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Inspection on 11/03/09 for Bilton Court

Also see our care home review for Bilton Court for more information

This inspection was carried out on 11th March 2009.

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

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

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bilton Court Windermere Drive Queensway Wellingborough Northants NN8 3FR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Carol Mitchell     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Bilton Court Windermere Drive Queensway Wellingborough Northants NN8 3FR 01933401613 01933401615 kerry.morgan@anchor.org.uk www.anchor.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Anchor Trust care home 48 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: No one falling within category DE(E) may be admitted into Bilton Court where there ae 10 persons of category DE(E) already accommodated within this home. No service users with a physical disability over the age of 65 PD(E) may be admitted to Bilton Court when there are already 24 service users accommodated within the home The total number of service users must not exceed 48 in Bilton Court Date of last inspection Brief description of the care home Bilton Court is a care home providing personal care and accommodation to 48 older people, 24 of whom may have a physical disability and ten of whom may have Care Homes for Older People Page 4 of 27 Over 65 10 48 24 0 0 0 Brief description of the care home dementia. The home is run by Anchor Homes, which is part of Anchor Trust. It is situated on a residential estate on the outskirts of Wellingborough with public transport to and from the town centre. The home is purpose built and has single bedroom accommodation with en-suite facilities consisting of shower, toilet and washbasin for all residents. There are two floors and a passenger lift provides access to the first. There are four separate units within the home each unit having a communal lounge/dining room and kitchenette. There are pleasant accessible grounds surrounding the home and there is some parking available at the front. Further information can be obtained from the home direct by phone, email or website. The following information about fees was obtained on 11th March 2009: Please note that there will be an increase of 5 percent from 1st April 2009: Minimum weekly charge 475 pounds, maximum weekly charge 505 pounds: Additional costs are applicable for some services including hairdressing, chiropody, delivery of magazines and newspapers, and pampering sessions. The home has an amenity fund but sometimes it is necessary to charge a contribution towards special day trips. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key or main inspection report takes account of information received by us since the last key inspection of 25th February 2008. This includes detailed information sent to us by the manager of the home on 25th November 2008. For this key inspection we sent surveys to residents living at the home and professionals who use it. We also visited the home on 11th March 2009 for around five hours. During the unannounced inspection visit we spoke with residents, staff, family members and the manager. We looked at some records including a sample of care plans and staff files, and looked around some parts of the building. We would like to thank everyone involved with the inspection visit. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to make sure that care plans clearly indicate instructions to staff about the care required by each resident, and that such instructions are carried out correctly. The home is currently reviewing staff training and taking other action to address issues highlighted by two referrals to the Councils safeguarding team please see text of this report. In addition the home needs to constantly check care Care Homes for Older People Page 7 of 27 staffing levels in relation to the spread out nature of the home and the fluctuating needs of residents. We have made recommendations about these matters at the end of this report. Residents money should not be pooled. The use of individual wallets introduced at the time of our inspection visit needs to be maintained. Important information from staff meetings should be routinely shared with people who are unable to attend, so that everyone knows what is going on. The manager is continuing to improve the monitoring of how well the home is doing. For example she is developing the questionnaires which are distributed. Residents and staff are looking forward to the purchase of a pager system in April 2009 because it will replace the sometimes annoying call bell system currently in use. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager makes sure that she considers the needs of any prospective resident before they move in. Therefore people living at the home are sure that their needs will be met. Evidence: We met a resident who had recently moved into the home, and we spoke to his brother. The resident and his family had been able to tour the home on separate occasions before admission, and written information was given. The resident was encouraged to choose which of the available rooms he wanted. The manager completed an improved needs assessment before the resident moved in, and a comprehensive individual care plan had been written. The resident settled into the home well. He looked relaxed and comfortable when we saw him, and his brother said He has settled really well, he looks much better and he loves the food. He takes part in everything going on. Care Homes for Older People Page 10 of 27 Evidence: All residents are given a contract. This home does not offer intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff call family doctors and others when they need to. The medicines are well organised. Staff know the residents well and they are going to receive more training to help them meet residents health needs. The manager is keen to make necessary improvements in the area of care planning. Therefore people