Inspection on 07/05/09 for Castlegate House

This inspection was carried out on 7th 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castlegate House 28/01/10

Castlegate House 13/10/09

Castlegate House 21/05/07

Castlegate House 01/06/06

Castlegate House 23/11/05

Castlegate House 28/06/05

Castlegate House 05/10/04

Castlegate House 14/04/04

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 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Castlegate House 49 Castlegate Grantham Lincs NG31 6SN     The quality rating for this care home is:   zero star poor 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: Alison Jessop     Date: 0 7 0 5 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 29 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 29 Information about the care home Name of care home: Address: Castlegate House 49 Castlegate Grantham Lincs NG31 6SN 01476560800 01476565672 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Castlegate House Rest Home Ltd care home 20 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Additional conditions: 20 0 The maximum number of service users who can be accommodated is 20 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not faling into any other category - code OP Dementia - Code DE Date of last inspection Brief description of the care home Castlegate House is an adapted, partially listed building situated a short walking distance from the town of Grantham. The home provides personal care for up to 20 residents. The bedrooms, which are mainly situated on the ground and first floors although two bedrooms are located between floors accessed by several steps. Access to these floors is by way of a shaft lift. There are two lounges and a separate dining area. Further seating is provided in two hallway areas. Care Homes for Older People Page 4 of 29 Brief description of the care home There is car parking for four vehicles at the side of the home and a small fenced terraced area with seats and plants providing an outside area for residents to sit. Fees charged by the home for care range from: £351.00 - £435.00 pw. Care Homes for Older People Page 5 of 29 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: This was an unannounced visit which formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of the people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission. The visit lasted approximately six hours and was undertaken by two inspectors. We took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us some information about their own assessment of how well they are meeting the standards and their plans to improve aspects of the Care Homes for Older People Page 6 of 29 service. We spent from between 10.00am to 12 midday in the sitting/music room with the very vulnerable people who live in the home, to see what life is like for them. We made notes every five minutes on their state of being (mood), their interaction with their surroundings and other people including staff interaction with the people who live there. We made notes every five minutes of what we observed. The details and outcome of this are included in the main body of this report. The other main method used to carry out the inspection is called case tracking, this includes following the care of a sample of four people through their care records and assessing their care. We spoke to four people who use the service, and 2 members of staff. We also gained feedback from Lincolnshire County Councils Quality Assurance Team and the Adult Safeguarding Team. The Registered Manager was present throughout the visit and the general outcomes of the visit were discussed with her. The outcomes were also discussed with the Registered Provider over the telephone. What the care home does well: What has improved since the last inspection? What they could do better: We found that the care plans and risk assessments are inadequate. They do not contain sufficient information to ensure that peoples needs are fully and safely met. We also found that systems for monitoring and recording peoples health and social care needs were inadequate. Care records were inaccurate or inconsistent. They were not being used for purpose which means that people are placed at risk. This was particularly concerning where peoples nutritional intake needed to be monitored and recorded. The manager was not aware of how to deal with complaints. We discussed issues which have arisen through adult safeguarding investigations however she was not aware of what the issues are and therefore we could find no evidence that people in the home were being fully protected. The manager was also not aware of many current pieces of legislation, policies and procedures and good practise guidelines. Care Homes for Older People Page 8 of 29 There is a staff training programme however the outcomes for people are poor and therefore the training appears to have been ineffective or out of date. 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 9 of 29 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 29 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. Admissions are not made until an assessment of needs has been carried out by staff, this satisfies them that the persons needs can be met. Evidence: We looked at the care records of four people who live at the home. Each person had been assessed by the manager of the service before being accepted for accommodation. The information gained did not link to the care plan. Care Homes for Older People Page 11 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and social care needs are not fully met and dementia care practise is poor. Care plans and other documentation do not protect people from harm as information is inconsistent and brief. Evidence: We looked at the care plans and records of four people who live in the home. We also observed the care that these people received during a period of time. The plans contained basic information on personal care, activities of daily living, health care issues such as continence, food and fluid intake and skin integrity. Each care plan also had a risk