Inspection on 06/05/09 for Elmwood Nursing Home

This inspection was carried out on 6th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmwood Nursing Home 07/06/07

Elmwood Nursing Home 04/05/06

Elmwood Nursing Home 30/11/05

Elmwood Nursing Home 24/05/05

Elmwood Nursing Home 27/01/05

Elmwood Nursing Home 10/05/04

Similar services:

Clovelly House Residential Home Ltd

Cherry Orchard Nursing Home

Coppermill Care Centre

Fountains Care Centre (The)

Eleanor Palmer Trust Home

Elmstead House

Bridgeside Lodge Care Centre

Dalemead

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elmwood Nursing Home Elmwood Nursing & Residential Home 32 Elmwood Road West Croydon Surrey CR0 2SG     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: Michael Williams     Date: 0 6 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 26 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 26 Information about the care home Name of care home: Address: Elmwood Nursing Home Elmwood Nursing & Residential Home 32 Elmwood Road West Croydon Surrey CR0 2SG 02086894040 02086894141 elmwood@highfield-care.com www.schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Care Homes No 3 Limited care home 60 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Date of last inspection Brief description of the care home Elmwood Care Centre is a purpose built care home providing both personal and nursing care. The home is situated in West Croydon and is near to shopping centres and transport. The service users accommodation is situated on the ground, middle and top floors. There is a lower ground floor accommodating the kitchen, laundry, plant machinery and offices. There are 46 single bedrooms and 7 double rooms. The Care Homes for Older People Page 4 of 26 Over 65 0 60 Brief description of the care home majority of bedrooms have ensuite toilets and the manager states all bedrooms meet the new National Minimum Standards for space. There are lounges and dining rooms on each floor and each floor has its own facilities including bathrooms, showers, kitchenette and office. There is a lift serving all floors. The Home has nearly completed its transition to providing nursing care (and not `residential? care) for all residents. Although Elmwood is a large building this does give service users ample space to circumnavigate the corridors in a safe and comfortable way. Fees not recorded for 2009; additional charges are made for personal requisites and some personal care such as chiropody and dentistry; additional charges for extra care will be by negotiation with the funding body. We are advised that there have been no changes to the owners details since we last inspected this service. Care Homes for Older People Page 5 of 26 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: We made a site visit and spoke to a range of people at the home including residents, visitors, staff and the manager. We checked documentation and statutory records. We toured the premises and we checked any information we have received since our previous visits. Care Homes for Older People Page 6 of 26 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 7 of 26 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 8 of 26 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. Residents can be assured that their needs will be fully assessed and can be met in this home and that they will be provided with information about the service, fees and the care to be provided. Evidence: The Commission is revising the registration certificates of care homes in order to clarify the category of residents and the criteria for admission. This required the homes statement of purpose and resident guide to be modified so as to give clearer information to prospective residents about whom the home caters for. We suggest that when the Statement of Purpose is again revised the phrase EMI, referring to Elderly Mentally Frail, is replaced or added to the actual registration category which is DE,N indicating that the home is registered to provide dementia care including nursing care. All new residents receive a full comprehensive needs assessment before admission this is carried out by staff with skill and sensitivity. The service is efficient in obtaining Care Homes for Older People Page 9 of 26 Evidence: a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. These are then translated into the homes own formats. For individuals whom are self funding, the assessment is undertaken by a qualified member of staff. Individuals are supported and encouraged to be involved in the assessment process. Information is gathered from a range of sources including other relevant professionals, and with the individuals agreement when is possible, relatives observations are taken into account. We are advised that all residents receive a Contract to which they or their representatives have agreed, it gives clear information about fees and extra charges which is reviewed and kept up to date. This information is meaningful, and can be provided in appropriate languages and formats, such as large print, or in translation if requested. The documents are also explained to individuals, so they fully understand the information but in many instances residents having failing memories and rely upon those around them to act in their best interests. We are advised that dental charges may be introduced by the PCT Primary Health Care Trust and so residents are now advised that this may become a new charge in addition to fees and other extras such as private chiropody. Care Homes for Older People Page 10 of 26 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 arrangements for care planning, the provision of health care, including end of life care, and the procedures for dealing with medication are adequate. This ensures the social and health care of service users can be met in most cases. Evidence: Personal healthcare needs including specialist mental health, nursing and dietary requirements are being recorded in each residents very detailed care plans. These give a comprehensive overview of residents health needs and act as an indicator of change in health requirements, for example a sudden change for the worse or an improvement. However, these documents, although complex and wide ranging do not record predictable challenging behaviour, there are no care plans