Inspection on 18/02/09 for Ashfields

This inspection was carried out on 18th February 2009.

CSCI found this care home to be providing an Excellent 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.

Other inspections for this house

Ashfields 11/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashfields 31 Salhouse Road Rackheath Norwich Norfolk NR13 6PD     The quality rating for this care home is:   three star excellent 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: Judith Last     Date: 1 8 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (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 30 Information about the care home Name of care home: Address: Ashfields 31 Salhouse Road Rackheath Norwich Norfolk NR13 6PD 01603721720 01603722346 ashfields@barchester.com 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) : Barchester Healthcare Homes Ltd care home 44 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: Date of last inspection Brief description of the care home 1 Ashfields is a care home offering personal care for up to forty-three elderly residents who are mentally frail. Barchester Healthcare have owned and operated the home since 2004. The homes accommodation for service users is all located on the ground floor. First floor rooms are used as offices. The home is situated in the village of Rackheath, a few miles to the north east of the city of Norwich. The front of the property provides a good degree of parking space and there are enclosed and well maintained gardens to the rear and sides. Fees are not currently set out in the service users guide but are specified in the terms and conditions of residence. Inspection reports are available in the home. Care Homes for Older People Page 4 of 30 Care Homes for Older People Page 5 of 30 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: three star excellent 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: Before we visited the home we looked at all the information we had about it. This includes information we have from the home itself, the things they have to tell us about, and the information we asked the manager to complete. We also looked at the history of the service and the way it had been run in the past. We visited the home unannounced and spent a total of about 7 hours there. We had comments from four staff and three relatives and spent time watching and listening to what was going on. During our visit, the main method of inspection we used is called case tracking. This means we look at records to see what they say about peoples needs and then try to Care Homes for Older People Page 6 of 30 find out from observation and discussion how well they are being met. We used all the information we gathered and the rules we have, to see what outcomes are delivered for people in their daily lives. 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 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 –0870 240 7535. Care Homes for Older People Page 8 of 30 Care Homes for Older People Page 9 of 30 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 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: There is a service users guide available to people to tell them what they can expect from the service. At present this information does not include the range of fees that regulations say should be there. (These are set out in individual terms and conditions though, at the point a placement is being considered and made.) The manager recognised in information she sent to us, that the brochure needed updating so we have not made a requirement about this. The organisation uses mystery shoppers to telephone as if they were enquiring on behalf of prospective service users. These people assess the responses given by the management team to see whether they provide a range of useful information about Care Homes for Older People Page 11 of 30 Evidence: the service. These are evaluated to see if enquiries have been followed up appropriately and show 100 compliance with the organisations expected standards when this was last looked at in October. This means staff help provide relevant information to those who may be thinking about using the service. The home accommodates people who have dementia and so the information is given to relatives or other representatives. The organisations survey and information from relatives of people already living in the home, shows that people feel they have the information they need to help make an informed decision about whether the home might be suitable. Each person has an assessment of their needs on file. These show that peoples health and personal care needs are assessed, as well as their vulnerability to falls, poor nutrition and developing pressure sores. These is also information about who may be empowered to act on the persons behalf because of their mental frailty. Assessments cover peoples religious beliefs and whether they are practising or wish to do so. Life story work has started in order to develop a better picture of peoples histories. Some information on care plan files shows that they are awaiting the involvement of relatives in developing this, where people are unable to do so for themselves. This helps the service respond appropriately to people with dementia and engage them in meaningful discussion or reminiscence. This means the assessment process reflects a holistic approach to finding out about peoples needs and preferences and whether the home will be able to meet them. People are able to stay at the home for a trial period or for respite care. Relatives are encouraged to visit so they can support people in making decisions about whether to live there. One told us that close cooperation is always available from managers and/or care staff in providing information. One says they selected this home after visiting and considering eight others and another tells us this home is very good compared to some I inspected before making my choice. The service does not admit people for rehabilitation. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Staff put into practice the principles of respect and dignity. Evidence: Everyone has a care plan setting out what staff need to do to support people effectively with their health and personal care. Care plans also set out the affect of mental frailty on peoples behaviour or communication. They are kept under review and we could see they recognised changes in peoples condition. For example, one person is shown on assessment as mobile but will need one carer to assist her while walking, getting in and out of a chair. There is a care plan update showing the person is able to walk with the assistance of two carers. (However this has not been dated to show when it took place and therefore when it is next due for review.) Three staff told us they always have access to up to date information about peoples needs and one commented that care plans are always updated and discussed. This means staff are made aware of peoples current needs and how to meet them. Care Homes for Older People Page 13 of 30 Evidence: Care plans set out individual strategies for managing people whose behaviour may challenge and how staff can minimise the risk of agitation. For example, one person is noted as occasionally being calmed by singing. However, records of such events in peoples daily notes do not always support that these interventions have been tried to reduce agitation. Records show that concerns about peoples health (including tissue viability, nutrition and continence issues) are referred to relevant professionals for advice. We could see that care plans set out what areas of care are to be monitored (for example intake of food and fluids) to help promote peoples health. Each person has a care plan section for promoting tissue viablity and we could see that these showed the equipment that was to be used to minimise risk and how staff were monitoring people. There was also evidence that the district nurse is involved. This means that there are measures in place to help reduce risk in this area and to follow up concerns so that people receive the treatment they need to help improve their condition. However, in some cases it is unclear from notes how difficulties with peoples health are identified and monitored. For example, one person is recorded on 04/01/09 as arm also seems to be a little stiff. There are no subequent entries showing that this had been followed up or had recovered. Similarly, the person was referred to the GP on 26th January with ossible oral thrush and cystitis. Although concerns about the persons condition had clearly been identified and referred for advice, daily records for the period leading up to this do not show any indication of concerns such as concentrated urine, smell, difficutlies with fluid output or signs of distress. This means there was no clear highlighted need to monitor the person more closely. Staff make use of bowel and bladder charts that refer to all service users who are being monitored rather than individuals, with everyone on the same list. The organisations own quality audit process has already highlighted issues of confidentiality this raises and which need to be addressed. Relatives feel peoples needs are always met. We had comments like there is good contact with the homes GP practice, first class hygiene/personal care, staff understand the needs of the residents and care is good. We looked at medication for those people whose care plans we had seen. Each person has their medication stored in a locked cabinet in their rooms. The process of administering medication we were told about, shows one person is given this at a time Care Homes for Older People Page 14 of 30 Evidence: with staff returning to rooms to sign records. There is no system at present for monitoring staff continue to sign the records on preparing the medication rather than after seeing it is taken, to avoid an extra journey to the room and so that they always follow expected procedures. Staff who have responsiblity for administering medicines, are given training in the management of medicines. The manager told us and we could see it on training records. Records we saw were complete showing whether medication had been given, was not needed or was refused. We could also see that, where medicines were prescribed for occasional use to control a particular condition (e.g. shaking and tremor) there was guidance about what this was for. Daily records of peoples conditions showed that the administration was justified on each occasion, to promote their wellbeing. These things show that there are measures in place to help ensure medicines are recorded and held safely and that people receive the medicine they have been prescribed to help promote their health and wellbeing. We saw that staff knocked on peoples doors before entering their rooms, so making efforts to uphold peoples privacy. Sometimes this is infringed by the behaviour of others and care plans recognise where this might happen. For example, that for one person identifies the risk of them going into other peoples rooms and urinating in their rooms. It says that staff are to supervise the person when they are near the rooms of those who are bed bound to ensure their safety. However, records also show that this did happen to one person who woke to find the other in their room and that person - who is bedbound - does not have a corresponding risk assessment about minimising this and ensuring that the person is not frightened or distressed by such events. Care Homes for Older People Page 15 of 30 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. Efforts are made to ensure peoples recreational and social needs are met and the providers have already identified areas that can be improved. People are able to enjoy their meals and provided with a good diet. Evidence: During our visit we saw that there were plenty of staff to engage people in small group activities or in one to one discussion and attention. We saw one staff member sitting quietly with a person talking to them and encouraging conversation. During the afternoon of our visit, staff came to collect creams and nail polish so they could do manicures and hand massage for those people who enjoyed it and wanted to participate. Daily records show some of the opportunities people have for activities - including celebrations such as Chinese New Year. However, the activities record charts provided are not currently being used. One showed no entries since 2007 (when we last visited) indicating that records do not do justice to the practice we saw and fully support how peoples recreational and social needs are met. This has been raised in monitoring visits on behalf of the registered provider where it is identified that care plans could be Care Homes for Older People Page 16 of 30 Evidence: more person-centred in relation to activities. During our visit, relatives and friends came throughout the day to see people living in the home. Some stayed to assist people with their meals. One relative says they feel very welcome in the home. The home has access to transport so that people can make use of the local community or go on outings together. Records show flexibility in routines - for example what time people want to get up or retire at the end of the day. People also told us they can have breakfast in their rooms if they wish. The manager says that staff do not mind if people are not dressed at that point and that there is flexibility around the domestic routine. Peoples rooms show that they are able to bring in personal possessions to help make Ashfields feel more homely and their surroundings more familiar. Everyone living at the home has some degree of dementia and so financial affairs are managed by appointees rather than people themselves. The home does not handle money on behalf of people moving in and Barchesters terms and conditions of residence make this clear. Families or representatives are invoiced for expenses incurred so they can help monitor peoples finances and