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Inspection on 29/07/10 for The Triangle Nursing Home

Also see our care home review for The Triangle Nursing Home for more information

This is the latest available inspection report for this service, carried out on 29th July 2010.

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

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

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 homes manager or deputy meets people before they move to the home to assess their needs and to ensure that they can be met. Prospective residents or their families have the opportunity to visit the home at any time, with or without an appointment, and the opportunity to stay for respite or short periods if they wish to ensure the home is the right place for them. There is a varied menu and all food is home cooked. There is a choice of menus at each meal. Residents told us that they enjoyed their food and one said ` I never feel hungry`. The home is homely and clean. There is an ongoing refurbishment programme, providing a pleasant environment for people to live in. People are encouraged to personalise their rooms. Residents told us that staff are kind and considerate and the manager said that she felt that the home was a happy home. Recruitment procedures are thorough protecting residents from unsuitable staff.

What has improved since the last inspection?

There are plans to improve the bathing facilities with the installation of a shower room. The manager said that they had been successful in recruiting new staff over the past year.

What the care home could do better:

The home should review mealtime arrangements to ensure that people are treated as individuals, given appropriate cutlery and glasses and appropriate language is used to enhance people`s dignity and independence. The home should review the approach to pressure damage risk assessment and agree which tool they are going to use to assess a residents risk of developing pressure damage. The home should ensure that there are sufficient profiling or height adjustable beds for all residents who require nursing care. The home should also review whether they have enough pressure relieving mattresses to meet the needs of all those identified as at high risk of developing pressure damage, should anyone need one at short notice. The home should ensure that the language, using words like `bibs` and `cot sides`, and behaviours of care staff do not undermine peoples` dignity. Although the home has appointed a `dignity champion` this project has a low profile at the present. This should be reviewed. Medication management must be improved to reduce the risk to residents of medication errors. Medication administration records should contain a photograph of the resident and handwritten entries by staff must be countersigned by two people to ensure they are a correct transcription of the prescription. Complaints records held in the home should be kept up to date and complaints must be responded to in a timely way, to ensure that lessons learned from complaints are used to improve the care and support for residents. All staff must have up to date training in the protection and safeguarding of vulnerable adults. All staff must have up to date training in safe working practices, including moving and handling, food hygiene, health and safety and infection control. The home should support care staff to obtain the National Vocational Qualifications in Care at level 2. The home should also ensure that staff have training to meet individuals needs, including meeting peoples nutritional needs and caring for people with memory loss or those who have challenging behaviour. The organisations quality assurance procedures should be improved with the development of clear action plans with timescales to address any concerns

