Inspection on 19/03/09 for Brookfields

This inspection was carried out on 19th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brookfields 06/02/07

Brookfields 05/12/05

Brookfields 08/07/05

Brookfields 12/01/05

Brookfields 12/07/04

Brookfields 05/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brookfields 488 Burton Road Derby DE23 6AL     The quality rating for this care home is:   two star good 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: Brian Marks     Date: 1 9 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: Brookfields 488 Burton Road Derby DE23 6AL 01332343840 01332294558 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Brookfields P.N.H. Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Brookfields is a detached house, which has been adapted and considerably extended to become a nursing home for Older People. The Registered Company is Brookfields Private Nursing Home Ltd. It is situated in Littleover, just a short way from local shops and a bus route. The Home provides nursing and personal care for up to 34 persons aged 65 years and over with physical health needs, and facilities are provided across two floors. The Home provides 26 single and 4 double bedrooms, with 29 rooms having ensuite facilities. Access to the first floor is by stairs or by one of the two passenger lifts. The Home has a dining room and 2 lounges on the ground floor. The garden is accessible to all Residents. Care Homes for Older People Page 4 of 27 Over 65 34 0 0 5 Brief description of the care home The charges made for a room at Brookfield Nursing Home range from £468.00 to £518.00 a week. Additionally charges may be made for any special needs. 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: two star good 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 was a Key Unannounced Inspection that took place at the home over one day. Additionally, time was spent in preparation for the visit, looking at key documents such as previous inspection reports, records held by us, the written Annual Quality Assurance Assessment document (AQAA), which was returned before the inspection, and surveys that had been previously sent out to the home, its staff and the people living there. All of the above material assisted with the preparation of a structured plan for the inspection. Surveys were returned by staff and people living at the home before the inspection and the information supplied in this way was analysed and the outcomes included in the inspection process and reflected in this written report. At the home, apart from examining documents, files and records, time was spent speaking to the manager, who was in charge of the home during the visit, and nine of the staff working on the day Care Homes for Older People Page 6 of 27 shifts. The care records of three people who live at the home were examined in detail and these were interviewed along with four others as well as three relatives, who were at the home on the day of the inspection. No other inspection visits have been made to the home since the last Key Unannounced Inspection on 6 February 2007 and the assessment was made against the key National Minimum Standards (NMS) identified at the beginning of each section of this report, as well as other Standards that were felt to be most relevant. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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. People do not come to live at the home without the care they need being properly identified but not enough attention is being paid to their social world and background history, which would help staff provide person centred care for everybody. Evidence: In the AQAA we were told that the care needs of people coming to the home are assessed, usually by the manager at home or hospital, before a decision is made for them to move in; this process also includes an assessment of the nursing needs of the person concerned. We were told that people are encouraged to visit the home before deciding and that all people are given a contract of residence when they have moved in that indicates the rights and responsibilities of all concerned. All of the information given to people helps them and their families make an informed decision. We looked at the care records of three people who are living at the home, including somebody who had moved in about a month before the inspection and somebody who Care Homes for Older People Page 10 of 27 Evidence: had lived there for three years. Within these records, there are clear assessments of the physical care required by the person concerned, including details of health and medical issues. The information has been obtained from the person concerned, from their family, or from professionals from public agencies such as physiotherapist or occupational therapist. However the amount of information about the psychological and social worlds of the people concerned was variable and in most of the files looked at was very brief. This does not fully support the homes intention to provide person centred care for everybody. All of the care records looked at contain assessments of the general and specific areas of risk that are relevant to the individuals concerned, such as safe moving and handling, skin breakdown and pressure sores, falls and nutrition. These were linked to an action plan that described how staff were to work safely and consistently and maintain the persons welfare whilst living at the home. The home does not provide 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at the home have care and risk assessment records that generally promote safety and consistency, and staff work in ways that respect individuality, privacy and dignity. Evidence: In the AQAA we were told how everybody has a care plan which is developed using as many different sources of information as possible, and that the documentation will be updated to include new material relating to the risk of falls. We were also told that care plans reflect activity in relation to health care needs and that respect for everybodys privacy is at the front of the homes care philosophy. The latter will be reinforced by more structured supervision of staff and through more regular staff meetings. We looked the care records of three people living at the home and their care plans were all completed to the same standard and format. These included, amongst a range of standard areas, mobilising, communication, personal care and nutrition. Additionally specific areas of need were also included that were individual to the Care Homes for Older People Page 12 of 27 Evidence: person concerned and these included weight loss, chest infection, catheter