Inspection on 06/05/09 for Belmont House

This inspection was carried out on 6th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Belmont House 23/10/08

Belmont House 07/05/08

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Snydale Care Home

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Belmont House High Street Starbeck Harrogate HG2 7LW     The quality rating for this care home is:   zero star poor 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: Irene Ward     Date: 0 6 0 5 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 40 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 40 Information about the care home Name of care home: Address: Belmont House High Street Starbeck Harrogate HG2 7LW 01423882100 01423882108 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross OPCO Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 106 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 106 The registered person may provide the following category of service only: Care Home with Nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 73; Dementia - Code DE, maximum number of places 42; Physical Disability, Code PD, maximum number of places 5 Date of last inspection Brief description of the care home Belmont House was built and opened in 2006, and is now owned by Southern Cross OPCO Ltd. It is situated between Knaresborough and Harrogate, near local shops and a Care Homes for Older People Page 4 of 40 Over 65 0 73 0 42 0 5 2 3 1 0 2 0 0 8 Brief description of the care home park. The home is accessible by local transport from both Knaresborough and Harrogate. Belmont House offers residential, nursing and personal care for up to one hundred and six people, some from the age of fifty-five upward, with nursing needs and for people with physical disabilities and dementia. The home has three floors, with three vertical passenger lifts to aid access to the first floor and second floor. There are five separate units. On the ground floor there is the Courtyard Suite for people who need residential help, and the Garden Suite for people with nursing needs. On the first floor there is the Promenade Suite for people with dementia and the Park Suite for people who need temporary care or rehabilitation and on the second floor the Spring Water suite for people with nursing needs. There are a number of bedrooms available for double occupancy and all have an ensuite shower room. There are gardens and internal courtyards for the residents to enjoy, and car parking is available on the site. Details provided on the 6th May 2009 outline the weekly fees between three hundred and seventy five pounds and eight hundred pounds. This does not include hairdressing, chiropody services and individual items like newspapers and branded toiletries. Care Homes for Older People Page 5 of 40 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: zero star poor 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 for this service is 0 star poor. This means that people who use the service experience poor quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed.The inspection process has now become a cycle of activity rather than a series of one-off events.Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This is what we used to write this report:We looked at information we have received about the home since it was registered. We asked for information to be sent to us before the inspection, this is called an annual quality assurance assessment (AQAA). We sent surveys to people who live at the home and to staff and Health Care Care Homes for Older People Page 6 of 40 professionals. Two inspectors visited the home unannounced. This visit lasted over eight hours and included talking to the staff and the manager about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live at the home and to two health care professionals and relatives who were visiting the home. We looked at six peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people who use the service. The inspectors were accompanied by an expert by experience for four hours of the visit. An expert by experience is a person who because of their shared experience of using services and /or ways of communicating visits a service with the inspector to help them get a picture of what it is like to live in or use the service. During this visit they were asked to look at peoples daily life, social activities, and the environment. Their observations have been used in these outcome areas. 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 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. The site visit took place on the 6th May 2009.The homes manager and the operations manager were both available to assist throughout the visit and available for feedback at the end of the day. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: People should have sufficient drinks made available to them at all times and have regular food to eat that they enjoy. This would make sure that peoples health is not put at risk. People should be able to access regular activities that they enjoy. This makes sure that the quality of life for people living at Belmont House is improved. People living at the home should have confidence in the homes complaints procedure and feel that it is effective and that when they do make a complaint, people are listened to and complaints are acted upon and are satisfactorily resolved. This makes sure that people living at the home live in an open culture where people feel valued. Staff could be more appropriately trained safeguarding people from abuse and any harm. This would make sure that people living at Belmont House are kept safe. The laundry service that is provided at the home could be improved, especially regarding the issue around peoples clothes that have gone missing. This would make sure that people receive a good service and have confidence in the laundry service at the home. Current staffing levels at Belmont House should be kept under review to ensure that they are sufficient to meet the needs of the people living at the home at all Care Homes for Older People Page 8 of 40 times,taking into consideration the lay out of the building. This will help to make sure that people who live at the home are well cared for and safe at all times. New staff should have induction training and evidence of this should be available for inspection. This would make sure that staff carry out their work properly and safely and the home can evidence that this is being done. Staff could receive more regular supervision and records of this should be held. This would make sure that staff work consistently in meeting the needs of the people living at the home. 