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Inspection on 02/11/09 for Ashlea Lodge Residential Home

Also see our care home review for Ashlea Lodge Residential Home for more information

This inspection was carried out on 2nd November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The catering staff provide meals which are nutritious, nicely presented and in sufficient quantities. The residents and relatives commented that the food is always good. The staff engage the residents in various social and recreational activities. The activities organiser is very enthusiastic about her role and residents and relatives commented positively on her role and dedication. There are several indoor and outdoor fund raising activities organised by the staff to raise money toward the residents` funds. The home is clean and well maintained. It is well furnished and equipped to meet the needs of the residents. The bed rooms are personalised and reflect individual preferences and taste. There are good arrangements in place for the residents to receive regular pastoral visits from the local churches. Comments by staff, residents and relatives include the following: "We are very happy with the care mom is receiving". "I now feel confident about the care that we provide". "There is no friction between the staff now". "Since this new manager, the staff have been working as a team". "I am happy here. The staff are very kind to us". "The food is good. There is always plenty to eat and drink". "Mom has settled well and that makes me happy". The Expert By Experience noticed high moral amongst the staff team. She made positive observations about the enthusiasm of the new manager. Relatives and staff spoke to her about the improvement in care practices in the past few weeks. Staff commented that they now look forward to coming to work and that the new manager is fair and willing to listen.

What has improved since the last inspection?

Since the last inspection there has been an improvement in staff training and there is a plan of action to make sure that all staff receive the required training. The new manager is reviewing the current care plans and examination of records show that the home is making good progress on the quality of information in the care plans.

What the care home could do better:

Up to date fire safety training must be provided to all night staff. The training records show that four night staff have not received up to date fire safety training. All staff must receive dementia awareness training. The home provides care for people with dementia and the training records show that only five staff have received training in dementia awareness. The manager and senior staff must receive training in Mental Capacity Act and Deprivation of Liberty Safeguards. This training should eventually be extended to all staff. Although records show that ten staff have been booked to attend this course, the training should have been provided long before as the home is providing service for people with dementia. Two staff who commenced work in September 2009 had no record of induction training. The provider must ensure that all newly appointed staff are properly inducted and a record of such induction training should be maintained on file. The manager should start to implement a program of staff supervision so that all staff receive regular supervision. The service user guide should be amended to reflect the contact details of the CQC.

