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Inspection on 11/02/09 for Acacia Lodge Nursing Home

Also see our care home review for Acacia Lodge Nursing Home for more information

This inspection was carried out on 11th February 2009.

CSCI 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.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acacia Lodge Nursing Home 15 Wellingborough Road Irthlingborough Wellingborough Northants NN9 5RE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 1 1 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Acacia Lodge Nursing Home 15 Wellingborough Road Irthlingborough Wellingborough Northants NN9 5RE 01933651660 01933652948 thedurrantm@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (CFC Homes) Ltd Name of registered manager (if applicable) Mrs Diane Pryce-Dyer Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home Acacia Lodge is a home situated on a main route within the small town of Irthlingborough in Northamptonshire. The home is within walking distance of Irthlingborough Town Centre where community resources include churches, shops, pubs and restaurants. The home is owned by BUPA Care Homes Limited and is registered to provide both Nursing and personal care for service users with a variety of needs, the majority of which are over 65 years of age. Accommodation to the service users is provided across two floors, there are 30 single rooms and 5 double rooms with Care Homes for Older People Page 4 of 29 0 0 18 0 Over 65 21 5 18 5 care home 40 Brief description of the care home the majority providing en suite facilities. The home has four lounge areas, one of which is a designated smoking area and a dining room on both floors. Access to the first floor of the home is by passenger lift. Care Homes for Older People Page 5 of 29 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: Standards identified as key standards and highlighted through the report were inspected. In addition to the key standards a number of other standards were inspected to assess the services ability as part of case tracking people that use the service from the admission stage to placement stage. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, the previous and current annual quality assurance assessment (AQAA), pre inspection planning, an unannounced inspection visit to the home, any information sent to us from the service and other professionals, collating information received in person from relatives and the people who use the service, and drawing together all of the evidence gathered. Care Homes for Older People Page 6 of 29 The service has not received any complaints since the last inspection. The pre inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection took place on the 20th August 2007. This unannounced inspection visit was carried out by one inspector and covered the morning and afternoon of a weekday. The inspection was carried out by case tracking, which involves selecting samples of records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. Views of a visitor, staff and people that use the service were obtained on the day of the inspection. The management of medication was checked through reviewing prescribed medication for a sample of people as part of case tracking. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of peoples general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was provided to the manager at the close of the inspection. The range of fees for the service are from 550.00 to 650.00 per week. This is excluding toiletries, hairdressing, visitors meals, private taxi fees, insurance for personal belongings, news papers, escorts, chiropody, private physiotherapy sessions and additional personal items. What the care home does well: What has improved since the last inspection? What they could do better: Staff must be in receipt of at least six supervisions sessions per year. Risk assessments should be in place where a restriction is imposed on an individual that may effect there freedom of movement within the service. Medication must be administered to all people who use the service as per the prescription issued by the GP. All staff must have suitable pre employment checks prior to commencement of employment. Staff must have Home Office clearance to work if this is applicable to them. A coding sheet should be used for the administration of medication to identify for example when medication has been refused or destroyed. Care Homes for Older People Page 8 of 29 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 set out 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 –03000 616161. Care Homes for Older People Page 9 of 29 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 29 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. People who use the service can be assured that the service is able to meet their needs through the completion of a detailed assessment process. Evidence: The service has developed a Statement of Purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. The details of how to make a complaint require to be up dated as the address held within has changed. All people who use the service are given a copy of the guide. The Statement of Purpose had been reviewed and contained all of the required information in order for Care Homes for Older People Page 11 of 29 Evidence: the person and or their representatives to make informed choices about the service. The Annual Quality Assurance Assessment (AQAA) states that The QUEST programme has been developed to ensure we provide continuously high levels of person centred care. The programme includes an extensive assessment taking into account residents choice. The assessment explored some areas of diversity including preferences, religion and involvement from family and or partners, sexuality, food preferences and personal care preferences. Recognised assessment tools were used to assess a persons risk level for nutrition, pressure prevention, falls and dependency levels. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. One person who uses the service stated that I am very happy here. One relative on site during the inspection commented that I think its absolutely marvellous, its staggering how they achieve what they do. Its the whole ethos of the place - the decor is lovely. My wife is a former painter too. Its so caring and they see my wife as an individual which is fantastic, the management are very hands on. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. Individual term and conditions of residency were in place and detailed the information required in order to ensure that that rights of the person were maintained. Care Homes for Older People Page 12 of 29 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. Suitable care planning systems and documentation was in place to ensure that the health, social and physical care needs of the people who use the service were being met, shortfalls in medication did not support people to receive all prescribed medication. Evidence: A total of two care plans were case tracked fully. It was established that the aim for the people who use the service is to receive personal and healthcare support using a person centred approach. Personal health care needs including specialist health, nursing and dietary requirements are recorded in the care plan. The care plan is generated from the pre admission assessment and includes guidelines, risk assessments for the management of falls, manual handling assessments, self medication risk assessments and care plans. A relative commented that The charge nurse went through my wifes care plan and I have signed to say that I understand the care plan. The relative added that When Care Homes for Older People Page 13 of 29 Evidence: she came from hospital she had some bed sores, the nursing care she has received is terrific, she does not have bed sores any more. A person who uses the service commented that I know about my care plan. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. Good practises were observed, with staff positively engaging with a number of people who use the service. It was pleasing to see a number of people engaging and being stimulated by the positive engagement. The service listens and responds to individual choices and decisions about who delivers their personal care. Information received from the service and in the AQAA, states that All residents have a comprehensive care plan produced with the help of the QUEST assessment tool A number of comments were received directly from people that use the service, their relatives and friends. One person commented that, the staff are nice, all of them. Another commented that the staff are friendly and caring and very nice. The service has an efficient medication policy supported by procedures and practise guidance, which staff understand and follow. The manager discussed the sound working relationship they have with the local high street pharmacist. It was noted that one persons medication had not been administered on several separate occasions. This was discussed with the manager of the service and corrective action was taken. An immediate requirement was left at the service to ensure that all people are in receipt of all prescribed medication. The medication room and fridge temperatures were recorded to ensuing that medication was being stored in line with the manufacturers suggested environmental conditions. The service also had all of the separate bottles numbered in the trolley, this process ensured ease and effective administration when completing a medication round and supported the nurse in remaining focused. It was noted that an appropriate coding sheet was not in place for the administrator to apply the code to in any events where by medication had not been taken, refused or destroyed. The management of controlled drugs is effective with records being accurate and stock balances being correct. Care Homes for Older People Page 14 of 29 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. The service provided sufficient and suitable meals and activities for the people who use the service to ensure that their individual needs, choices and preference are taken into consideration at all times. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. On the day of the inspection a number of people who use the service were waiting for family members and or friends to visit and commented that they are able to have visitors as they wish. One relative commented that I am able to visit when ever I like. I usually come twice a day. I can have meals if I want to, they are very welcoming. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. This was indirectly observed through the practices of the staff on duty. A number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. The people using the service had a variety of communal and or personal spaces to relax. One person Care Homes for Older People Page 15 of 29 Evidence: commented that I like to keep myself busy, we have a girl in every weekday to entertain us, we play bingo, watch films, play games, she is so lovely. Part of the care planning process does identify peoples preferred activities and comments in brief about their life history. There is an area for activities and a notice board with forth coming events and important updates for the people who use the service. In this communal area, during the inspection a number of staff were indirectly observed simply sitting with a number of individuals and taking about every day life. The AQAA determines that We have a structured activities programme with a dedicated activities organiser. During the inspection it was determined that between fifteen and twenty hours of activity is provided per week for the people who use the service. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Menus were on display. The food provided appeared appetising and well presented. Comments received included, The food is good and there is always a choice available for lunch and tea time, we have tea at 5pm. Generally very good efforts are made with the food. The AQAA determines that The menu master helps ensure every menu within the business is customer led and nutritionally balanced. The care staff are sensitive to the needs of those people who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the individual, making them feel comfortable and unhurried. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The services robust management of complaints ensures that the people who use the service are protected, however recruitment check shortfalls do not consistently ensure people are protected from abuse. Evidence: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. Complaints leaflets were on display at the service, it was observed that a detailed record of all compliments is maintained at the service and the AQAA determines that no complaints have been received in the last twelve months. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. The AQAA determines that BUPA Care Services has a clearly defined complaints policy with agreed time scales for managing complaints. The information that accompanies the procedure is clearly displayed in the home. The AQAA further adds that BUPA Care Homes has robust allegation of abuse and neglect polices, allowing staff to raise concerns within the home or to senior staff outside the home. Care Homes for Older People Page 17 of 29 Evidence: The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. The service understands the procedures for safeguarding adults and would attend meetings as required. One staff member commented that I have completed my abuse training, it was detailed. The training matrix indicates that a significant number of staff have received the Safeguarding Adults training. As part of the inspection process, we reviewed a random selection of staff files. Four staff files were audited to ensure suitable checks had been conducted. It was found that one of the staff members working unsupervised had only received a POVA 1st clearance, a second staff member did not have suitable documentary evidence for clearance to work from the Home Office and a third staff member had two references on their file, however one of these references was from a friend of the employee and was not a professional reference. Care Homes for Older People Page 18 of 29 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 service provides a satisfactorily maintained safe, clean environment ensuring that all people are in comfortable surroundings and protected from risk. Evidence: The people who use the service are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of individuals and can be changed if their needs change. The building design supports the needs of people using the service. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The home has an infection control policy. The service is clean, well lit and it smells fresh. A number of people using the service commented that they liked living at the service. One person using the service commented that its very comfortable and warm, I am very lucky with my room. The AQAA determines that the home is supported in maintaining the environment by a central team of experts. We have a specialist property and estates department as well as hotel services department. Care Homes for Older People Page 19 of 29 Evidence: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the people and is homely, clean, safe and comfortable, satisfactorily maintained and reflects the individuality of the people using the service. A number of the separate living areas do have pictures on the doors to support people with memory loss and recognition of self. Individuals are encouraged to see the home as their own. It is a satisfactorily maintained, and has good access to community facilities and services. The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. It is fully accessible throughout to people with physical disabilities, adaptations and specialist equipment are designed to fit within the homely environment. The management has a proactive infection control policy and they work closely with their own staff and external specialists, such as NHS infection control staff, to ensure that infections are minimised. The bathrooms are homely and include aids and adaptations to meet the needs of the people using the service. There are sufficient toilets to enable immediate access. It was noted that a bathroom was being used as a store room. It was noted that a number of doors were pin code protected and or locked, whilst this was explained as a health and safety issue appropriate risk assessments should be conducted to ensure that the reason for any restriction as agreed and documented in the persons best interest. Recently new fire fighting equipment has been purchased for the service to support evacuation from the service should the situation arise. The service is currently working with the local fire authority to ensure full compliance is achieved. Care Homes for Older People Page 20 of 29 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 who use the service are cared for by a conscientious, adequately trained work force ensuing that they are supported and protected from harm, however recruitment practices do not consistently ensure people are adequately protected. Evidence: There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards (NMS). All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. The service has a recruitment procedure and policy in place, however as part of the inspection process, we reviewed a random selection of staff files. Four staff files were audited to ensure suitable checks had been conducted. It was found that one of the staff members working unsupervised had only received a POVA 1st clearance, a Care Homes for Older People Page 21 of 29 Evidence: second staff member did not have suitable documentary evidence for clearance to work from the Home Office and a third staff member had two references on their file, however one of these references was from a friend of the employee and was not a professional reference. Staff were indirectly observed supporting people appropriately and it was pleasing to observe people engaging positively with people though out the day. The AQAA states that we have a good level of staff retention and are always endeavouring to maintain this to ensure continuity. Care Homes for Older People Page 22 of 29 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. Management systems are in place to ensure that the health, safety and well being of the people who use the service are protected, however shortfalls were identified in staff supervisions. Evidence: The Manager has the required qualifications and experience and is competent to run the home. The Manager and the staff team have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve the service. Feedback received on the day of the inspection from staff and the people who use the service determines that the management are effective and approachable. The Manager leads and support a stable staff team who have been trained to satisfactory levels. The AQAA determines that over 50 percent of the staff team hold or are working towards their National Vocational Qualification in Care (NVQ). Care Homes for Older People Page 23 of 29 Evidence: The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. There was some evidence on staff records that staff have supervision but this is not always carried out on a one to one basis where staff have the opportunity to discuss their personal development. The manager confirmed that continued development and progress is being made with training and supervision. Staff commented that they received supervision, however records did not show that staff were receiving a minimum of six supervision sessions per year. The manager commented that he was aware of this and that new supervision groups, roles and responsibilities had been devised in order for this to be achieved. The manager stated that improvements would be made. Staff meetings take place regularly and minutes of the meetings are available. The home works to a clear health and safety policy. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The service provides in house training regarding safeguarding and staff showed a sound working knowledge of action to take in such an event. A training matrix has been developed. Whilst the AQAA determines that staff have completed their mandatory training. The manager also confirmed that a monthly training plan, the plan showed that POVA was scheduled for March 2009. It was confirmed that manual handling, fire awareness, risk assessment, fire assessment, continence, medication, safeguarding, food hygiene, personal best and control of substances hazardous to health (COSHH) have been completed by a number of staff to date. All health and safety checks observed were up to date and organised. BUPA is currently working in conjunction with the Fire Authority to ensure full compliance is achieved. As part of the inspection process, we reviewed a random selection of staff files. Four Care Homes for Older People Page 24 of 29 Evidence: staff files were audited to ensure suitable checks had been conducted. It was found that one of the staff members working unsupervised had only received a POVA 1st clearance, a second staff member did not have suitable documentary evidence for clearance to work from the Home Office and a third staff member had two references on their file, however one of these references was from a friend of the employee and was not a professional reference. Care Homes for Older People Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 All people who use the service must receive all medication as prescribed. To ensure that their medical and health needs are supported at all times. An Immediate Requirement was left at the service on the 11th February 2009 and compliance was achieved on the 12th February 2009. 06/03/2009 2 18 19 All staff must have an Enhanced Criminal Records Bureau Disclosure to work unsupervised. To ensure all people are protected from harm and abuse. An immediate requirement was issued on the 11th February 2009. Compliance for the specific staff member was achieved with immediate effect. 06/03/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 1 18 19 All staff must have suitable pre employment checks, before commencing working within the service. To ensure that all people who use the service are protected from harm. 19/03/2009 2 35 18 Staff working at the service 01/04/2009 must be appropriately supervised at least six times a year. To ensure staff are supported within their roles. 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 1 The Statement of Purpose should be reviewed to amend the complaint contact details, to ensure people can make contact with the required people. A coding sheet should be used to ensure that full details of medicines not administered, refused or destroyed are accurately recorded and an audit can be made. Bathrooms should not be used to store equipment. Restrictions in movement to protect an individual should be assessed and documented. 2 9 3 4 21 24 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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