care, pain management and the use of rails to improve bed safety. The care plans looked at also contained clear descriptions of the areas in which people are independent, and the care and nursing activities to be carried out by staff were identified. As referred to above, apart from in one example, the descriptions of social interests and life background were generally brief. Generally the staff activities identified in the care plans were clear but in one care plan the entries that related to support with personal care were handwritten and the document format did not leave enough room for changed entries and did not clearly identify the current support required. The various elements of the care records looked at held documented evidence that they had been reviewed at regular intervals. Discussion with the manager indicated that along with other nursing homes in Derby, they are reviewing the structure of the written care plans to bring them in line with the requirements of the Health and Social Services contracting departments. The care records that we looked at confirmed that contact with external healthcare services is routinely made, particularly the local doctors and district nurses, as well as a number of specialist healthcare services such as mental health services and optician and chiropodist. Additionally in the written records and the direct comments from people, it was evidenced that the staff at the home work hard to care in sensitive and dignified ways, and to keep people as independent as possible: The staff are very good with me and because I cant get about by myself; they work at my pace and let me do what I can. The staff are very helpful and treat me with great sensitivity. Im unsociable and they respect that. I am in my room all the time but that doesnt affect they way they work with me. Ive kept the same family doctor whom weve had for a long time , and that was important when I became very ill a couple of years ago. Its been a miracle improvement. Staff are always in and out of the room to make sure I am OK and they look after me with great care. They use the equipment and I tell them how to do it if properly. Examination of the arrangements for the receipt, storage and administration of medicines indicated that these were generally satisfactory and that all entries in the written records we looked at had been made properly. Medication is stored securely and the home uses a Monitored Dosage System for administration. However, when we checked the records and storage cupboard used for the management of controlled medicines we found one package belonging to somebody who had died six months before and another package for somebody who had only stayed for a short time, three months before the inspection. We were told that the equipment for destroyong such medicines had arrived from the pharmacy the day before the inspection and that it would be used immediatiely. Care Homes for Older People Page 13 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. People at the home enjoy lifestyles and routines that suit them and have opportunities to take part in organised leisure and social activities if they want to. Evidence: In the AQAA we were told about the comprehensive individual and group motivation programme which includes musical entertainment, individual celebrations, calendar events and trips out. We were also told that staff, visitors and residents enjoy the wholesome and appealing balanced diet provided at the home, and that comments from them are positive. We were told that the homes management have acted on suggestions made about the homes catering and recently introduced fresh fruit with mid morning drinks and expanded the menus, by popular demand.. An activities coordinator is in post and she has the responsibility for encouraging activities and structuring leisure time. She was in the home during the morning of the inspection, involved with a group in one of the lounges. During the inspection visit we spoke to a number of people in their rooms and in the communal areas, some of whom had visitors with them. They told us that they are generally happy with life at the home and they are able to do very much what they like. They told us how they had developed their own routines, including spending time in the communal areas or Care Homes for Older People Page 14 of 27 Evidence: in their rooms; the latter is the choice of the quite a number and these told us that this wish was respected and didnt hamper the receipt of care and support. A number also choose to take their meals in their rooms and this is well planned by staff at the home. They told us about their lives: I have settled in quickly here and have my own routine; I like my own company. I spend time watching TV, reading, crosswords and reading my newspaper. However, we did not see any evidence of large print newspapers and talking books. I am in my room all the time and the response time to the bell is very prompt. This is the perfect place, Ive always been happy here. I get involved with some of the activities such as the music. I like my room a lot and love the garden in the summer. Its a home from home here. The relatives seen at the home during the visit and in the written feedback told us that family visits are encouraged and welcomed: I visit every day and have now bought an appartment next door; we go there for afternoon tea when we want to. The manager and staff are keen for my wife to carry on with this arrangement. They have arranged her feeding so we can sit in the lounge in the morning and she goes back to her room in the afternoon when she is tired. They do well to provide a welcoming feel to the home. There is regular entertainment at the home and efforts are made to have fun. As a family we visit my father regularly and are satisfied that he is well looked after and comfortable. I take her out to church by taxi and other residents and staff sometimes come with us. We also have a monthly service in the home. A brief visit was made to the kitchen and the cook described current arrangements. Good standards in the catering service have continued, and a 4 week menu is being followed. The menu indicates a choice at the main meals of the day, and a hot option regularly available for breakfast and sometimes at teatime. People were generally very positive in their feedback about the standard of food at the home with several mentioning good quality and quantity: The meals are fine and suitable for a diabetic like me. The food is excellent and is quite varied enough. Arrangements for purchase, storage and stock control are satisfactory. The cook routinely deals with people who have special dietary