Key inspection report Care homes for older people Name: Address: The Triangle Nursing Home London Road Wheatley Oxfordshire OX33 1YW     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: Chris Sidwell     Date: 2 9 0 7 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Triangle Nursing Home London Road Wheatley Oxfordshire OX33 1YW 01865875596 01865873992 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chiltern Care Homes Ltd (part of the Southern Cross Healthcare Group) Name of registered manager (if applicable) Amanda Longford Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home The Triangle Nursing Home is a purpose built home registered for 28 service users, built about 12 years ago. It is located in the village of Wheatley on the old A40 approximately three miles east of Oxford. The Triangle can provide accommodation for 28 older people who require nursing care. The accommodation is provided on two floors, and there are 26 single rooms and one shared room. The home has limited Care Homes for Older People Page 4 of 27 0 Over 65 28 Brief description of the care home outdoor space. Care Homes for Older People Page 5 of 27 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 inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home on the 29th July 2010 of eight hours and the time taken to write the report. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. Residents and families were spoken to on the day of the unannounced visit. Discussions took place with the manager, deputy manager, care and ancillary staff. Feedback was given at the end of the visit. Care practice was observed and the care of three residents was followed through in detail. The environment and accessibility of the home for people with disabilities was checked. The homes approach to equality and diversity was considered throughout. 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: The home should review mealtime arrangements to ensure that people are treated as individuals, given appropriate cutlery and glasses and appropriate language is used to enhance peoples dignity and independence. The home should review the approach to pressure damage risk assessment and agree which tool they are going to use to assess a residents risk of developing pressure damage. The home should ensure that there are sufficient profiling or height adjustable beds for all residents who require nursing care. The home should also review whether they have enough pressure relieving mattresses to meet the needs of all those identified as at high risk of developing pressure damage, should anyone need one at short notice. The home should ensure that the language, using words like bibs and cot sides, and behaviours of care staff do not undermine peoples dignity. Although the home has appointed a dignity champion this project has a low profile at the present. This should be reviewed. Medication management must be improved to reduce the risk to residents of medication errors. Medication administration records should contain a photograph of the resident and handwritten entries by staff must be countersigned by two people to ensure they are a correct transcription of the prescription. Care Homes for Older People Page 7 of 27 Complaints records held in the home should be kept up to date and complaints must be responded to in a timely way, to ensure that lessons learned from complaints are used to improve the care and support for residents. All staff must have up to date training in the protection and safeguarding of vulnerable adults. All staff must have up to date training in safe working practices, including moving and handling, food hygiene, health and safety and infection control. The home should support care staff to obtain the National Vocational Qualifications in Care at level 2. The home should also ensure that staff have training to meet individuals needs, including meeting peoples nutritional needs and caring for people with memory loss or those who have challenging behaviour. The organisations quality assurance procedures should be improved with the development of clear action plans with timescales to address any concerns 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 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 9 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. Peoples needs are assessed before they move to the home and they are encouraged to visit if possible to help them decide whether the home can meet their needs. Evidence: The care files of three residents were looked at. All showed that the manager or the deputy manager had visited the prospective resident before they moved to the home to ensure that their needs could be met. The manager said that people were welcome to visit the home at any time, with or without an appointment. She also said that people were welcome to stay for a period of respite to help them decide whether the home was for them. The home does not offer intermediate care for those requiring intensive rehabilitation. 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. Residents care needs are recorded and are in general met. Medication management should be improved to reduce the potential risk of error when staff are giving medication. Staff should use appropriate language to promote peoples dignity and respect. Evidence: The care of four residents was looked at in detail. All had care plans although they varied in completeness. The care people needed was recorded and the staff spoken to knew the residents well and could describe their care needs. Peoples social profiles and preferences were either absent or not recorded in any detail. Peoples risk of developing pressure damage were assessed although the home uses two different tools. Staff understood the difference but were unsure why two separate tools were in place and whether they should be using both. This should be reviewed. The manager said that where people were assessed as at high risk of developing pressure damage they had the appropriate mattress. She also said that should she need more they could be borrowed from other homes. Care Homes for Older People Page 11 of 27 Evidence: People had been assessed as to their risk of malnutrition and those followed through had either gained weight or their weight had remained stable. Two risk assessment tools were also in use and it was unclear whether both should be used. This should be clarified. The care records showed that people saw a General Practitioner when needed and they were helped to attend specialist appointments when necessary. A chiropodist and optician visit the home regularly. Residents personal care needs were met and all were well presented with clothing in a good state of repair. All personal care is given in residents bedrooms. People told us that their privacy was respected. There were some inappropriate comments by