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 40 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 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are properly assessed prior to admission, this makes sure that Belmont House is the right place for them to live. Evidence: Belmont House is situated in the area of Starbeck which is between the towns of Harrogate and Knaresborough.The home is near to a number of local amenities that people can access if they are able to or wish to do so. The manager confirmed that information is made available to anyone interested in moving into the home and a copy of the homes statement of purpose is given to prospective residents.The statement of purpose was not seen at the time of the site visit.The manager said that no changes have been made to either the Statement of Purpose or the service user guide and that it continues to be available in different formats such as on DVD or audio cassette.People considering moving to Belmont House are encouraged to visit the home and spend a day there. They can stop for Care Homes for Older People Page 11 of 40 Evidence: lunch and tea and a trial stay is offered. Six peoples care records were looked at. These showed that one person, who had recently moved to the home had had an assessment before they had moved into the home. These arrangements were in general use and each assessment,which had been undertaken by the manager or one of his senior staff, contained details of every aspect of peoples daily life and health needs. Examples of the information included were daily living,dependency assessment, social interests, and the condition of peoples mental health. The manager said that they visit people and get information from them as well as their relatives and other professionals to help them decide if they will be able to meet peoples needs before a place is offered.This was also confirmed by people living at the home at the time of the site visit. A discussion took place regarding the manager being aware of the skills needed in making a decision as to the home being able to meet peoples needs, especially where nursing care maybe required. The manager gave assurances that in those circumstances a qualified nurse would always carry out an assessment as he was not qualified to do so. This makes sure that peoples needs are always properly assessed before they are admitted into Belmont House. One nurse on one of the units confirmed she did carry out the necessary assessments of peoples needs thinking of moving to her unit, however because there were only six hours each week where there were two nurses on duty, this often had to be completed on her days off,although she was paid for this.As a matter of good practice the management of the home should look at staffing levels and how they can improve the time qualified staff have to carry out assessments in work time rather than in their own time so that they are able to carry out the necessary assessments of peoples needs before they move into the home. Although the home is registered for one hundred and six people, there were eightynine in at the time of the site visit. People who had recently moved to the home confirmed that they had been provided with all the necessary information before making a decision if Belmont House was suitable for them and able to meet their care needs. Three surveys were received by the Commission. People told us that they received enough infomation before moving to the home and that they received a contract. Separate files are held in the administration office that held copies of terms and conditions or contracts for individual people.All of the files seen held contracts in them that had been agreed and signed by people living at the home or their representative. Care Homes for Older People Page 12 of 40 Evidence: The expert by experience who spoke to both relatives visiting the home and people who live at Belmont said in their report, I spoke with four service users and two relatives on the residential unit who all seemed satisfied with the level of care they or their relative received. One relative speaking about his aunt on the dementia unit praised the carers for their patience and understanding. Another service user on the nursing residential was also positive about the care she was receiving. Two relatives and three service users were aware of care plans and had been consulted in their choices for care. The home does not offer intermediate care. Care Homes for Older People Page 13 of 40 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. Despite the care staff working very hard the health and personal care people recieve is compromised by lack of staff. And the lack of food and sufficient drinks could have detrimental affects to their health. Evidence: Six care plans from different units were looked at in detail as part of the inspection. These are needed to describe the care and support people need to maintain some day-to- day control of their lives. They are also there for care staff to refer to and to check that the care they are providing is the right care. Those looked at were generally satisfactory. They were written in a person-centred way, such as can wash face and front, but needs help with lower half, and is able to brush teeth independently and help (named person) to select his clothes and assist him to dress. This detail is good practice as it recognises that people are very different and care staff can support people to maintain these skills, rather than taking over. One person has communication difficulties and both the care plan and items in their room showed how the staff were alert to their need to make sure they did not become isolated. The care plans recorded peoples preferences with regard to getting up and going to bed. Care Homes for Older People Page 14 of 40 Evidence: People spoken with said that this was followed wherever possible. One person said they had no preference as to whether they received personal care from a male or female carer, whilst one lady said she would definitiely not want this sort of care from a male carer. Peoples preferences need to be discussed as part of the admission process and then followed wherever possible. On the whole peoples care plans were well documented and written in detail although one persons care plan needed to be more explicit when describing someone as maintains their independence and showers in their own room.This needs to be clearer as to whether the person needs or does not need any assistance from staff with a shower,such as getting the water in the shower to a temperature required.People maybe independent and need little or no assistance with personal care, however good practice indicates that well written care plans are clear as to what peoples needs are and how they can be met.Care plans seen had also been reviewed regularly. Care plans also covered all areas of daily living. They included details such as bathing,dressing,daily records,body map,nutritional assessments,falls risk assessments,pressure ulcer risk assessment,dependency risk assesment,moving and handling risk assessment,personal hygiene and records of professional visitors. Any changes to peoples health care needs are also recorded in daily records contained within their care plan. On the residential unit one person said they had fallen recently.Their care plan confirmed this. Although they had a falls risk assessment in place, this had not been reviewed since