needs, and at the time of the inspection these included diabetic and softened, indicating a sensitive approach to individual needs. All special individual requirements are recorded on a wriiten record kept in the kitchen. Care Homes for Older People Page 15 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 home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect them from harm. Evidence: In the AQAA we were told that the homes management is open to comments, suggestions and complaints, and that the latter are carefully logged and immediately addressed. The home has a written complaints procedure which is given to everybody as part of the Service User Guide. The AQAA indicated that there had been two written complaints in the past 12 months and this was borne out by our examination of the record book. All had been dealt with appropriately and responded to in writing. In the feedback that we received before the inspection, we were told that people know about getting their problems resolved and were confident that they would be listened to: There is always someone to deal with concerns either personally or on the telephone. They have responded well to the issues I have raised since Ive been here; very positive. The AQAA told us how the people running the home have rigorous procedures in place to support zero tolerance of abuse of any kind and how senior staff have undergone aditional training with regard to Deprivation of Liberty and the Mental Capacity Act, which will be increasingly influential on how the home is run in the future. The manager confirmed that staff have received training in their responsibilities to recognise and alert others to suspected abuse. All the staff spoken to were able to Care Homes for Older People Page 16 of 27 Evidence: describe their understanding of this subject and were aware of their responsibilities. The policies and procedures in place are in line with the statutory procedures on safeguarding adults, and there have been no situations investigated under these in the past year. Care Homes for Older People Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built and has been maintained to a high standard so that people can enjoy a comfortable environment suited to their needs. Evidence: In the AQAA we were told that there is an ongoing maintenance programme in place for the home, and also about the recent improvements that have been made to the homes environment. We were also told about new equipment that has been bought and improvements outside the building so that people can enjoy the gardens. From a brief tour of the building and visits to some of the bedrooms we saw that the home had a light and airy atmosphere, with wide corrodors and doorways for easy access. Decoration standards were high and the use of themed paintings in the corridors makes for an individual and stimulating environment. We were told how bedrooms are redecorated when they are vacated and saw good colour scheming with matching fabrics, carpets and bedding. Improvements made recently include new carpets in the dining room and parlour, complete electrical rewiring and the provision of a canopy cover in the garden to allow its use in wet weather. We also noted that bedrooms have good levels of personalisation to suit individual residents and which create a sense of personal space. We also noted a separate room for hairdressing and noted a good range of equipment in different parts of the building available for staff to help people with mobility difficulties. Overall this tour of the bulding demonstrated Care Homes for Older People Page 18 of 27 Evidence: that the home has been maitained to a high standard and, in spite of its size, creates as one visitor put it: a nice homely atmosphere. Additionally, people living at the home and relatives commented: I have a very nice room and after the last home I was in this is a great improvement. The home is always clean. Ive added a few personal touches to make it a home from home. Garden areas are accessible and well maintained and seating is available, and a number of ground floor rooms had bird feeders outside which entertained and maintained interest. We were told that the recommendations made at the last visits by the Environmental Health and Fire Officers have been carried out, although copies of these could not be found in the administration office. On the day of the inspection the home was clean, tidy and free from odours and everybody spoken to was very complimentary about the service provided by the laundry. A visit to the latter indicated well organised facilities and its effectiveness is supported by the clean and well-presented clothing worn by everybody we saw. We did note that cleaning chemicals and detergent were being stored open in the laundry which does not have a lockable door. The member of staff in charge of the laundry informed us that these would be locked in the adjacent store cupboard. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has satisfactory levels of staff to carry out the physical care needs of the people living at the home, and they have received training in an appropriate qualification as well as other subjects that help them to do their jobs properly. Evidence: In the AQAA we were told how the home has a planned recruitment process which ensures that all the required checks are made on people coming to work at the home and how the home does not use agency staff to fill gaps in staffing levels. We were also told how staff are encouraged to gain an appropriate qualification and how achievements in this area have been high. Examination of the duty roster and discussion with staff indicated levels of nursing and care staff on duty unchanged from the last inspection. In the written feedback that we received people said that there is always or usually enough staff on duty, and the people we spoke to confirmed this view. Foor example, as reported eleswhere, the people in their rooms said that response times to the call buzzer was fine and within acceptable standards. The staffing roster indicated that there were two nurses on duty during the day and one at night although the former is reduced to one during the evening period and the manager herself covers four day shifts a week. The staff spoken to did not generally feel that their workload was excessive but that they are busy at times and we do not prioritise paperwork over patients. We were also told Care Homes for Older People Page 20 of 27 Evidence: that mealtimes can sometimes be a bit pushed, especially if we have people who are ill in bed. During the inspection we interviewed most of the staff on duty and one appointed in the past