Key inspection report Care homes for older people Name: Address: Ashlea Lodge Residential Home Hylton Road Millfield Sunderland SR4 7AB     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: Sam Doku     Date: 0 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ashlea Lodge Residential Home Hylton Road Millfield Sunderland SR4 7AB 01915109405 01915109406 ashlea.lodge@btconnect.com(Notavailable130208) Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Winnie Care Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 40 Dementia Code DE, maximum number of places 15 Date of last inspection Brief description of the care home Ashlea Lodge is a two-storey building, which has been specifically designed to provide personal care for older people who may have a variety of needs, including people who have dementia. The layout of the building allows for the home to be divided into two separate units and each contains a lounge, dining room, kitchen, bathroom, toilets and en suite bedrooms. A garden, which is accessible to people who use a wheelchair is at the rear of the building and there is a car park at the front. The home is located close Care Homes for Older People Page 4 of 28 Over 65 0 40 15 0 2 9 0 7 2 0 0 9 Brief description of the care home to St Marks Church and a GPs surgery, both of which are easily accessed. The Metro line has a station within walking distance from the home. In addition, there is a regular bus service, which stops opposite the home. Ashlea Lodge is situated relatively close to a shopping area, which has a post office, grocers and public houses. The home is registered to admit 40 people who may have physical disabilities or who may have dementia type illness. The home is owned by Winnie Care Limited. The scale of charges for the home is 407 to 422 pounds per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of this service is 1 Star. This means the people who use the service experience adequate quality outcomes. The inspection was unannounced and commenced on 2 November 2009 and completed on the same day. Before the visit the inspector looked at: Information we have received since the last inspection visit on 11 May 2009. How the home dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The providers view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQAA). Following the pre-inspection review, the decision was made to ask for an Expert By Experience to accompany the inspector on this inspection visit. Care Homes for Older People Page 6 of 28 During the visit the inspector did the following. Talked to the people who use the service, the manager and the care staff. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The Expert By Experience concentrated her involvement by talking to staff and relatives, and to observe the general atmosphere in the home. The inspector told the manager what he and the Expert By Experience found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Up to date fire safety training must be provided to all night staff. The training records Care Homes for Older People Page 8 of 28 show that four night staff have not received up to date fire safety training. All staff must receive dementia awareness training. The home provides care for people with dementia and the training records show that only five staff have received training in dementia awareness. The manager and senior staff must receive training in Mental Capacity Act and Deprivation of Liberty Safeguards. This training should eventually be extended to all staff. Although records show that ten staff have been booked to attend this course, the training should have been provided long before as the home is providing service for people with dementia. Two staff who commenced work in September 2009 had no record of induction training. The provider must ensure that all newly appointed staff are properly inducted and a record of such induction training should be maintained on file. The manager should start to implement a program of staff supervision so that all staff receive regular supervision. The service user guide should be amended to reflect the contact details of the CQC. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good information about the home in the form of a service user guide and other information leaflets. Furthermore, the positive pre-admission process allow people to make positive decision about whether or not to come and live at Ashlea Lodge. Evidence: Generally there is good information around the home and in the reception area about the home and the service that is provided at Ashlea Lodge. However, the service user guide is out of date regarding the information about the service and also about the contact details of the Commission. The service users files that were examined contained details of the assessments that were carried out by social workers and also details of visits by the staff of the home to the prosepctive residents to assess them for residential care. All these were done before the residents were admitted to the home. Care Homes for Older People Page 11 of 28 Evidence: One resident was sopken with and she stated that she was given the opportunity to visit the home and to meet with staff and other residents before she finally decided to come and live at Ashlea Lodge. This arrangement is stated in the homes service user guide and staff also confirmed that this is the practice. Staff said that in most cases the prospective residents family visit the home of their behalf. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that the healthcare needs of the residents are fully met. However, the care plans need to specific in ensuring that staff know who is responsible for specific tasks in order to safeguard the welfare of the residents concerned. Evidence: The inspector and the Expert By Experience spoke with a number of residents and they used the opportunity to find out from them if their healthcare needs are met. The residents and their relatives confirmed that they have access to healthcare facilities including visits from their GPs and other healthcare professionals. The residents files provide details of the healthcare support that each individual resident gets. The care notes show entries of visits to or from healthcare professionals. The care plans show that the new manager is beginning to review them and to make sure that peoples healthcare needs are met. There is general improvement to the care plans that have recently been reviewed by the manager, but there is still room for improvement, especially in the case of specific tasks. For example care plan statement like, staff to ensure that Mrs X has regular eye test, is not helpful. It Care Homes for Older People Page 13 of 28 Evidence: should state who should be responsible for that task and how often the task is to be undertaken. The home has detailed written policies on the storage and administration of medicines. The manager confirmed that the staff who are responsible for the administration of medicines have received up to date training on safe handling of medicines and they follow the homes medication policies. Random check of the medicines administration system was undertaken by the inspector. There were no discrepancies noted, and the administration sheets have been signed and dated as required. The interaction between staff and residents was good. Staff showed respect to the residents and this was commented on by a number of residents. The residents stated that the staff treat them with respect and dignity. The inspector and the Expert By Experience observed that the staff were polite, courteous, friendly and professional in the way they related to the residents. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have the benefit of meaningful and fulfilling social and recreational activities which enhance their wellbeing. The residents are provided with good variety of wholesome and nutritious meals, which promote their health and wellbeing. Evidence: There are two dining rooms in the home, one on each floor. These are pleasantly decorated and furnished to a good standard. The inspector had his lunch with the residents on the first floor and the Expert By Experience had her lunch with the resident on the ground floor. The tables were appropriately set and residents had their meals in pleasant and comfortable environment. The residents were given plenty of time to enjoy their lunch and people who require help from staff with their meals were given that support in ways that preserved their dignity. Residents said they like the food and that there is always plenty to eat. The menu show that there is choice of meals for the residents to choose from. The home has an activities coordinator who organises social and recreational activities Care Homes for Older People Page 15 of 28 Evidence: for the residents. She maintains a record of all the activities that individuals take part in. She said that sometimes she gives one to one attention to individual residents who are not usually able to actively take part in activities. She said that some of the activities she organises include bingo, card games, sing along, films and outings. The hairdresser visits the home once a week and she said that the residents enjoy the experience of having the hair done for them. The inspector spoke with the residents about times for going to bed and rising. Those who were able to talk about this said that they are able to go to bed when the want and rise when they want. One resident said, no one is made to go to bed if they dont want to. One gentleman said that he prefers to have a lie-in and the home has no problems in allowing him to enjoy his lie-in. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and families have information they need to make complaints if they wish. However, the information is out of date in some cases. The information should be updated so residents would know who to contact if they have any concerns. Evidence: The home has a complaints procedure and a summary of this is included in the service user guide. However, the information about the Commission is grossly out of date and needs to be updated so that people who need to contact the Commission can do so. At the time of the inspection, record of specific complaints that the Commission received could not be found at the time of the visit. However, the inspector received a phone call later to say that the records have since been found. The manager said that she is reviewing the records relating to complaints so that these are easily accessible and contain all the necessary information that is required, and in line with the homes complaints procedure. Relatives and residents who were spoken with said that they are aware of the complaints procedure and would know what to do if they have any concerns about the home or the care that they receive. Records show that most of the staff have received POVA training. Ten staff have been Care Homes for Older People Page 17 of 28 Evidence: booked to go on Mental Capacity Act and Deprivation of Liberty Safeguards training. In view of the home providing services for people with dementia, such training should have been provided for the staff long ago. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides safe, secure, clean, warm and pleasant environment for the residents to live in. This promotes the safety and and welfare of the residents. Evidence: The home is clean and maintained to a good standard. The bedrooms that were visited were clean and personalised, reflecting individual tastes and preferences. Residents have been encouraged to furnish their rooms with personal items which enhanced the homeliness of their rooms. All rooms are single occupancy with en-suite facility. The bedrooms are spacious and have good ventilation and natural lighting. Residents and relatives described the bedrooms as comfortable and homely. Window restrictors have been fixed to all windows for safety. There is effective underfloor heating system and controls are in each room to allow residents to control their room temperature. Checks of hot water at randomly selected bathing outlets confirmed that hot water did not exceed the safety level of 43 degrees centigrade. There are good arrangements in place for regular maintenance work in the home. The home has suitable infection control policies in place. Staff have had training in infection control and records show that the home has adhered to effective infection Care Homes for Older People Page 19 of 28 Evidence: control procedures. The kitchen is clean and well organised. All the records that need to be maintained including food temperatures, cleaning rotas, fridge temperatures and other records are well documented and maintained. The Environmental Health Officers report for September 2009 made no requirements or recommendations. The officer was very happy with the state of the kitchen. The laundry was found to be well ordered, and appropriate COSSH notices are in place. The laundry machines are suitable for cleaning foul linen. There are good infection control measures in place. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers are generally satisfactory and meet the needs of the residents. However, there is lack of proper induction training program for newly appointed staff. This compromises the health and safety of the residents. Evidence: The staff rotas were examined and there are always sufficient number of staff on duty to meet the residents needs. Staff who were spoken with said that generally they are happy with the staffing levels, but on occasions, either through staff sickness or holiday commitments, they are slightly stretched but this is not something that has any negative impact on the care that they provide. To overcome this, the newly appointed manager stated that sometimes she uses agency staff to make sure that the staffing number are maintained. Five staff files were examined to see if the home has been following proper recruitment practices. The records show that all staff had completed application form and interviews were conducted. In some cases the interviews notes were kept on file. All staff have had enhanced CRB checks done on them. Two staff who were appointed in September this year have no record of induction training on their files. The three remaining files that were examined had record of the homes Basic Training Record of Induction and Competence in Care on their files but Care Homes for Older People Page 21 of 28 Evidence: these were half completed and some have not been signed or dated by the person why carried out the induction training. One other staff member who was appointed less than a year ago had only one reference. It was noted that since the last key inspection six months ago, the home had organised a number of training courses for the staff, including fire safety training, moving and handling, health safety, POVA, first aid and infection control. However, one senior carer on night duty had only received fire training and nothing else. This was brought to the attention of the manager who assured the inspector that immediate steps would be taken to address this with the individual involved. In the mean time the manager should ensure that when the senior is on duty, he is supported by staff who have received all the necessary training and have been assessed as competent. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some improvement to the way the home is managed and this has enhanced the quality of care that the residents recieve. Evidence: A new manager has recently been appointed and has been in post for six weeks to the time of the inspection visit. She has good experience of residential care and was Principle Senior in the home since May 2009 before being appointed as the manager. She stated that she is in the process of applying to the Commission to registered as the registered manager. Staff and relatives who were interviewed stated that the home is now making progress and they are confident about the new manager, whose aim is to run the home for the benefit of the residents. The manager stated that she is currently making the necessary arrangements for staff to receive one-to-one supervision from her. She said she has started this process with Care Homes for Older People Page 23 of 28 Evidence: the senior staff. The inspector will check how the manager is making progress on this at the next inspection visit. The company Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH), protection of vulnerable adults, infection control, disposal of clinical waste and record keeping. There is evidence that staff adhere to the policies as set by the company. Servicing records confirm that all portable appliances have been tested. A record is maintained of regular water temperature tests in the home. Regular servicing of fire equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. These included servicing of passenger lift, hoists, water treatment, electrical installation and gas servicing. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 17 13 All staff must receive training 30/06/2009 to prevent residents being placed at risk of harm or abuse. Staff have not received up to date training in POVA and deprivation of Liberty. 2 30 18(c)(i) Staff induction programme must be fully implemented and all new staff should receive induction training. This must be documented and retained on the individuals file. 30/06/2007 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 17 13 The senior staff must receive training in the Mental Capacity Act and Deprivation of Liberties safeguards. Senior staff have not received training in MCA and DOLs. 08/01/2010 2 30 17 All staff must receive dementia awareness training. Only five staff have received dementia awareness training. 15/01/2010 3 30 18 All newly appointed staff must receive induction training and evidence of this must be kept on individual files. Recently appointed staff had no record to say they have had induction training. 31/12/2009 Care Homes for Older People Page 26 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 30 18 The senior on night shift 29/01/2010 must receive proper training and to be assesed as competent to take charge of the home in the absence of a senior member of staff. One senior on night has not had statutory training. 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 7 The care plans should be specific so that the care staff would know who is responsible for carrying out specific tasks for the residents. The service users guide should be updated to include the current address and contact details of the Commission in the event of residents wishing to contact the Commission with any concerns. The manager should apply for registration with the Commission as the registered manager of the home. All night staff should receive up to date fire safety training. All staff should receive one-to-one supervision from the manager. 2 16 3 4 5 31 36 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!