March, although the fall happened in April. Care plans had good records detailing both telephone and direct communication with healthcare professionals, like the family and specialist doctors, the community matron, speech therapist and dietician. There was also information about the individuals medical condition so that staff could understand a little about what it was like to live with the condition. Care staff had also received specific training so that they had the skills to support an individual in the right way. Care plans were in place for specific health care needs. Although people spoken with said they knew they had a care plan they said no-one had discussed the contents with them. This should be done wherever possible as then the person has the opportunity to say what matters to them. Any system introduced, which is a form of restraint, should be signed by the individual or their representative to give their consent.The bedrail risk assessment looked at had not got these signatures. Three surveys were returned to the Commission. All three people told us Care Homes for Older People Page 15 of 40 Evidence: that they recieve the medical care they need. People were observed on one unit as not having any drinks during the morning.When spoken to people did say that they did not always get a drink and that they did not get anything more to eat after their evening meal. We have gone into more detail regarding food and drink provision at the home, in the daily life and social activities outcome area in this report. Each person living at the home is registered with a General Practitioner. There are nine GP practices involved with looking after peoples health care needs.Other health care professionals are involved with peoples health care needs such as the chiropodist,district nurses,community psychiatric nurse and the tissue viability nurse.People living at the home attend Harrogate District Hospital for all A & E (Accident and Emergency) and for most out patient appointments. There was opportunity on the day to speak with visiting district nurses who made positive comments about the home such as, we have good communication with staff, staff will assist and help us,we do not have to wait.Staff are not unreasonable with requests they make and questions they ask are always valid. Some staff need training in pressure areas.There have been a few hiccups however a new form for pressure sores has been introduced and now seems to be working. Medicine systems looked at were generally satisfactory. Medication training for care staff was being provided on the day of the visit. Medication record sheets were filled in properly and there were no gaps seen. The home uses extra written documentation to record the quantity of all boxed tablets on each occasion they are used, to check for anomalies. This though means that each drug round takes longer as there are extra records to be completed. It is unclear whether nurses actually count the number of tablets each time they open the box, or just write the appropriate number on the record sheet. The medication fridge temperatures are being recorded twice daily, though the fridge is empty. Prescribed dressings are now stored securely in the treatment room. The recording of controlled drugs showed that there had been three occasions for the one drug looked at, where the time had been missed off in the record book. There must be an accurate record of the storage and use of controlled drugs at all time to comply with law. Medication audits are carried out regularly by nurses on the unit, however it would be better practice for this to be done by a nurse who does not work on that unit, as they are more likely to spot anomalies. The same medication system operates on the Springwater Unit. The record keeping was satisfactory. Insulin currently in use was stored in the fridge, which should be Care Homes for Older People Page 16 of 40 Evidence: stored at room temperature. There were a lot of prescribed supplement drinks in the fridge and one looked at expired this month. The nurse said the dates of all the drinks would be checked to make sure they were used in an efficient way. Also some blood specimen bottles, some of which have a short shelf life, had expired. Staff were observed supporting people in a sensitive and respectful manner. People were spoken with politely and care staff explained what they were doing and reassured individuals whilst they were helping them to move with the hoist.Staff were observed knocking on doors before going into rooms.The home operates a key worker system. Staff were observed using disposable aprons and gloves.This maintains and promotes good levels of hygiene control.However on one unit it came to the inspectors attention in discussion with a nurse,that a person had been left on the commode for over one and a half hours. This was discussed with both the manager and opertions manager who were not aware of this situation occuring.The homes manager was instructed to report the incident under safeguarding protocols to the appropriate authority.This shows us that there are not enough staff to provide people with the health and personal care they need. Care Homes for Older People Page 17 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health could be put at risk and be detrimentally affected by the lack of sufficient drinks and good food especially at suppertime. People who live at the home have little opportunity to participate in varied and suitable activities. Evidence: Relatives and visitors all confirmed that they are able to visit the home at any time. This ensures those who have relatives living in the area have the opportunity to maintain their social and family connections whilst living at the home.One visitor had had two Saturday dinners at the home and said they were very good. One person had their private hairdresser visiting.There is a new activities person employed, who one nurse said was excellent. However she was not at work. The organiser from another Southern Cross home was observed playing Scrabble with an individual. There is an activities board in the main hallway of the home. And the home produces an activities programme for the month, however this is very general. It would be much better if a programme of actual planned events could be produced and made available for all people and their families to look at. If they knew something was definitely going to happen then they could plan their week and look forward to the event. People spoken with felt the general programme was of no value, as it did not Care Homes for Older People Page 18 of 40 Evidence: match what was actually happening in the home. The home also has started to produce a newsletter called the Belmont News which informs people of what has happened or is happening at the home. The activities programme given to an inspector, showed various activities taking place in the home such as,coffee mornings,reading,painting class,scrabble,exercise class,arts and crafts,sing song,pub lunch and so on. On Saturday and Sundays activities focus on people