assessment. The plans provided were very brief information and although peoples needs had been identified, there was minimal information and detail on how to prevent risks or meet peoples needs. An example of this was where a person needed assistance with personal care. The care plan stated help them to feel clean and refreshed at all times, facilitate independence and ensure that they have the appropriate equipment available. It did not say what care was needed, how often, what equipment was required and how it should be used. Another example was where Care Homes for Older People Page 12 of 29 Evidence: a resident had been assessed relating to confusion, loss and aggression however there was no information on how staff should manage this. The views of the people who use the service were also not recorded. A lot of the forms in the files were incomplete and there was no reference to any capacity assessments under the Mental Capacity Act. This is new legislation which ensures that the choices and rights of people who are being cared for are fully protected where they may lack mental capacity. We observed one person who was sitting in a recliner chair in the lounge from the time that we arrived (9.30am), the person was still sitting in the chair at 13.00hrs. They were not taken to the toilet and when we looked at their care plan and risk assessment it stated that the person was at high risk of getting pressure sores. We also observed that they were not offered a drink when the tea trolley came round as she was asleep. Eventually we had to point out to staff that they had not been given a drink for over 2 hours. When the drink came they drank 2 sips and then the cup was taken away by staff. A drink was also not provided throughout lunch and although the person declined a cup of tea after lunch, the staff did not pursue this and left them again without access to fluids. When we looked at the care plan of this person, there was a food and fluid intake chart for the recording of this which should be used as a tool so that staff can indicate how much fluid and food has been taken. The chart had not been completed and therefore there was no way of staff knowing how much fluid they had taken during the morning. We looked at the food and fluid chart and daily notes of the same person on the previous day. The daily notes stated xx has been very quiet today, has hardly eaten anything. No concerns at time of writing. However the daily food diary stated that they had eaten cereal and toast, pork dinner and angel delight, jacket potato with cheese, sandwichs and cake, biscuits and a milky drink. When we looked at the monthly record of weight monitoring the resident had lost 7 kg in one month. Although it had been recorded that this may not be an accurate reading, the residents weight was not tested again until one month later. On the day of the inspection there were two students working in the home on placements from college. One of the students decided to give a resident a nail manicure. The persons nails were very long and they cleaned a lot of dirt from underneath the nail. We observed that the nails of two other people looked long and were unclean underneath. We looked at the medication procedures and looked at the medication administration records of three people. We found that the records and procedures were satisfactorily maintained. Care Homes for Older People Page 13 of 29 Evidence: During the observation we saw some very sensitive, dignified and caring practises when staff interacted with the people who use the service. One member of staff that we spoke with said Its nice to be able to talk to the residents and show them we care, we want them to feel comfortable and happy. We provide care for people who have dementia this means being patient and generally being there for them and to help them feel safe. We saw that some communication with people who have dementia was inappropriate. Staff were observed shouting across the room to people and did not speak clearly and slowly. We overheard a conversation between a visiting professional and a member of staff about a resident. The staff were standing around the desk which is situated in the main hallway. Care Homes for Older People Page 14 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are a range of activities available, not enough time is given to providing individual occupational stimulation to people who have dementia. Staff are not fully aware of the specialist nutritional needs of people who have dementia and food intake monitoring was inconsistent which means they are at risk. Evidence: On entering the home at 09.40 we saw three people in the music room. It was later confirmed by the manager that they had dementia. These people were seen to be left unattended for 35 minutes. On the day of the visit there was two students working in the home. We told the manager that we had seen the two students standing around in the hall ways, or sitting on the stairs with nothing to do. The manager accepted this and acknowledged that they could have been given some work or direction to spend time finding out about the past life and interests of the people with dementia and could have provided appropriate ways to stimulate them. During the afternoon staff engaged people in a game of throw the hoop. They became very animated and seemed to enjoy this. One person who was sitting in a recliner chair was enabled to participate in the game which clearly seemed to lift their mood. Care Homes for Older People Page 15 of 29 Evidence: Music was playing and residents were involved in choosing the music. Staff communication was not always appropriate for people who have dementia for example staff shouting across the room to speak to them. The person did not respond until the member of staff communicated more appropriately. We did not observe any residents holding items that may have provided them with comfort. Feedback about the meals was good. One person said I love the food, they always give us a nicely cooked meal. Another said I have no complaints about the food, we get a hot meal every day which is always