expenditure is being incurred appropriately. We saw the main meal being served in the large dining room. People were assisted to the counter to choose what they would like to eat. One person told us that the food is very nice, very tasty. A relative also told us they feel the home provides good food. However, there were distractions in the dining area when we visited, with two radios clearly audible and tuned to different stations. This added to the routine noise from people arriving, being assisted or served by staff and selecting their meals. This can lead to over-stimulation or confusion in people with dementia who may find it difficult to orientate themselves in such an environment. Peoples care plans set out what help they may need to eat, what they can manage for themselves and whether they need additional monitoring or support. Daily records show this monitoring is given to make sure people are properly nourished. Care Homes for Older People Page 17 of 30 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. There are measures in place to help ensure people are protected and that any concerns they (or their representatives) have are taken seriously and addressed. Evidence: People living at the home have dementia and so would require some support to make their concerns known clearly. All of the relatives making comments to us say that they know how to make a complaint and - if they have needed to raise a concern - these have always been dealt with appropriately. One comments that they would raise any complaint first with the home and indicates they are confident in doing so. Three of the staff say they know what to do if someone expresses concerns about care. Staff have access to training to help them understand, recognise and respond to any concerns about abuse of people living in the home. Barchesters quality monitoring systems provide for checking that appropriate training has been given and that staff know what they should do to report concerns. The manager says staff do not start work without appropriate checks against the register for the protection of vulnerable adults. She says that - pending completion of the full enhanced Criminal Records Bureau check, staff work only under supervision to Care Homes for Older People Page 18 of 30 Evidence: ensure they do not present a risk to vulnerable people. Letters of appointment seen show that new staff are informed who their mentor will be while full checks are awaited. However, on one of the files for new staff appointed, the check against the list that would identify if someone presented a risk to vulnerable adults had not been obtained until the day after the person started work. The potential risk had been minimised by ensuring the person worked with a named and appropriately checked member of staff. See also the staffing section of this report. We discussed this with the manager who was clear this was not her expectation and that there had been an administrative error. There was a checklist to help ensure the appropriate process was completed. Care Homes for Older People Page 19 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, safe and hygienic environment that suits their needs. Evidence: Since our last visit to the home, the first floor has been withdrawn from use as accommodation for people with dementia. This means that the risk of people accessing that part of the home has been removed. (The management team also say problems with the hot water supplies, noted at our last visit, have been resolved now people no longer use rooms on the first floor.) We saw some peoples bedrooms. Records show there are regular audits and monitoring checks to make sure that any hazards are identified and addressed and members of the regional team for Barchester also make checks that the environment is being maintained. This means that people live in an environment that is well decorated and maintained and has not been allowed to become shabby in any way. Fire systems are tested regularly and equipment is maintained. This is also checked for compliance by members of the regional team. Where shortfalls in compliance were identified the manager had addressed them. This helps ensure that people are not exposed to avoidable risk as a result of fire. Care Homes for Older People Page 20 of 30 Evidence: There were no unpleasant odours around the home when we visited, and no odours associated with difficulties managing continence. We saw that staff had access to (and used) protective clothing to help minimise the risk of infection spreading. There are ancillary staff who deal with laundry, cleaning and other housekeeping responsibilities, and separate catering staff. This also helps minimise the risk of infection spreading. The manager says in written information sent to us that 45 staff have received training in infection control. This represents all the staff (care and ancillary staff) who were in post at the point she sent us the information. Staff records sampled confirmed this training as in place. This means there are measures in place to help ensure the home is always clean and hygienic and that any outbreak of infection would be managed appropriately. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained, competent and in sufficient numbers to support people effectively and meet individual needs. Evidence: Our observations showed that there were sufficient staff to support people with activities, with personal care and with help to eat their meals. Five staff say there are usually enough staff to meet peoples needs effectively and one says this is always the case. Relatives commented to us that people are always given the support for care they expect and that care staff always have the right skills and experience to look after people properly. Senior staff told us about how the responsibilities of senior staff are divided so that there are systems for checking things are happening as they should. A senior carer is responsible for allocating tasks on a day to day basis during shifts to make sure care is delivered appropriately. This indicates staff are clear about their responsibilities and there are systems in place to make sure those with less experience are appropriately supported and monitored. Information from the manager indicates that no agency staff are used and so support is provided by permanent staff. This helps to ensure consistency and that staff Care Homes for Older People Page 22 of 30 Evidence: understand and get to know peoples individual needs. Over half of the staff team have completed national vocational qualifications to level 2 or above, to give them the underpinning knowledge required to support people effectively and help them understand their roles. Records show there are training profiles for staff members, and that those undergoing induction have named mentors to support them while they are learning about the work. Certificates of training completed, including those obtained by staff who had worked in care in other establishments, were available on