being supported to attend special occasions and events escorting residents to functions,weddings, christenings etc. Since the last inspection there have been a number of complaints raised with the Commission regarding the standard of the food and the lack of activities at the home. Complaints had been raised with the home for them to address. The expert by experience who accompanied the inspectors at the time of the visit has also completed their report on their findings on what life is like at the home, which they fed back to the manager and the operations manager on the day . The expert by experience findings were as follows: When I arrived - mid morning as arranged, I found it to be strangely quiet for a care home of this size. After greetings with the Inspector I was introduced to the Manager and just by coincidence the Area Manager who had arrived that morning. The Area Manager showed me round most of the unit. It was agreed with the Inspector beforehand that I would look at the Dementia unit and then concentrate on the Residential side. There was little activity or evidence of staff when looking round. In the dementia unit service users were sat quietly in small individual lounges, one lounge with a TV on but no one watching it. Some of the service users, who were either too ill to be dressed or come out of their rooms were in bed. I didnt see many staff in evidence. Everywhere we went was very quiet. We moved downstairs to the Plaza suite situated near reception and the entrance. This was nursing residential. It also accommodated facilities for dining. The Area Manager told me that this was where all main activities, concerts took place. She said there had been an Opera evening where a gentleman and his young daughter came in to sing. On looking at the size of this main lounge, I found it difficult to imagine it accommodating more than 50. In this main lounge there were about 6 people sat watching a very large plasma TV. There was also some music playing. I found this area to be the most pleasant atmosphere to be in. We then proceeded to the Residential unit. I saw no staff and no service users Care Homes for Older People Page 19 of 40 Evidence: anywhere on the corridors. I asked to see the residents lounge which was situated at the end of the unit. This was very pleasantly decorated but was quite cold and the windows were open. In this lounge there were about 5 easy chairs and a board room table, seating perhaps 12. There was no one in here either. Moving on to a small dining area, all the tables were very well presented for lunchtime. The area manager then showed me one of the rooms a suite which had patio doors and a garden area. I entered another room and this was clean and tidy, which had a hotel type look to it apart from a few personal photos belonging to the service user. Most other rooms seemed to be like this but I did see one service users room that contained her own furniture. All rooms were clean and well decorated with (shower) en suite. As I had not seen any service users or relatives to speak with, I sat in Reception making notes, in the hope of meeting someone and also took the opportunity to have lunch in the Residents Dining Room. I spoke with 5 service users (4 residential and 1 nursing residential category) and 2 relatives about their daily life in Belmont House. Overall they were happy to be there. They said the staff were kind and friendly, they could get up and go to bed when they liked. They were able to lock their doors if they wished. One lady said she was not too happy with the laundry, another said she felt safe living there. All of them said there wasnt much to do in the way of activities, this was contrary to what was posted in Reception, where numerous activities were displayed for the month, each activity was repeated weekly. Such as scrabble, quiz, exercise class, gardening, pub lunch, painting class, trips to garden centres, shopping centres. The home has one mini bus seating approximately 12, sometimes carers have to be in attendance on the trips. Saturdays and Sundays were called Special Occasions this was escorting service users to christenings, weddings, special functions, and birthday parties etc. None of the service users I spoke to were aware of this service. Also two relatives said they didnt think foot massage nails beauty and hairdressing be classed as an activity because these had to be paid for by the service user. All relatives and services users I spoke to were not impressed with the level of activities. Belmont House had been without an Activities Organiser for sometime and the new one, who had recently started, was not at work. When mentioning the The Residents lounge this brought a series of surprise looks and wry smiles from all the service users and the relatives I spoke with. I was told that no one ever goes in there and if you wanted to go in there, there is usually a staff meeting going on. This may explain the large board room table being in there. Perhaps introducing smaller tables would be more user friendly ? Later that morning when I asked a member of staff to re direct me to the Residents lounge she said its down there, but I think theres a staff meeting going on. Care Homes for Older People Page 20 of 40 Evidence: These are some of the comments I received from service users and two of the relatives in reply to questions about their daily life and activities. Always kind and patient to my relative(relative dementia unit) Never heard a cross word from the carers(relative dementia unit) All the carers are lovely they are very kind They always help me if I need it, but a lot of staff left and we have had some agency people. Its okay but the food is poor The girls (staff) are very helpful, but I dont bother them a lot as they always seem to have a lot to do I have been here 3 years and I have been happy and the carers are wonderful What activities?!! I wish there was more to do. Theres nothing much to come out of your room for except meal times If activities are going on my mother is in her room, a gentle reminder wouldnt go amiss. Ive been visiting for 15 months and I have never seen much in the way of activities I dont bother with the residents lounge, usually the staff are in there having a meeting. Why cant the residents lounge be utilized for coffee mornings,it would get people together for a chat (relative) It would be better to serve coffee in the residents lounge for people to get together instead of drinks being taken to each room in the mornings (relative) Three surveys have been returned from people who live at the home.This is what they told us. One person said that the home always arranges activities that people can take part in. Whilst one said sometimes.And the third person said they did not know. When asked do you like the meals at the home one person said usually and two said sometimes. People spoken to by inspectors said the quality of the meals varied a lot. Sometimes they were very tasty and other times adequate and very up and down. One person said the breakfast in particular was good. Meals are