very tasty. Food and fluid intake monitoring records were not accurate as we monitored this against the daily care notes and observed where notes had been made where a resident had not had a drink. Although people were offered drinks and snacks throughout the day from a trolley, there was no food available at all times for residents to snack on. One person spent a lot of time walking around asking for a cup of tea. She was given a cup but when she saw someone else with one she kept saying that they hadnt given her one. She was constantly asking for/looking for food and drinks. No finger foods and drinks were available other than when the tea trolley went round at specific times or lunch times. We had a discussion with the manager about the importance of a high calorific intake for frail older people. Care Homes for Older People Page 16 of 29 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. The service does not have a robust complaints procedure and their is little understanding of the purpose of a complaints procedure in relation to checking quality assurance. Evidence: We asked the manager if we could see a record of complaints received. The manager said that no complaints had been received. We had a long discussion about the two Adult Safeguarding investigations that were being carried out by Lincolnshire County Council Adult Safeguarding Team. Both alerts were made as a result of complaints about the care their relatives received. One relative had contacted CQC as they had been dissatisfied with the response from their complaint. The manager did not fully understand what constitutes a complaint and said that she was not aware of what the issues were. We confirmed with Lincolnshire County Council who told us that an action plan had been put into place in order to protect the safety and welfare of the people who live in the home and to improve the quality of the care. The manager had not recorded any information following any discussions she had held with relatives who had concerns. Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people with a comfortable, homely environment to live however an ongoing programme of refurbishment would benefit as some areas look unkempt. Evidence: Inside the home there are two communal lounges. One which is called the music room where the people who use the service were observed listening to music and participating in games. There is a main dining area and a small dining table in the music room where three people ate their lunch. The lounges looked homely and provided a comfortable area for people to sit. Some people sat in recliner chairs. The home has a small enclosed back garden which provides people with a safe area of outdoor space. Two people said that they enjoy spending time in the garden. The dining room carpet was heavily stained and some areas of the walls had stains where drinks had been spilled. This looked very unsightly. It was suggested to the manager that a more appropriate flooring be fitted which can be cleaned more easily. Generally looking around the home and in bedrooms and bathrooms, many rooms looked tired and in need of refurbishment. The manager stated that there is not a rolling programme of refurbishment. Care Homes for Older People Page 18 of 29 Evidence: We talked to staff about their knowledge of infection control procedures. They said that they receive regular training on this and they appeared to be aware of good practise in this area. The home looked clean and we did not detect any unpleasant odours. Care Homes for Older People Page 19 of 29 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. Although there is a variety of training provided, this does not provide the staff with the skills needed to provide care which fully meets the needs of the people living in the home. Evidence: We received feedback from a Course Tutor for two students working in the home, they were completing their Level 2 Health and Social Care Course. The Tutor said that the staff team are very supportive to the students. On the day of the inspection there were a lot of staff milling around and the manager told us that the staffing levels are currently above the levels required to be able to meet the needs of the residents. The manager also told us that she only has three shifts per week in which to solely fulfil her management role as she also covers the rota. She said that she covers carers shifts if they are on sick leave. A discussion was held with the provider during the inspection and it was agreed that the managers role would immediately become supernumerary. The Annual Quality Assurance Assessment (AQAA) reports that approximately 55 of staff have completed or are currently completing an National Vocational Qualification (NVQ). Care Homes for Older People Page 20 of 29 Evidence: We asked the manager if she kept a centralised record of staff training. The manager could not produce this so we asked her to send us a copy. Although staff told us that they had received specialist training on how to care for people who have dementia, this was not reflected in the day to day practise that we observed in the home on the day of the inspection. We also identified other areas where staff require more training for example on record keeping, health care monitoring and risk management. We asked the manager if she and the staff team had done training on the Mental Capacity Act. She said that she had received a book about this and that someone from Social Services was going to come to the home to do training. This had not been arranged by the manager who did not know what was required or what the implications of this are. We did not fully look at the recruitment records for this service as there has not been any issues identified. We spoke with staff who told us that they have been vetted prior to commencing employment. We will look at this standard fully at the next key inspection. Care Homes for Older People Page 21 of 29 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 manager has very limited knowledge of current and legislation, good practise guidelines and policies and