for addressing residents who may resist care support or may strike out at staff or other residents for example. We make a requirement to include these risk in the care planning so staff may better prevent untoward incidents of this nature. Residents have access to healthcare and clinics Residents have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services, including general Care Homes for Older People Page 11 of 26 Evidence: practitioners, nurses and specialist such as the Tissue Viability Nurse for skin care and a Palliative Care Nurse for end of life guidance. Residents have the aids and equipment they need and these are well maintained to support residents and protect staff in daily living activities such as bathing and using toilet. Staff have access to training in health care matters and are encouraged and given time to attend courses on specialist areas of work. During our inspection of medicines and the systems for ordering, receiving, administering, recording and disposing of medicines we noted a serious lapse in recording. A series of medication charts had been left unsigned but a nurse. The nurse on duty during our inspection had we are told already identified the problem and contact the person concerned. It would appear that medicines were administered as prescribed but the charts were not signed to record this. The fact that a series of entries were missing indicates poor practice, for example each chart was not being signed at the time the medicine was given to the residents. A requirement is made to improve practice and the manager has already indicated that she investigate the problem and take appropriate action that may include retraining and possible disciplinary action if it is indicated. Care Homes for Older People Page 12 of 26 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. Residents capacity to control their lives and make significant decisions and choices is somewhat constrained. The initial assessment and information provided by family and friends helps staff gauge residents wishes and preferences. Meals are wholesome and nutritious so as to ensure residents are well nourished. Evidence: Residents are supported to enjoy as full and stimulating lifestyle as their condition will allow. This is however inevitably limited by the residents increasing frailty and forgetfulness caused by various forms of dementia. For the most part residents are entirely dependent upon staff initiating activities and keeping them occupied during the day. On this occasion we found staff were with the residents in the various lounges and this is an improvement on previous inspection visits when residents were seen to be left unattended for lengthy periods. However we did find some short periods when residents were again left unattended or when residents could wander to another residents bedroom. We also saw what appears to be an over reliance on the television, they were being left on for long periods, often in conflict with other entertainment such as radio. The programmes often not very appropriate and were being ignored by residents in the room. The fact that the televisions were left on with no one in the room tended to support the impression they provided nothing more than Care Homes for Older People Page 13 of 26 Evidence: background noise. The homes care plans include the expectation that staff will seek the views of the residents and relatives so as to gauge what activities and entertainments will be of interest to residents. We did not see a great deal of evidence of residents leaving the home to attend community events, unless this was arranged by family members. Whilst the home would strive to ensure routines and activities are resident focused, flexible, regularly reviewed, and quickly changed to meet individuals changing needs this aspiration is somewhat restricted by the dependency of residents and the size of the home, there are twenty residents on each floor so much of the time residents sit in serried rows, quiet and somnolent. Despite our observations about how sleepy and quiet residents appeared the activity coordinator works very hard to occupy residents and does so in very imaginative ways. She ensure residents celebrate personal anniversaries and birthdays and helps them enjoy national days both religious and social, Christmas, Easter, Eid, Diwali, St Valentine, St George Day and so forth. The home also celebrates other social events such as marriages and the births amongst visitors and staff. This provides ample opportunities for residents to enjoy the day or give more thoughtful consideration to life events. Given the considerable frailty of residents the outcomes for residents is reasonably positive, and there is some evidence that they are content with life in Elmwood. For example relatives tell us they think their mother or father is doing well and is happy, safe and well looked after. During this inspection visit we checked the kitchen and catering arrangements. The home provides a homely and varied set of menus which seem very popular with residents when we observed the midday meal beings served. The chef provides a variety of meals reflecting different cultures. The care plans and assessments include nutritional assessment and weight charts to monitor residents well being. On this occasion we were again impressed to see staff asking at the time of service what each resident wanted to eat from the choices set up by the kitchen. It is commendable, and of course to be expected, that staff were present throughout the meal to support and assist residents eat their chosen meal. They were doing so in a polite and caring manner. Care Homes for Older People Page 14 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident their concerns will be dealt with promptly and effectively. To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of service users and their property but residents have not always been effectively protected in the last year. Evidence: The service has a complaints procedure that is clearly written and easy to understand. It can be made available on request in other formats such as translation or large print to help anyone living at or involved with Elmwood to complain or make suggestions for improvement. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service such as the reception area. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made and visitors confirmed this was the case. The home keeps a written record of complaints and this includes details of the investigation and the action taken by the homes manager or more senior managers in the company. We were advised that unless there are exceptional circumstances the service tries to respond within the agreed timescale, typically within 28 days. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. We interviewed staff working at the service to check that they know when incidents and allegations of abuse need external input and who to refer the incident to, that is, to the local Social Service Department. There Care Homes for Older People Page 15 of 26 Evidence: have been several such referrals in the last year and include a number of incidents where residents have or are alleged to have assaulted other residents and staff members. These have been investigated by the local social service department and the home has taken steps to address these incidents. Action taken by the home includes referring residents to a care home better able to meet their needs, or referring residents to doctors and care managers to review care plans and treatment. Whilst we assess the outcomes from any referral as being managed well and, whenever possible, issues are resolved to the satisfaction of all involved we do find that care plans need to be improved so staff can anticipate challenging behaviour before it becomes an assault. We also suggest that staffing levels need to be reviewed. There may be occasions when the standard level of staffing is insufficient to support residents when agitated or predictably challenging. We make a requirement to this effect. Training of staff in the area of protection is regularly arranged by the Home and again we confirmed with staff directly that this is the case. Other training around dealing with physical and verbal aggression is also made available to staff as needed and advice is sought from visiting health professionals including Psychiatrists and General Practitioners. Care Homes for Older People Page 16 of 26 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 layout of the home and the manner in which it is being maintained means that this is a safe, comfortable and suitable environment for the service users but some areas need renewal or refurbishment. Evidence: The home provides a physical environment that meets the needs of the people who live there. Those residents and relatives that choose Elmwood say they like the layout, which allows residents to wander freely around the corridors in a safe and comfortable way. Elmwood is comfortable but not a homely property, it is quite large at 60 beds on three floors. It has a programme to improve the decoration, fixtures and fittings but there is slippage of timescales and maintenance has been reactive rather than proactive. Elmwood is large building and there always appears to be some areas in need of attention. Bedrooms need upgrading where floor covering is damaged and where furniture is broken or damaged such as handles of drawers and warn laminate on drawers cabinets and wardrobes. The front entrance is not as attractive as it might be, there are more weeds than grass on the front lawns and hanging baskets were being stolen making the managers task to beautify the area rather frustrating. We have in the past suggested a small picket-fence is used to enclose the front area and seating placed here to give a more attractive and inviting presentation, this would also help to provide a clear boundary and might reduce vandalism. A sixty bedded, and very busy, nursing home would justify a receptionist but there is not one so there are Care Homes for Older People Page 17 of 26 Evidence: still delays in opening the front door. The sight of receptionist near the front of the building is also likely to deter antisocial behaviour near the premises. Residents in Elmwood can personalise their rooms and this point is included in care planning. One relative we spoke to was unaware of this and also noted with me the rather poor state of decor in the bedroom. We observe that the home is generally fairly clean, warm, well lit and there is sufficient hot water. Ensuite facilities toilets are available, and all bathrooms are accessible to all people using the service. The home has not been subdivided into small group living for the residents so each floor has a single large lounge and a separate dining room. This means residents are cared for in very large groups and is self evidently rather institutional. It also means the size of each floor makes the close supervision of all residents at all times somewhat problematic for staff with the current ratios of approximately one nurse or carer for every 5 residents. Hygiene equipment is available including sluices and washing machines with a sluice cycle and clinical waste appears to be managed appropriately. The manager explained with some relief and satisfaction there are no more mice, or other unwelcome rodents or vermin, living in the home and the long standing heating problem has finally been resolved with the installation of new equipment. Care Homes for Older People Page 18 of 26 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 a staff recruitment, induction, training, support and supervision regime in place so residents can be assured that staff are competent in their jobs. Evidence: As we have identified in other sections of this report, the size and layout of each floor in this large service, with about 20 residents on each floor, makes the close supervision of all residents at all times inherently problematic for staff. The current ratio is approximately one nurse or carer for every five residents. There may be occasions when the standard level of staffing is insufficient to support residents when agitated or predictably challenging. We have received a number of notifications about incidents affecting the well being of residents. As we have already indicated, these have been investigated under safeguarding procedures and action taken when required. Nevertheless we suggest that staffing levels need to be reviewed. In particular the service needs to take account of the fact that during each shift staff leave the floor for a number of reasons, such as breaks and this immediately reduces the ratio of nurses or carers to residents. Staffing levels are no longer fixed to rigid formulae but the former registration authority recognised that 1 nurse is required for every 10 residents, a ratio of 1 to 10. In Elmwood there are only three qualified Nurses for 60 residents. There is also a deputy and a home manager who are also nurses but their duties are not always directly related to the supervision of residents. Care Homes for Older People Page 19 of 26 Evidence: Staff members undertake external qualifications beyond the basic requirements, for example they are being trained and guided in the good management of end of life care, that is, the care of the dying. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role, and are consistently able to meet their needs. Elmwood is now ensuring that all staff receive relevant training that is focussed on delivering improved outcomes for residents. The service sees training as a vital competent in the quality of care provided and in improving staff moral. Staff report to us that they are supported, through training, training and supervision meetings, to meet the individual needs of residents. Elmwood now has in place a good recruitment procedure that clearly defines the process to be followed. We checked a number of records this year to confirm that this procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff recruited confirm that the service was clear about what was involved at all stages and was robust in the following of its procedure and this included checks on immigrant workers some of whom need visas and work permits and these are in place and checked by Elmwood or the managing organisation. Staff meetings take place regularly. Supervision sessions are regular and staff say they find them helpful. Care Homes for Older People Page 20 of 26 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 well managed, including finances, and is mostly safe for residents but with several changes of owner, regional managers and home manager this home still needs to consolidate improvements. Evidence: The manager is qualified and has the necessary experience to run the Home and is aware of and works towards the basic processes set out in the National Minimum Standards. In the case of the corporate provider which is Southern Cross. The manager is aware of the need to keep up to date with practice and continuously develop management skills. This home has had many owners and managers in the past ten years and now needs an extended period of consolidation if it is to make improvement from merely adequate to good or even excellent standards of service and then go onto demonstrate that it can maintain high enough levels of service and this will take time. The manager is now ensuring staff are properly trained and now many are generally competent and knowledgeable to care for the residents. The service is planned to be user focused, to take account of equality and diversity issues, Care Homes for Older People Page 21 of 26 Evidence: and generally works in partnership with families of residents and professionals. It is commendable that staff speak a number of languages and there are both male and female carers. However few staff share the same mainly English background as residents. The manager acknowledges this and has arranged for staff to have training sessions from an external agency to help with their understanding of English language and English culture. The home has a Statement of Purpose that sets out the aims and objectives of the service. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home and is supported in this by regular visits from senior managers in Southern Cross. The manager is aware of the need to promote safeguarding and uses the organisations health and safety policy to meet health and safety requirements and legislation. Both the local manager and senior managers in the organisation have identified areas where they need to make, or are already making, improvements and they have an action plan for undertaking the work. End of life care is one example, English as second language is another. Improvements have been made to the environment and maintenance, the use of road signs, in the many corridors of this home, help to orientation and is a good example. The upgraded heating system is also example of working towards better standards. Our checks of a sample of records, care plans, staff records, accidents, resident money, complaints, senior manager visits, kitchen records and fire safety checks, show that records are generally up to date and in good order. The poor medication records were an exception to this. Care Homes for Older People Page 22 of 26 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 23 of 26 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 1 19 23 Broken or damaged furniture 28/08/2009 such as handles of drawers and warn laminate on drawers, cabinets and wardrobes must be repaired or replaced without delay. This is so that residents can live in a well maintained environment. 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 Care Plans must reflect known risks associated with challenging behaviour. This is so that residents relatives and staff know that this area of care is being well managed. 30/07/2009 2 9 13 Medication charts must be 30/07/2009 signed at the time medicines are administered. This is for the safety and well being of residents. 3 18 13 Residents must be protected 30/07/2009 from harm including the challenging behaviour of other residents. Care Homes for Older People Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is so that residents are protected from harm and injury. 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 1 Statement of Purpose and resident guide, it is recommended that these documents be revised to reflect registration category DE for dementia and not EMI as at present. This is so that people reading these documents will now the correct category and definition. It is recommended that staffing ratios be reviewed so as to confirmthat there are adequate numbers of staff on duty to ensure residents who challenge the service can be supervised and other residents protected from harm. 2 27 Care Homes for Older People Page 25 of 26 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). 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