chosen a day in advance, and whilst this makes it easier for planning the catering, it is sometimes difficult for people to know what they may feel like eating the following day. There is a menu choice each day, but no vegetarian option.The manager said the main meal each day could be adapted, so it is suitable for vegetarians, however the home caters for a lot of people and a planned vegetarian option would help to ensure people with those needs receive a varied, planned, nutritious diet.One person said that there is nothing to eat after the evening meal. Some people spoken with said they would like to have a copy of the whole weeks menu each week so that they could plan what they ordered and be able to look forward to favourite meals. One person said this would also help to pass the time. It was observed that people in one unit did not have a hot drink mid-morning. Nor did those people in the lounge have access to cold drinks. One person living on that unit said they rarely got a hot drink then, and rarely got a hot drink in the evening either. They said though they always got an afternoon drink with a biscuit. Sometimes they Care Homes for Older People Page 21 of 40 Evidence: get offered a piece of fruit and occasionally home baking. This does not correlate with the printed menu, which says home baking is available each day. When questioned, care staff said that it was their responsibility to give people these drinks. However as they prioritised the need for people to get washed and dressed each day and helped back to bed in the evening, then these drinks were sometimes missed. The manager of the home needs to look at how this can be improved as people not being given sufficient liquid could be detrimental to their health. One person spoken with said they struggled when using cutlery with their meals. They said that adapted cutlery may help them to remain more independent. This information was passed on to the manager, however these aids should be offered to people more readily, to check whether they would help people to maintain their life skills. The chef at the home was spoken to on the day and appeared to be under pressure. When we spoke with her which was at about 3.00 pm, she had not even had the time to have a cup of tea.The chef said that the home was currently advertising for a second chef as she works Monday to Friday and an agency chef works most weekends. We also discussed the supper menu and what is provided. The chef said that sandwiches,cakes etc. are always made daily and available for people.The chef was surprised when she was informed that people had informed us that they did not receive anything but a drink at suppertime. The home should look towards trying to resolve the situation of one chef as quickly as possible as it is impacting on the quality of the meals at the home. And people living at the home are not receiving all the meals that is expected to be provided by the home.This again could impact on peoples health. The expert by experience findings regarding food provision at the home was as follows: The kitchens are on the top floor and all food is distributed down to the dining areas by way of hot trolley. In the reception/foyer a Menu is displayed showing this weeks menu and next weeks. A four weekly rotation was in operation. The menu was varied with always a choice of two hot meals each lunchtime, along with three choices for evening tea including a hot snack. Alongside the menu was an impressive looking chart/graph recording the nutritional value of each menu. The nutritional graph was analysed by content on items such as Iron, Vit C, carbohydrates, fat, and protein. Both myself and the Inspector visited the top floor kitchen and spoke with the Chef. The impression we both agreed on was that she was under tremendous pressure, and Care Homes for Older People Page 22 of 40 Evidence: was not receiving the support from Management. She was the only chef. We queried the problem with her about sandwiches at supper time, some of the service users on the Residential unit said they had not seen any. The chef was surprised and told us that they were made every day. It was also told to us by the service users that sometimes the supper trolley didnt even get round - it depended on how busy the carers were. However on the nursing unit the sandwiches arrived there. A member of staff on the dementia unit told me that facilities are in place to make snacks for the service users there, if and when they are hungry. Service users told me that the tea trolley in the mornings and afternoons was also hit and miss. I spoke with 5 service users and 3 relatives about the quality of the food in the Residential unit. All were in agreement that it was not good. They said chefs had come and gone. One relative, after making complaints about the quality of the food, said the Area Manager had agreed to come in and see her about it, but she went on to say nothing improved. One relative said she had been notified that her mothers fees would be increased by 60 pounds per week. She said she hoped the food would improve. I took the opportunity to eat my lunch with the service users in the dining room on the residential unit. On this occasion the food was excellent. There were 10 service users eating in the dining room. A carer told me there were 22 people in the unit. However there was only seating for 16 in the dining room. On the whole the comments I received regarding food from service users on the Residential unit were all negative. These are some of the comments I received. The meat is so tough we cant cut it I have difficulty chewing when the meat is tough Its nearly always cold when we get it Its nice to see everyone eating all their food - this meats tender (inspection day) Weve never had jugs of cream on the table before,they must be trying to impress someone (inspection day). The food is very poor When its cold its not worth eating My mother says the food is of poor quality The tea/coffee trolley is hit and miss, we dont always get a drink Sometimes we dont get a drink after 6pm, if they forget to come round with the tea trolley Care Homes for Older People Page 23 of 40 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 poor 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 have access to a complaints procedure, however it appears that this is not effective as people feel they are not listened to and complaints are not resolved.Safeguarding procedures are not always followed and could put people at risk. Evidence: A comprehensive complaints procedure is followed and is made available to people and any other interested parties. The complaints procedure was on display in the main foyer of the home.The home has received 21 formal complaints since the last inspection, which have been investigated by the home and 12 complaints have been received by the Care Quality Commission.These have been mainly about the food, activities, lack of staff and poor care practices. People when asked were clear as to whom they would speak to if they had any concerns or worries. Some said they