procedures. Therefore management systems in the home are ineffective and practise is out of date. Evidence: We had a long discussion with the manager who said that she did not know what person centred care is, she said that she had heard of it. She was unaware of issues relating to how the environment can affect people with dementia. She acknowledged that some of the care records did not contain sufficient information to enable staff to provide the appropriate level of care or stimulation. We asked the manager how she kept up to date with current legislation and practise, she said that they have always just be doing what they have always done. She said that they did not receive any information from the company, and they do not have Internet access. When we explained about the system called KLORA (the CQC Key Care Homes for Older People Page 22 of 29 Evidence: Lines of Regulatory Assessment) which is how we make decisions about ratings, the manager said that she had never heard of them. We looked at some copies of notifications which have been sent to CQC by the manager about incidents that have occurred in the home. Although there were some delays in these being sent to CQC previously, the manager is now submitting information without delay. The Annual Quality Assurance Assessment (AQAA), which is a self assessment completed by the manager of the service provided us with brief information about the service. We looked at the daily notes which is a record of the care that has been provided to the residents. Some of the the notes contained inaccurate and inconsistent information. The manager told us that a new quality assurance system is being implemented however the manager did not understand the purpose of a complaints system in relation to ensuring that a good quality service is being provided. We saw that some risk assessments were in place, however these did not tell us how the risk will be minimised or eliminated. We did not see any risk assessments for the use of recliner chairs. The Fire Safety Officer inspected the home in September 2008 and made five statutory requirements with a timescale of 30th of April 2009 for compliance. The fire safety officer visited again on the 30th April 2009 and three of the requirements remained outstanding. The fire officer will re-visit the home again on the 8th June 2009 to check compliance. Care Homes for Older People Page 23 of 29 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 29 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 7 15 You must ensure that each resident has an up to date care plan, which contains detailed information in respect of the persons health and welfare. This will ensure that the persons individual needs are fully met. 05/08/2009 2 8 12 You must make sure that proper provision is made for the health, welfare and supervision of the people who live there. Peoples health care must be closely monitored and action must be taken if and when issues are identified. This will ensure that people receive good quality care that protects their safety and well being. 30/06/2009 3 10 12 You must make sure that where residents are not capable, regular nail care must be provided. 30/06/2009 Care Homes for Older People Page 25 of 29 This will protect both their dignity and ensure good hygiene. 4 12 16 You must make sure that their is a meaningful way to stimulate and communicate with all of the residents who have dementia. This will enhance their quality of life and provide them with comfort. 5 15 16 You must make sure that 03/07/2009 drinks and snacks are available to the people who use the service at all times. People who require assistance with meals must be offered drinks and snacks on a regular basis. This will ensure that people have sufficient nutritional intake throughout the day and night. 6 16 22 You must ensure that any complaints made under the complaints procedure are fully investigated. This is to ensure that the appropriate action is taken to resolve any issues in relation to the quality of the service. 7 18 13 You must make sure that procedures are put into place to prevent service users from being harmed or placed at risk. This will ensure that when 30/06/2009 30/06/2009 03/07/2009 Care Homes for Older People Page 26 of 29 adult safeguarding investigations are being carried out you are aware of the issues and take action to reduce the risks to people in the home. 8 19 23 You must replace the dining room carpet. As this is very heavily stained and looks unsightly. 9 19 23 You must ensure that all parts of the home are kept in a reasonable decorative state. This will ensure that the environment is pleasant for the residents. 10 31 9 The registered manager 03/08/2009 must ensure that she has up to date knowledge and skills to manage, direct staff and to support people living in the home. This will ensure that the home is managed in a competent and safe manner. 11 37 17 You must make sure that records are accurately maintained in respect of all care provided. This is for the protection of the people who live in the home and are to be used to monitor wellbeing. 12 38 13 You must ensure that 02/07/2009 comprehensive risk assessments are carried out. You must ensure that a risk assessment is carried out on Page 27 of 29 05/08/2009 31/03/2010 03/07/2009 Care Homes for Older People all specialist equipment such as recliner arm chairs. This is to ensure that risks to service users are identified and so far as possible eliminated. 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 Information gained during the needs assessment must be transferred and linked into the care plans and risk assessments when a person moves into the home. It is recommended that the desk which is situated in the hallway is removed as it encourages staff discussions which does not protect the privacy of the residents. Staff need to record/show evidence that their mental capacity has been considered when reviewing their care. 2 10 3 14 Care Homes for Older People Page 28 of 29 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 29 of 29 - 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!