staff which indicated that they may not have understood how to best promote peoples dignity. One staff member was observed to counting residents in the lounge and when asked why said I am counting how many bibs I need. Another referred to bed rails as cot sides. Another called from the trolley to ascertain what residents would like to drink. One entry in the care plans stated usual noisy behaviour in the evenings. The resident concerned told us that she did not like to call out in the lounge that she wished to go to the toilet. The manager said that there was a call bell in the lounge but that it was only given to people who were able to use. She felt that this particular lady might use it all the time but had not actually tried her with it. The manager said that she had appointed a dignity champion in line with recent good practice although she was based on night duty and the project had a low profile. This should be reviewed and staff should be supported to understand how their everyday language and behaviours can undermine peoples dignity. There are medication policies and procedures in place and the staff spoken to were aware of these. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. There were a number of handwritten medication entries on the medication administration records which were either not signed to show who had made the entry or only had one signature and not two which is in line with good practice guidance. This must be addresses to ensure people receive their prescribed medication safely. A number of medication administration records did not hold a photograph of the resident. The manager said that agency staff were used occasionally although most nurses would know the residents. This must also be addressed to help staff who may not know everyone to identify the correct resident when giving medication. Care Homes for Older People Page 12 of 27 Evidence: Appropriate procedures were in place to deal with variable dose medication such as warfarin. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident lacked capacity, the doctor and family would be told and a way forward agreed. Controlled drugs are stored correctly. The controlled drugs and associated records were checked and found to be correct. 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 is a limited programme of activities to bring interest and diversion to the day. There are no specific activity programmes designed to support older people to remain independent or to enable people who are forgetful or who have dementia to participate, according to their ability. There is a varied menu which meets peoples nutritional needs, although the presentation of meals should be improved to promote peoples dignity. Evidence: There is an activities coordinator in post and she supports residents with a number of activities, including a Pat the Dog visitor and musical entertainment. She arranges a programme of activities and 1:1 sessions with residents and has arranged a number of outings. The manager said that it was sometimes difficult as residents did not always want to join in and she found it difficult always to provide staff to accompany residents on a one to one basis. The activities coordinator was not on duty on the time of the visit. The manager said that she had not had training in specialist activities for older people or the provision of meaningful activity for people with dementia. There was no specific activity on the day of the visit and residents were resting in their rooms. The television was on in the background in the lounge area. Families spoken to said that they felt more activity would be beneficial for residents. Residents spoken to Care Homes for Older People Page 14 of 27 Evidence: said they had a choice as to whether they joined in with activities on offer and how they spent their day. Some chose to spend it their rooms, others in the lounges. People are supported to maintain contact with a church of their choice. There is a varied menu and all food is home cooked. There is a choice of menus at each meal. There is a cooked breakfast, choice of main meal at lunch time and a light cooked supper. Milky drinks and biscuits are available in the evening. The residents spoken to said that they enjoyed their food and one said I never feel hungry. People had a choice as to whether they ate in their rooms, in the lounge at a small table or in the dining area. The dining room tables were laid with tablecloths and cutlery. People were offered drinks in plastic mugs irrespective of whether they could manager a normal glass which most people in the dining area could. Carers also referred to residents needing bibs and not serviettes. The home should review mealtime arrangements to ensure that people are treated as individuals, given appropriate cutlery and crockery and their dignity and independence is supported at all times. Carers were observed to be supporting residents, who could not eat unaided, discretely. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home know how to raise a concern. There are safeguarding policies and procedures in place although all staff should have training in protecting older people to ensure that they are protected from harm. Evidence: Families and residents told us that that they knew who to speak to if the had concerns and that they knew how to make a formal complaint. There is a copy of the complaints procedures in the home. The manager said this was included in the residents guide and that everyone was given a copy when they moved to the home. Complaints are recorded although the files were incomplete and copies of responses had to be sought from the head office. There have been four written complaints since the last inspection, two in 2008 and two in 2010. Of the four one response showed that it had been dealt with within twenty eight days, one was with solicitors and the subject of an insurance claim and responses were not available for two. The most recent complaint had been acknowledged but the complainant had not received a full response within the twenty eight days stipulated in the organisations complaints policy. Although the home has a low level of complaints those received should be replied to promptly and accurate records should be kept to ensure that lessons learned from complaints are used to improve the care and support offered to residents. The home has a copy of the local multi agency safeguarding policies and procedures and staff spoken to said that they would speak to the manager if they had any Care Homes for Older People Page 16 of 27 Evidence: concerns. The training records however showed that eleven of the twenty six members of staff had not had training in safeguarding older people and a further seven had had initial training but were due an update. This must be addressed and all staff should have up to date training in the protection of vulnerable adults. 