files seen. This helps to show that staff have been trained in the skills hey need to support people effectively. We saw from quality audits and from staff comments, that they have access to elearning facilities to update their knowledge. A member of the management team has also completed training to liver moving and handling and first aid training. This means that staff can be kept up to date and work safely with people living in the home. Additionally, the senior staff member is undertaking training in Alzheimers disease and will be able to support and train staff to understand and meet the needs of people who are confused. Four staff commented to us that they feel they are given training that was relevant, helps them to understand individual needs of people and keeps them up to date with new ways of working. Barchesters own quality monitoring systems look at gaps on staff knowledge and computer records seen show what needs to happen to improve and the actions taken to address any identified shortfalls so staff are competent in their roles. We looked at recruitment files for three members of staff recently taken on to work in the home. These show that references and checks to make sure people are suitable to work with vulnerable adults are completed. However, for one of the three the check against the register listing people unsuitable to work in this capacity was not completed until the day after their appointment. One of the references, supposed to be in place before people start work, was dated the day after their appointment and one, the day of their appointment. This means that the basic information was not completed before the person started work, although we were told they were supernumerary and supervised by experienced and properly checked staff. Barchesters guidance for new staff sets out that they are not to undertake personal care for people until their full, enhanced criminal records bureau checks have been received and that they must decline this if they are asked in error. This means that Barchester are clear in their expectations about staff roles and how vulnerable people Care Homes for Older People Page 23 of 30 Evidence: are to be safeguarded. Two senior staff confirmed peoples roles in mentoring and supervising the work of new staff while they were on shift - confirming the arrangements set out in letters of appointment. However, we were not able to verify this from duty rosters as these had been archived and were not available to us. Care Homes for Older People Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is competently, effectively managed and administered by the management team. There are very good systems for monitoring, assessing and improving the quality of the service. Evidence: The manager has many years experience working in the service and has the qualifications and training she needs. She is supported in her role by other members of the management team, who - although not registered with us - are undertaking training to help them with management skills and competencies in care that they can use to develop other members of staff. This means that it is run effectively in peoples best interests. The annual quality assurance assessment the manager sent to us before we visited, contained a range of information about how well the service was doing and what Care Homes for Older People Page 25 of 30 Evidence: evidence there was to support this. It was fully complete. The providers make regular monthly visits to the service to comment on service quality and to give the manager feedback about what needs to happen. In addition, there are annual audits of a whole range of practice and areas to see how well the service measures up to expected standards. Parts of this process provide for gathering views of people who are connected with the service, and of relatives of people living there. This means that the organisation and manager take responsibility for ensuring that improvements continue to be made in peoples best interests. The manager told us that no money is held on the premises on behalf of people living there. This is because the home supports only people who are mentally frail. Where expenses are incurred - for example for hairdressing - families or appointees are invoiced as appropriate. The terms and conditions of Barchester, issued to people or their representatives, make this clear so people (or their representatives) are aware of arrangements before they move in. We looked at a sample of records to do with health and safety. These include arrangements for servicing and testing equipment to make sure it is safe. These were attended to at regular intervals. Staff have training in first aid, and health and safety is also looked at in the context of the quality monitoring systems and regular audits so shortfalls can be addressed promptly. For example, there was prompt action shown in staff meeting minutes to give explicit instructions to staff when moving and handling procedures were not consistently followed. These things lead us to conclude that there are measures in place to help promote the safety and welfare of people living in the home. Care Homes for Older People Page 26 of 30 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 27 of 30 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 29 19 Recruitment processes must 15/05/2009 be monitored to ensure they always comply with the law. This is so measure for safeguarding vulnerable people are consistently and robustly implemented at all times. 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 8 Periodic checks on the process staff follow for administering and then recording medicines should be carried out to ensure staff always follow expected procedures for recording what medicines people have taken. Daily records should show the strategies staff try to reduce agitation and that these match the identified needs for the individual concerned. Daily records should show where health concerns are identified and should provide for follow up to show improvement. This is to help minimise the risk that concerns might be overlooked. Where people are bedbound and may be unable to raise Page 28 of 30 2 8 3 8 4 10 Care Homes for Older People concerns if another resident enters their room and causes distress, risks should be looked at for those people to see whether additional resources or assistive technology would help to enhance their privacy. 5 12 The home should review how participation (or refusal to join) in recreational and social activities is recorded so that the management team can monitor how effectively peoples needs are being met and what else could be done to improve this area. Copies of duty rosters showing named mentors for staff undergoing induction and pending full checks, should be available as evidence the procedure expected by Barchester is consistently followed. 6 29 Care Homes for Older People Page 29 of 30 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. 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