would speak to the homes manager whilst others did not feel that their complaints are listened to or addressed. It would appear that both people who live at the home and relatives do not have confidence in the current management of the home, to put things right for them. The organisation must look at ways to improve the current systems they have in place, regarding peoples complaints being addressed with a satisfactory outcome. Management must make sure that people do have confidence when they make a complaint that it will be resolved. There have not been regular meetings with people who live at the home. The last Care Homes for Older People Page 24 of 40 Evidence: meeting was held on the 22nd December 2008. Although the next meeting was scheduled to take place on the 8th May 2009. Given that there has been quite a few complaints about the home, the management really need to consider how they give people the opportunity to voice their veiws about the home.It may be that more regular meetings are needed, with people who live at Belmont House to make sure that they are satisfied with the service they receive. There is a policy and procedure with regard to safeguarding adults and the procedure to take if there is a suspicion of abuse.Staff receive training in adult protection and safeguarding issues during induction training and further training when required. The staff had recently had training in safeguarding on the 5th January 2009 and more recently on the 3rd May 2009 although certificates had not yet been received.There have been two safeguarding incidents one had been reported to the appropriate agency by the home.Whilst the other incident came to light during the inspection. The homes manager was instructed to report the incident under safeguarding protocols to the appropriate authority. Appropriate recruitment procedures are followed, with references and CRB (Criminal Records Bureau) checks made to reduce the risk of unsuitable people working in the home. Peoples finances were found to be appropriatly managed with receipts being obtained for all purchases made. The expert by experience findings regarding complaints was as follows: I spoke with 2 service users relatives who had in the past complained to management regarding the quality of the food and lack of activities. There have been a few managers in place, which has made it difficult for continuity of resolving complaints. No positive outcome occurred in either case. Four service users I spoke to said they would complain if the need arose and they would try and speak to the manager about it. One said she didnt like to complain. The comments I received were: (of the Manager) I never see him; hes never spoken to me I keep quiet; I dont like to make a fuss Ive been visiting here for 18 months, I have attended 3 residents meetings, I asked him if we could have a relatives support group. He put a notice up, but nothing has happened. Because there was no manager in place at the time, my complaint was directed to the Catering Manager. The manager arranged to see me. I was complaining about the quality of the food, he listened to me but nothing improved. (relative). Care Homes for Older People Page 25 of 40 Evidence: I went to see the manager when I found out that my mothers fees were being increased by 60 pound per week, I said to him that if the quality of the food improved then I wouldnt mind so much, but it hasnt. My washing keeps going missing They dont iron my trousers properly My husband on the dementia wing lost his jacket, it never did get found I have lost 5 pairs of M & S pyjamas and numerous socks Care Homes for Older People Page 26 of 40 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 clean and comfortable environment which is maintained to a high standard. Evidence: The home is newly built and was only opened in November 2006, and has 106 bedrooms over three floors, which is split into five units, providing care for people with different needs. The furnishings throughout the home are to a high standard. Some of the bedrooms on the ground floor have patio doors leading to the garden. All the rooms have an en-suite bathroom, which have a toilet, wash hand basin and shower. Some rooms can accommodate two people. It was possible to look at some of the rooms available during the site visit when we had the opportunity to speak to people in their own rooms. The home was quiet and there did not appear to be any activity going on during the morning. Most people seem to be in their own rooms. People were spoken to after lunch as they were leaving the dining room as this was the only time there seemed to be something going on in the home. There are enclosed gardens to the rear of the building and enclosed courtyards within the building. Some people living at the home had patio doors leading onto their own patio. There is a range of communal space where residents can meet with their families. Care Homes for Older People Page 27 of 40 Evidence: There are communal bathrooms, which have the appropriate aids and adaptations.The corridors are wide and give ample space for wheel chair or electric chair use. The home is clean and fresh and decorated to a high standard. People who live at the home and relatives and visitors made positive comments about the cleanliness and said it was always clean and fresh.Three surveys from people who live at Belmont House were returned to the Commission. People confirmed that the home is always fresh and clean.When asked what does the home do well? Two people did not reply one person said,Provides a pleasant,welcoming and attractive environment. Gloves and aprons were available throughout the home. Peoples personal clothing and bedding is attended to in a separate laundry area.However several people complained about clothes going missing. A visit was made to the laundry. The laundry appeared to have no system in place to deal with lost clothing, a shelf held lost property and when asked the laundry person said that people just asked if they had lost any clothes.There did not seem to be any attempts being made to return clothing identified as lost property back to people.The issues regarding clothes going missing was raised at the last inspection.The manager of the home needs to look at this area and see if improvements can be made for people who have lost any of their clothing. The laundry was suitably equipped with industrial washers and dryers. The home employs a housekeeper and two laundry assistants. The expert by experience findings regarding the environment was as follows: The home is purpose built and is on three floors. The decor and furnishings give the impression of a hotel type feel to the place. It was very clean and spacious. The area manager then showed me one of the rooms a suite which had patio doors and a garden area. I entered another room and this was clean and tidy, which had a hotel type look to it apart from a few personal photos belonging to the service user. Most other rooms seemed to be like this but I did see one service users room that contained her own furniture. All rooms