels of personal care, they were also concerned that their relative was left in bed and not encouraged to get up and sit in a chair. They also expressed concerns about the quality of food in particular there was not enough fresh vegetables and fruit. The lunch was observed on the first floor. Tables were set in preparation and the dining room was a pleasant place to eat in. Fourteen residents sat in wheelchairs for their meal out of eighteen residents in the dining area. A review of the seating during meal times must be considered. The food looked appetizing and portions were of a good size. Two hot choices of meals were available. Again there seemed not enough staff to assist all the residents that needed it and this was further compounded by approximately ten residents in bedrooms that needed assistance. One resident had a plate of cheese sandwiches, these were placed in front of her for some time and were taken away uneaten. Her pudding was put in front of her, again after prompting from us, staff assisted her with it, although she did not finish this either, which meant she had a very small lunch. There seemed to be a lot of food waste, many plates with about half of the meal left on them. These observations were followed up by viewing the supporting documentation including food and fluid charts which were found to be incomplete, with long gaps between fluids and without the 24 hour totals recorded. There were very few entries overnight for food and fluids. In the residential unit, on the whole the residents are able to feed themselves but a number needed support and encouragement to eat, one resident had a very sore mouth and was not offered an alternative to the main meals, soup would have been more appropriate, until the off duty team leader intervened some time later. There were only two staff assisting with meals and one staff member giving medication. The AQAA said the following : We have a structured activities programme, with a dedicated activities organiser. Themed activities such as world Cruise, Wimbledon and Garden party have become an integral part of activities Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that complaints will be taken seriously. Staff were fully aware of how to action suspected abuse and use whistle blowing procedures should they need to. Evidence: A copy of the complaints procedure is displayed in the home an is available in other documents produced for the service such as the Statement of Purpose. Within those comment cards received from residents several stated that they were unaware of how to make a complaint or who to refer them to. The information on complaints needs to be reiterated to residents and relatives so they take concerns through the appropriate avenues. BUPA Care Homes have robust policies in place to deal with allegations of abuse and neglect as well as policies for dealing with complaints. There is also a whistle blowing policy and more information on the subject was on display. BUPA Care Homes has a national team of Quality and Compliance experts available to Provide advice and help where needed. We looked at the documentation relating to complaints including the complaints log. There have been eight concerns/ complaints about this service in the last month. In the main they related concerns over staffing levels and care delivery. Two had been Care Homes for Older People Page 16 of 27 Evidence: referred through safeguarding procedures. The information showed complaints are dealt with within specific timescales; documented correctly, investigations conducted, including where applicable statements taken, and complainants informed of outcomes. Those that have been referred to the home for investigation, showed to date, one was still outstanding after a significant period of time. This was discussed a the key inspection and the Regional Manager said she will endeavor to conclude this. Staff with whom we met were aware of how to action complaints and most importantly they all knew they must report it. Staff told us they receive updates on the topics and have access to information including the company policies. Training is available to staff covering all aspects of protection. Staff were also aware of what whistle blowing meant and the action they should take. Care Homes for Older People Page 17 of 27 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 is well maintained and provides a pleasant and comfortable environment for people living in the home. Evidence: The home is located just off the High Street in Sidcup. It is easily accessible by public transport, several bus routes operate through the High Street. It has its own parking spaces adjacent to the building. The home has just been completely refurbished and a rolling programme of maintenance and redecoration ensures it is retained to a good standard. The home was pleasant and comfortable and this would benefit people living in the home. All the floors seen were clean and tidy and odour free. Bedrooms seen were clean tidy and personalised. Residents spoken with stated they were satisfied with their accommodation and cleanliness of the home. Some maintenance issues which had been raised in comment cards had been addressed through the refurbishment. In all areas toured there was no evidence of malodours. All areas we visited were free from hazards and obstacles which is difficult when so much equipment is in use. Care Homes for Older People Page 18 of 27 Evidence: There was lot of equipment seen to be available, staff told us the company provide equipment promptly to ensure that they can meet residents needs. Clinical waste was stored in lidded bins and hand-washing facilities were good. Staff stated they are good supplies of protective clothing, antiseptic hand wash etc. Bacterial gel was also provided and located in areas accessible to staff and visitors. Care Homes for Older People Page 19 of 27 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. People living in the home would benefit from an increase in staffing levels to ensure there are a sufficient number of staff employed to meet their needs. Sound recruitment procedures help to protect people living in the home from harm. Residents benefit from receiving care from staff that are suitably qualified supported by care and ancillary staff members. Evidence: Staff were very busy on the first floor and those staff with whom we spoke felt that there were insufficient staff to fully address care. This was borne out by long waiting times