living at the home can be sure that every effort is being made to make certain that their health care needs will be met. Evidence: Written information we received before our visit confirmed that an organised approach is taken when residents need to see health and social care professionals. Special care is taken with the documentation of appointments to make sure that these are not missed. Staff receive training about health matters and have recently been trained in falls awareness. The company is currently reviewing staff training in relation to meeting residents health care needs. Care Homes for Older People Page 12 of 27 Evidence: During the visit We spoke to a resident who told us They have just got my diabetes sorted out. The doctor came and increased my insulin. They look after me, its very good here. The resident thought she had a care plan and was aware of a need to keep a check on her fluid intake and her position, and she measured her blood sugar levels advising a member of staff so results could be noted down. The resident could easily access the call bell which she told us was responded to well. The resident was seated on a pressure relieving cushion. A member of staff spoken to knew the lady and could discuss her needs in considerable detail. We discussed the medicines with the staff member responsible for organising them and we found this to be well ordered. The providing chemist has recently completed a satisfactory inspection. We witnessed the safe administration of medicine, and the four administration record sheets we looked at were well maintained. Staff who administer medicines are trained, and two have received more advanced training. The home methodically checks that the medicines are being handled and administered correctly. We looked at the care plans corresponding to five residents whose care and support we considered during the visit. We found that care plans were in place and that each resident has a well organised folder with lots of useful and individual information.The company makes checks to make sure that documents are comprehensive, completed and updated in an organised way. Life histories and end of life wishes are now recorded. The work that has taken place has resulted in improvements in the area of care planning. However in order to make sure that the care plans are meaningful and useful to busy staff, and reflect the care required, the prescribed care should include detailed and specific instructions. Within a small sample we found several examples where lack of specificity and detail could lead to confused understanding or omissions by staff. For example when describing a necessary fluid intake words like plenty and enough give inadequate guidance which can be interpreted in different ways. We spoke to staff and found that they are very well motivated and know a lot about residents and their needs. However, although a staff member knew that a residents position needed changing regularly, she was unaware that there was a specific instruction about the frequency of position changes/relief of pressure in the care plan. A staff member was aware of instructions from the district nurse regarding action to be taken if a dressing should fall off. A record of this was found within the notes, but when the instructions in the care plan were checked, the information had not been added. We also found at least one example where a piece of information had been carefully recorded at the assessment stage but not then included in the care plan. Care Homes for Older People Page 13 of 27 Evidence: Problems associated with care planning including specific examples were discussed with the manager on the day of our visit. She is aware that improvements are necessary and is keen to make them. Two recent alerts to the team responsible for safeguarding vulnerable people have prompted some relevant actions. These include training in health related matters to be delivered by a district nurse, and a visit from a Primary Care Trust nurse who will work alongside staff for a period. We observed staff in the home and saw that they knocked on doors before entering rooms, and that they deal with residents in a professional, kind and knowledgeable manner. Residents needs are attended to in private and we did not witness any breaches of confidentiality during our visit. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff try to make sure that individual residents have choice in their every day lives. There is plenty going on and the food is good. Therefore people can be sure that their expectations of living at the home will be met. Evidence: The home tries to have different routines for different residents. We spoke to a resident who told us that she has choice in how she lives at the home saying They leave me until I wake. I go out on Wednesdays to get my hair done and I am very happy with that. The relative of a resident who has recently been admitted was pleased that there is plenty going on and that his brother has been participating well. Two people are employed to coordinate activities and they are supported by volunteers. A variety of activities and entertainment takes place, and on the day of our visit residents were successfully encouraged to take part in and enjoy a bingo session. There are links with local churches and schools, and some community group meetings are held at the home. Volunteers run a mobile shop. There is an updated notice board giving details of future events, and a newsletter is published every month. The home is actively trying to improve meaningful occupation for people with dementia. Life histories are now recorded and staff have been receiving training in person centred care. In May 2009 four staff including the manager and activities Care Homes for Older People Page 15 of 27 Evidence: coordinator are booked to undertake special training to enable them to become dementia champions. Residents told us that their family members can visit when they wish and that they are made welcome. The home encourages visitors to eat with their relative, or perhaps participate in food preparation such as bread making. Residents told us that food at the home is good. Our food is good and we get a choice said one. Residents are involved with the ongoing review of menus, and the chef was able to talk to us about particular residents needs. He knows the residents well. Accurate menus were displayed in the foyer, in dining rooms and on tables on the day of our visit and people told us that their lunch of chicken chasseur or vegetable chow mein was hot and enjoyable. The tables had been layed attractively and with care. A variety of snacks is available at different locations, with an emphasis on healthy eating. Nutritional assessments are done, and residents are weighed. The home has been awarded a Catercraft Award and five stars at a recent environmental health inspection. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager tells the right people if she thinks that a resident is at risk, she responds well when advised of actions to take, and uses initiative to make sure that residents are safe. People can complain when they need to, knowing they will be listened to. Staff are checked out before they are allowed to work at the home, and they receive training. Therefore people living at the home know that every effort is made to keep them safe. Evidence: The home has a complaints procedure, and the company and manager welcome complaints as a means of obtaining feedback about the home. Comments and suggestions are actively sought. The manager and staff are easy to talk to and people we spoke to said that they would find no difficulty in complaining should they need to. A resident said I have had no complaints but I would talk to the carer on duty in the first place. Ive never had any complaints. A family member of a recently admitted resident told us he felt comfortable about raising matters with the manager although he has no cause to currently. He said I would speak to Kerry if I needed to complain; these staff are lovely. Arrangements are in place to provide residents with advocacy services when necessary. The home has received four complaints since the last key inspection, one of which was upheld. Complaints received are recorded and investigated, and information is given to the complainant. Care Homes for Older People Page 17 of 27 Evidence: Staff we spoke to at the home had received training about the safeguarding of vulnerable adults, and were able to discuss actions they would take if they should be worried about a resident being at risk of any abuse. Discussions with the manager and the staff files we checked confirmed that checks are made on staff before they are employed at the home. The manager recently alerted the councils safeguarding team about two matters regarding the possibility of residents being exposed to risk. The concerns were to do with residents personal and health care. As a consequence a special meeting was held to identify problems and solutions, and to support the home to improve where it needs to. At the time of our visit the following initiatives were underway: Training and input for staff from district nurse booked; visits by nurse from Primary Care Trust to work with staff booked; tools to monitor that specific aspects of care are delivered have been introduced; care plans are being audited; staff training is being reviewed, and all staff are receiving training in falls awareness. The company and the manager have been open to suggestions and are keen to address any issues of concern. (Please also see sections on health and personal care, and staffing). Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Organised cleaning and laundry staff are employed and the home is maintained, decorated and improved in a planned and structured way. Therefore people at the home can be sure that they are living in a safe and well maintained environment. Evidence: We looked around the home and the areas we saw were clean and decorated to a good standard. A resident told us that she likes her room which has her own possessions in it and is cleaned every day. We saw well organised and committed cleaning and laundry staff during our visit. We spoke to a laundry assistant who has received training and reported the recent provision of a new machine and liquids. We also noticed that staff have awareness of infection control matters and record activity such as the cleaning of wheelchairs, and making sure protective gloves are ready for use. The home has been awarded the maximum five stars following a recent Environmental Health inspection. We checked the logs and found that regular checks are made of fire alarms, emergency lighting, and hot water. The companys surveyor team is responsible for the ongoing maintenance and redecoration programme at the home. The colour schemes used in the home have been chosen following discussions with residents and with the needs of people with dementia in mind. Since the last key Care Homes for Older People Page 19 of 27 Evidence: inspection hand wash basins have been fitted to the kitchenettes, new curtains have been purchased, and new emergency lights installed. Refurbishment of en-suite bathrooms is scheduled to take place over the next twelve months. A resident and a member of staff explained that the noise from the homes call bell system can sometimes be annoying. However,the manager told us that the system will be replaced by pagers in April 2009, and this should alleviate the problem. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are pleased with the staff, who are checked before they can work at the home. Staff are receiving better training and they enjoy their work. The spread out nature of the home means that how staffing is organised presents special challenges as well as advantages, and the manager is aware of this. Therefore residents can be confident that every effort is being made to make sure that they are in safe hands at all times. Evidence: Residents and a family member told us that they are pleased with the staff at the home. They said They look after me, they are very good here; and These staff are lovely. Staff we observed and spoke to were friendly and kind in their manner, well motivated, and able to discuss the care needs of individual residents. Training needs for staff in the area of health care have recently been identified and are currently being addressed. (Please also see section on health and personal Care). Staff told us they had worked at the home for some time, they receive training, they enjoy working there and they get on well with each other and the manager: I enjoy working here. I have just done NVQ (National Vocational Qualification ) training and Ive done lots of courses; I get on well with the manager and staff, I like it here. Staff are valued by the organisation. We saw the Anchor Reward board displayed in the staff room, and a staff member told us she was to have a role as peoples voice. Care Homes for Older People Page 21 of 27 Evidence: This will involve keeping managers informed as to the opinions of staff. Staff have supervision sessions and meetings, although not everyone can always attend. Therefore the manager is going to introduce a means of making sure that information discussed and decisions made are communicated to all staff. Robust recruitment procedures are in place and we checked a sample of staff files to confirm this. National Vocational Qualification training and induction training for new staff are well established. Part of the induction period consists of shadowing an experienced staff member. Since the last main inspection, the use of agency staff has been reduced to a minimal level. Numbers of permanent staff on day and night duty have increased, and the manager and deputy manager were interviewing for additional staff during our visit. On the day we visited the following staff were on duty for 38 residents: Two team leaders, seven care assistants, chef manager and kitchen assistant, three cleaners, laundry assistant, administrator, and activities coordinator. Residents, a family member and staff we spoke to felt that this level of staffing was sufficient to meet the current needs of residents. The layout of the home is very spread out and whilst this encourages a homely atmosphere and independence for residents, it also may present challenges for individual care staff and regarding the deployment of staff generally. Staff we spoke to were worried in case more residents might be admitted and that this would compromise care. However, the manager told us that no one will move in until vacant care staff positions are filled. A meeting with the companys human resources representative to discuss matters related to staffing was booked for the week following our visit. The manager agreed with us that when considering staffing issues it would be useful to objectively measure the degree of residents dependency, together with the impact of the layout of the home. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is well supported, friendly, listens to what people say and tries hard to make any necessary improvements. Therefore people living at the home can be sure it is run with their best interests at heart. Evidence: During our visit we saw that the manager is enthusiastic and committed to improving how the home is run. She is currently undertaking the Registered Managers Award. The manager is well supported by company representatives in fields including human resources, health and safety, finance, catering and care provision. There is also administrative support at the home and a deputy and team leaders are employed. The manager and others receive ongoing training from the company, and the management team are going to attend a five day Dementia Champions course in the summer. We noticed that the manager has an open and friendly demeanour, and people find her approachable: I get on well with the manager; Kerry is easy to talk to. The home is developing a Residents Forum to increase the involvement of residents in Care Homes for Older People Page 23 of 27 Evidence: the running of the home. Questionnaires are distributed to residents and the manager aims to improve these, involve family doctors and others and publish the results. The company and manager check that the home is well run through a range of initiatives including: monthly monitoring checks by a company representative; making formal checks in areas such as medicines, finances, infection control; having a method to make sure staff do not miss essential training; and checking that care planning is thorough and effective (the manager is currently making improvements in care planning at the home). During our visit we looked at the fire log and hot water records and confirmed that the expected checks are made. The home attained the companys Safe Site award in March 2008. We also checked the records and money held by the home for a resident. We found that accurate and individual records were maintained, receipts kept, and we confirmed that checks are done by the company. The amount of money held for residents is strictly limited and any cash is securely locked away. Although individual amounts were not available for checking, this was corrected at the time of our visit. Staff told us that they receive supervision, and the manager undertook a supervision session with a member of staff during our visit. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 In order to minimise possible confusion or omissions in the provision of health and personal care: Each care plan should be checked against assessment information and the required individual care; You should make sure that relevant instructions are included, and that these are clear, detailed and specific (and therefore more meaningful and useful to staff). You should continue with your efforts to carefully review training needs, staffing levels and the deployment of staff in the spread out units of your home. You should consider using objective information about residents dependency levels to help. We suggest that this, together with other initiatives, will support you in your efforts to address matters referred to in the health and personal care section of this report. 2 27 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!