were clean and well decorated with (shower) en suite. People who spoke to the Expert by experience made comments such as: My washing keeps going missing They dont iron my trousers properly My husband on the dementia wing lost his jacket, it never did get found I have lost 5 pairs of M&S pyjamas and numerous socks The service user who said the last comment was upset by losing so many sets of pyjamas and the costs incurred to Care Homes for Older People Page 28 of 40 Evidence: replace them. I asked him if I could mention this to the Manager and he agreed for me to do so. There seemed to be many problems concerning the laundry and items of clothing going astray. I fed this back to the Inspector. She suggested we visit the laundry. On our visit we found one laundry assistant in a laundry which looked in chaos. There was no system in force. She pointed to a shelf where items were placed in lost property. No system was in place to get these items reunited with the owners. Service users said wrong items of clothing were returned to them on occasions. The Alzheimers Society is using one of the residents lounges to meet carers and families of people who suffer from dementia every last Wednesday of each month.This supports the local community, however the manager must make sure that people who live at the home and whose lounge is used agree to it being used by outside organsations.As this could stop people using their own lounge. Care Homes for Older People Page 29 of 40 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. Proper recruitment procedures are followed,although current staffing levels should be kept under review and a lack of training at the home may put people at risk. Evidence: People living in the home said that there did not appear to be enough staff available. People living at the home made made comments to the expert by experience such as: The girls (staff) are very helpful, but I dont bother them a lot as they always seem to have a lot to do They always help me if I need it, but a lot of staff left and we have had some agency people. People also made positive comments about the staff such as: Always kind and patient to my relative(relative dementia unit) Never heard a cross word from the carers(relative dementia unit) All the carers are lovely they are very kind, I have been here 3 years and I have been happy and the carers are wonderful Three surveys were returned to the Commission. When asked what could the home do better? Two people did not reply one person commented,Improve the staffing level (patients carers especially in the early mornings it is a frantic race against time. The numbers of carers may be acceptable but the dependency rate for acceptable work practice is notcomfortable and could even be dangerous,taking into account the age Care Homes for Older People Page 30 of 40 Evidence: group being nursed.Re-think the medicine round. At present this can take the whole morning,allowing for interruptions to the progress of the senior carers, emergencies,telephone calls,doctors visits. Is there anything else you would like to tell us? Two people did not reply one person said, Ideally offer study sessions of say an 1 hour duration on chronic conditions/medication re Parkinson Disease,Strokes, Dementia etc. During the site visit the staff rotas show that there are normally the following staff working: Garden suite(nursing)which caters for 13 people. In the mornings there are 4 staff in total. 1 nurse and 3 carers.In the afternoon there are 3 staff in total.1 nurse and 2 carers. Courtyard Suite(Residential) caters for 25 people.In the mornings there are 5 staff in total. 1 nurse and 4 carers. In the afternoons there is 1 Senior carer and 3 carers. Park Suite (EMI Residential)caters for 17 people. In the mornings there is 1 nurse and 3 Carers. In the afternoons there is 1 nurse and 2 carers. Promenade Suite (EMI nursing).Caters for 28 people. In the mornings there are 2 nurses and 4 carers. In the afternoons there are 2 nurses and 3 carers. Springwater Suite (general nursing)Caters for 7 people. In the mornings there is 1 nurse and 1 carer.In the afternoons there is 1 nurse and 1 carer.The total of staff on duty in the mornings is 21 and going down to 16 in the afternoons through to the evening.Night staffing arrangements are as follows: The manager said there are 9 night staff on duty each night plus occasionally 1 staff who is a floater who works between floors.Ground Floor 1 nurse and 3 carers. Middle floor 1 nurse and 3 carers. Top floor 1 nurse and 1 carer.Therefore there maybe 10 night staff on duty although it was not clear as to when there is no floater where this is reduced and on which floor. There have been concerns raised by relatives following the inspection regarding the staffing levels at the home and especially at night.There are on-call arrangements in place for staff in cases of emergency or if they need further advice. The manager is available by phone and there is always an operations manager on duty seven days a week. When looking at staffing levels the layout of the building should also be taken into account which is over three floors.This was discussed with the manager and the operations manager.Day and night-time staffing levels should be kept under review with specific regard to peoples dependency levels. The hours did not include the managers hours or all the ancilliary staff at the home such as domestic staff, kitchen staff,maintenence person, housekeeper and admin staff. All staff spoken to on the day seemed to be very busy and under pressure. Nobody seemed to have the time to just be able to chat and talk to people living at the home. Care Homes for Older People Page 31 of 40 Evidence: It appeared that staff were always busy doing some task or other. Staff spoken to made comments such as: Things are improving at the home.There have been problems with food but this has improved. Some people will complain as when Lincare had the home the food was like in a 5 star hotel. Food is better on some days than others - depends who is cooking. One staff said, Its allright working here but we are very busy there should have been 4 staff on duty this afternoon but there are only 3. We looked at four staff records to make sure the home were employing suitable people for the job. We found all the necessary pre-employment checks had been carried out prior to the new workers starting in post. All records showed completed application forms, two written references, CRB (Criminal Record Bureau) checks had been obtained. The manager said that there is an induction programme in place that ensures new staff members are given the right information to be able to do their jobs well.However the staff files looked at for two new staff did not hold any evidence that they had completed any induction training.The homes training matrix also did not give any dates against induction for most staff apart from one staff who had completed their induction on 27/1/09. A copy of the homes training matrix was given which showed that various training is available such as pressure