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 comfortable and clean. There is a need to continue with ongoing investment to provided more profiling, height adjustable beds, specialist mattresses and individual hoist slings if people who require nursing care are to be cared for comfortably and safely. Evidence: The home has been adapted to meet the needs of people with disabilities. Residents rooms vary in size. All have a washbasin and toilet. There are two bathrooms which have been adapted to meet the needs of people with disabilities. The manager said that had received a quote for a shower to be installed as some residents prefer a shower, which was not available at present. The manager said that she had 12 profiling and 1 height adjustable beds and 12 specialist pressure relieving mattresses. The home is registered for the care of twenty eight people who need nursing care and does not meet the standard that a height adjustable bed should be available for people who require nursing care. The home should review the number of profiling beds and specialist mattresses available to ensure that they have sufficient to meet residents needs. There is a small courtyard and outside sitting area alongside the care park. Care Homes for Older People Page 18 of 27 Evidence: The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. There are infection control policies and procedures in place. Residents rooms have soap and hand towels available for professionals and staff use alcohol hand gel to sanitise their hands. Residents share hoist slings which is not good practice and is against current guidance issued by the Department of Health. This should be reviewed. 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. There are sufficient staff to meet peoples health and care needs in a timely way although the training programme must be implemented more consistently if all staff are to have the skills and knowledge that they need to care for older people. Recruitment procedures are thorough and should protect people from unsuitable carers. Evidence: There is a consistent staff team. There is a registered nurses (RN) an on duty at all times supported by a team of carers. Residents told us that care staff usually came wen they called although some families said that residents might have to wait longer in the evenings and had concerns that the lounge area was not always supervised in the evenings. There is an ongoing training programme although this has been allowed to lapse over the last year. The training records showed that only six of the homes fourteen care staff hold the National Vocational Qualifications in Care at Level 2 or 3. Sixteen members of staff had had dementia awareness session and twelve had had pressure care updates in June 2009. Nine people had had nutrition training in 2009 and two in 2010. No one had had training in managing challenging behaviour. This must be addressed and the home must ensure that all staff are trained to the organisations own standards to ensure that they have the skills and knowledge to care for older Care Homes for Older People Page 20 of 27 Evidence: people. The recruitment files of three members of staff who had started at the home since the last inspection were checked. All had the required documents. There was evidence of the staff members identity and work permits were in place where necessary. Criminal Records Bureau disclosures and references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. There was evidence that staff had had an induction programme. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of the home should be improved to ensure that there is systematic monitoring of the quality of care which takes into account residents views. Not enough staff have up to date training in safe working practices to ensure that residents and staff are protected from harm arising from their care. Evidence: There is an experienced manager in post and residents and staff expressed confidence in her. One resident said this is a happy home. The manager has started but not completed the National Vocational Qualifications in Management at level 4. The company has a quality assurance programme although this had not been fully implemented in the home. The companys quality assurance team undertook an audit of the quality of care and supporting procedures in June 2010 and identified a number of areas which required improvement. The manager said that some of the areas for improvement had been addressed. There was no clear action plan describing how all the issues identified would be addressed and by when. The quality assurance Care Homes for Older People Page 22 of 27 Evidence: programme in the home should be strengthened and clear action plans with timescales should be developed and monitored to ensure that the necessary improvements are made. There are health and safety policies and procedures in place and records showed that routine maintenance and servicing of essential services was up to date. Not all staff have had training in safe working practices. Only three people had up to date fire safety training, no one had up to date food hygiene training, five care staff had had no moving and handling training and eight care staff had not had infection control training. This must be addressed and all staff must have up to date training in safe working practices to reduce the risk of harm to residents and staff arising from their care. The company undertook a fire risk assessment and a number of issues were identified for improvement including not storing combustible items such as spare mattresses in the stair wells. These were still evident on the day of the unannounced visit. The home must implement the findings of their own fire risk assessment to ensure residents are protected. 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 9 13 Medication administration records should have a photograph of the resident. To help staff, who may not know residents, correctly identify the resident to whom the medication should be given and minimise the risk of residents being given the wrong medication. 25/09/2010 2 9 13 Hand written entries on the medication administration records should be signed by two people, to show that it is an accurate transcription of the prescription. To protect residents from the potential risk of not receiving their medication as prescribed 25/09/2010 3 38 13 All staff must have up to 30/09/2010 date training in safe working practices including moving and handling, food hygiene and infection control. Page 25 of 27 Care Homes for Older People 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 To minimise the risk to service users of harm arising from their care. 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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!