for buzzer to be answered, insufficient supervision of residents, and at lunch time not enough staff to assist residents to eat. Several concerns were raised in comment cards about insufficient staff and how this affected their care being addressed. In previous sections of this report the shortages of staff are also evidenced. We were advised that one staff member was off sick that morning and a replacement was being sought. A review of staffing levels needs to take place to ensure there are a sufficient number of staff employed to meet residents needs. On the ground floor the qualified staff felt that there were insufficient qualified nursing staff to fully address all of the work a registered nurse must undertake particularly the documentation an record keeping. Care Homes for Older People Page 20 of 27 Evidence: When speaking to a group of four more able residents, on the residential floor, they said that there were not enough staff to meet the needs of the resident in the unit. The told us that they had raised these issues in the residents meetings in the past but nothing had been done. Staff personnel files which were inspected were very well organized and the information easy to extract. Staff files were examined including those who had recently taken up post. months. Files included all of the appropriate and relevant documents, there was evidence that CRB/POVA checks had been undertaken, two references, application form, record of interview, recent photo, proof of identity, job description, signed contract and information about the persons health. There were three references which were without an official company stamp or something other to validate them. In one file the CRB had not been received although the POVA first was dated August 09 and the full CRB clearance should have been received. I requested these issues to be followed up. Training is organised to ensure that staff received enough training and that mandatory topics are updated regularly and there is a system to prompt staff to attend. Staff have to complete a question and answer test following mandatory topics to ensure they have sufficient knowledge of the subject. Staff, during interviews, stated that they received training and several had completed their NVQ qualification. The training matrix showed mandatory topics as well as specific subjects such as nutrition, infection control and mental capacity awareness had been conducted. Care Homes for Older People Page 21 of 27 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 lack of a stable management team introduces an element of risk and may lead to inconsistencies. Health and safety aspects are well addressed to ensure the home is safe. Quality assurance systems seek out the views of all those who use the service and the information gained used to improve the service. Evidence: The home is under a temporary manager at present. The manager left October 2009 and Sharon Karsteds is acting up. The Regional Manager has been in attendance frequently during this period of temporary management. A new manager is due to start January 2010 who has experience of working in this type of setting although he is not a nurse. The unit leaders on the ground and first floors are also due to leave and replacements are being sought. Care Homes for Older People Page 22 of 27 Evidence: Health and safety records were inspected with the maintenance man. These were well organsied and up to date. Records seen indicated there are systems in place to carry out routine maintenance checks on hoists, slings, bed rails, wheelchairs and monthly checks on hot water temperatures. Service certificates indicated regular checks on gas appliances, electrical equipment and the lift. The fire alarm is tested weekly and the system regularly serviced. The last fire drill held in the home included night staff. The record included staff signatures and comments on the response. The manager is prompted by the computer programme to ensure all staff attend mandatory training and updates. Staff with whom we spoke referred to updates in these topics. Supervision was something which had lapsed and this will need to be re established to ensure all care staff receive supervision six times a year. There are quality assurance systems in place to monitor and improve the service being provided. There is an annual survey which is sent out to all parties and the information received is collated into a report which is sent to BUPA. An external agency is appointed to review the information and complete the report. Audits are conducted by the manager on medications, pressure sores, complaints etc. These are further followed up by the Regulation 26 reports which are produced as a result of the monthly unannounced visits carried out by the Regional Manager. Residents and relatives meetings are held at different times to maximize attendance. Minutes are taken and there is an open agenda. The manager has an open door policy where by anyone can see her at any time. Financial information is retained through computer records, whereby money received and spent is logged and receipts obtained on residents behalf. Financial records were checked for two residents and found to be correct. BUPA also undertake regular audits of the system. Care Homes for Older People Page 23 of 27 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 24 of 27 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 8 12 There must be sufficient staff to provide supervision to residents and the necessary assistance with care. To ensure residents needs are met. 30/12/2009 2 12 12 Residents must be provided with sufficient stimulation to meet their social and leisure needs. Residents need to be provided with leisure and social support to ensure they feel a sense of wellbeing. 30/01/2010 3 15 16 Residents need to be adequately hydrated and receive a nutritious diet . A poor diet and fluid intake will affect the residents heath problems. 30/12/2009 Care Homes for Older People Page 25 of 27 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 4 27 18 Staffing levels need to be reviewed and increased in light of dependence of residents. There must be sufficient staff to meet residents needs and provide enough supervision. 30/01/2010 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 36 Supervising needs to be re established to ensure all care staff receive supervision six times a year. Care Homes for Older People Page 26 of 27 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!