year described her induction training which she followed just after they started working at the home. She indicated that this includes training in all the basic health and safety subjects, as well instruction about how they must look after the safety of everybody living at the home and report any suspicions of abuse they may have. The files of two recently appointed staff supported that their recruitment had been carried out properly with the right checks being made, although one demonstrated the difficulties in obtaining meaningful references from past employers. Beyond the induction programme referred to above staff told us that they have received good opportunities for continuing training and the manager reported a high commitment to getting staff through the National Vocational Qualification (NVQ) level 2 with the required 50 target being exceeeded. Additionally good numbers have achieved level 3. Some staff spoken to also described attendance on a course aimed to help them care better for people with dementia and, as noted above, some have staff have attended training about the Deprivation of Liberty and the Mental Capacity Act. We looked at a sample of individual staff training files and, in the absence of an overall record of staff training, the manager described success with fire safety and general health and safety training, safe moving and handling, infection control and first aid. Care Homes for Older People Page 21 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 home is a well-managed and safe environment in which to live and work. Evidence: The AQAA told us that the home is well managed and that this is supported by the low turnover of staff, the qualifications of the manager and general resident satisfaction. Staff motivation has been encouraged by the introduction of the monthly colleague award which recognises the extra contribution to the welfare of residents they have made. We were also told about the monthly drop in consultation session the manager has organised that allows for relatives who may not be able to get to the home during the daytime to talk about any problems they may have and to air their views about the running of the home. Staff spoken to were positive about the way the home is run and how the manager supports them if they have any problems. They have been able to meet together as a group irregularly during the past year to talk about the running of the home and, although the system for planned meetings between manager and individual staff is in place, the manager agreed that the arrangements are not yet occurring regularly enough to meet the National Standard and to ensure staff are Care Homes for Older People Page 22 of 27 Evidence: properly supported. The manager has been in charge of the home for six years and has extensive experience in general nursing and care homes over many years. We have noted above that she is rostered as the second nurse for a number of shifts each week, and this was the case for the day of the inspection. During the afternoon we observed her attendance at a key resident review meeting, deal with an urgent technical problem faced by somebody with specialised equipment, receive and log in medical equipment, deal with staff questions about their deployment and attempt to gain access to the homes record systems (unsuccessfully) to assist with our evidence gathering. This demonstarted to us an unnessecarily wide spread in her responsibilities. She described this as being a normal afternoons work. Generally good administrative and management systems are in place at the home and the manager is supported by two senior colleagues who take responsibility for housekeeping and for staff induction and training. The homes owner is at the home on a daily basis and also takes responsibility for a number of management and administrative responsibilities, and was present during the inspection. Systems for finding out how well the home is doing have been tried during the past year, including Friends of Brookfields and the managers monthly consultation referred to above. The former has not generated a lot of interest so far but she says that the latter may prove to be more useful in the longer term to allow people and family members to consult and be consulted in a formal way. The home does not routinely manage any money on behalf of the people living at the home and the system for purchasing and billing any additional expenditures remains the same as at the last inspection. The AQAA told us about good standards of health and safety activity and regular servicing of equipment, and observations made around the building and a sample of fire safety and servicing records indicate that the home was hazard free at the time of the inspection. Staff training and risk assessment activity have been discussed in previous sections of this report. Care Homes for Older People Page 23 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 24 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 1 9 13 All medicines not in use for people living at the home must be disposed of as soon as it is not needed and in a properly approved way. So that the medicines management system remains safe. 30/04/2009 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 3 Information about the social world and history of people coming to live at the home should be obtained, so that staff have a more complete picture of the person and will be able to work with more consistency. The home should adopt the format for care plans being proposed by the Health and Social Services Departments so that care is provided in a modern and efficient way. All materials and chemicals used in the laundry area should be stored so that vulnerable people loving at he home do not have access to them. The people responsible for the running of the home should 2 7 3 26 4 31 Care Homes for Older People Page 25 of 27 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 review the amount of time the manager spends in direct care activities so that she is able to concentrate her time in areas that improve the standards of care being carried out. 5 33 The people responsible for the running of the home should develop systems that allow them to monitor how well the home is operating and how successful they are being in providing a quality service. All staff should receive formal 1-to-1 supervision from their line manager, at intervals of every three months; one of which must be observed practice. This will ensure the opportunity for regular consultation about and monitoring of their work. 6 36 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. 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