care,customer care,care planning,dementia awareness,first aid, moving and handling,fire training and medication training. Medication training was taking place on the day of the inspection.Evidence of fire safety training was seen on one staffs file which they had completed on the 13/3/09. Individual training files are held for staff. These files had little or no evidence/records/copies of training certificates. We were informed by admin staff that some staff had completed safeguarding training on the the 3rd May 2009 although they were waiting for certificates.The training files seen were poor and did not evidence any training that staff had completed.The manager said that The National Vocation Qualification Level 2 (NVQ) training has been completed by six people and seven staff have completed NVQ Level 3.NVQ level 2 training is to be commenced by fourteen staff. NVQ level 3 training is to be commenced by three staff.The registered manager holds NVQ level 4 and the registered managers award in care.The homes management informed us that they are actively seeking to employ a clinical nurse as a deputy manager. Out of the four files seen there was only one record of supervison seen for a member of staff which had taken place on the 2/3/09. The manager of the home needs to make sure that staff receive regular supervision and records of this are held on individual staff files. Care Homes for Older People Page 32 of 40 Evidence: Staff meetings are held two or three monthly and were last held 1/5/09. Head of department meetings are held weekly and was last held 5/5/09. All are minuted. Care Homes for Older People Page 33 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not managed in the best interests of those who live there. Evidence: The manager has worked at Belmont House since the end of 2008 and has been recently registered with the Commission. He receives regular support from the organisations Operations Manager.Concerns have been raised with the Commission since the previous manager and the last inspection. These have been mainly about the food,the lack of activities, lack of staff and poor care practices. The manager said that a quality assurance system is in place. The home carried out a Quality Audit and sent out surveys two weeks ago and are waiting for people to return them. The home has sent surveys to residents/relatives and health and social care proffessionals. The manager said that the last residents meeting was last held on 22/12/08 and the next one is organised for 8/5/09. Information provided from the AQAA (Annual Quality Care Homes for Older People Page 34 of 40 Evidence: Assurance Assessment) and the examination of selected health and safety documents show that regular checks to electricity and gas and fire safety equipment are regularly undertaken. A range of other records was seen such as care plans, staff files, supervisions records, minutes of meetings and health and safety records.Although some records were up to date and well maintained others such as staff training files and records of staff supervision were not. Accidents are recorded as required and accident books on the individual units are maintained in line with the requirements of Data Protection. Peoples finances were checked at this site visit and evidence was that their financial interests are safeguarded by the systems the home has in place. Staff meetings have commenced being held. The last one was held on the 1st May 2009.Head of Department meetings take place weekly. The last one was held on the 5th May 2009. The home is not managed sufficiently to ensure that peoples interests and care needs are continually met. This includes people not always having access to sufficient drinks and food so their health could be put at risk, poor care practices, lack of activities, complaints are not being dealt with effectively, a lack of staffs understanding of safeguarding people from harm,a lack of evidence of staff training including induction training and of staff receiving regular supervision. Care Homes for Older People Page 35 of 40 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 36 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 An accurate record of the storage and use of controlled drugs must be maintained at all times. This makes sure that any controlled drugs held in the home are accounted for and that records comply with the law. 16/07/2009 2 12 16 The amount and variety of activities that are available to people living at the home must be increased to meet peoples needs and wishes. This will improve the quality of life for people at Belmont House. 16/08/2009 3 15 16 People living at the home must be provided with enough food to eat and plenty of drinks should be available at all times. 16/07/2009 Care Homes for Older People Page 37 of 40 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 This makes sure that peoples health is not put at risk. 4 16 22 The homes complaints 17/08/2009 procedure must be followed and appropriate action taken to ensure that satisfactory outcomes are achieved wherever possible. This makes sure that people can be confident in the homes complaints procedure and know that when they do make a complaint they are taken seriously and that action will be taken to resolve concerns raised wherever possible. 5 18 13 All staff must receive appropriate training regarding safeguarding people. This makes sure that people are protected from harm and are safe. 6 37 17 All records that are required by regulation must be kept up to date,to a good standard and be available for inspection at all times. 16/07/2009 17/08/2009 Care Homes for Older People Page 38 of 40 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 This ensures that the home is run in the best interests of people who live at the home. 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 2 8 8 Risk assesssments in respect of falls should be monitored and reviewed regurarly to prevent people from injury. Bedrail assessments along with any other system introduced, that is a form of restraint, should be agreed with and signed by the individual or their representative to give their consent Any stocks of blood specimen bottles,where the shelf life has expired should not be used and should be disposed of. To ensure good and effective audits are carried out, the home is advised that nurses audit other units medication rather than their own units medication.So that all errors are more easily identified and rectified. The laundry service that is provided at the home needs to be improved, especially regarding the issue around peoples clothes that have gone missing. Staffing levels at the homeshould be kept under continuous review to ensure that people who live at the home are having their needs fully met at all times. Staff at the home should receive regular supervision and records should be held on staff files when this has been carried out. 3 4 9 9 5 26 6 27 7 36 Care Homes for Older People Page 39 of 40 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. 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