Inspection on 02/02/09 for Grace Lodge Nursing Home

This inspection was carried out on 2nd February 2009.

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

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

Other inspections for this house

Grace Lodge Nursing Home 05/05/10

Grace Lodge Nursing Home 24/08/09

Grace Lodge Nursing Home 25/06/09

Grace Lodge Nursing Home 22/06/07

Grace Lodge Nursing Home 09/11/06

Grace Lodge Nursing Home 08/12/05

Grace Lodge Nursing Home 07/07/05

Grace Lodge Nursing Home 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grace Lodge Nursing Home Grace Road Walton Liverpool L9 2DB     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: Patricia Thomas     Date: 0 3 0 2 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 30 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 30 Information about the care home Name of care home: Address: Grace Lodge Nursing Home Grace Road Walton Liverpool L9 2DB 01515237202 01515237203 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ocean Cross Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 65 Number of places (if applicable): Under 65 Over 65 65 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 65 Date of last inspection Brief description of the care home Grace Lodge provides nursing and residential care and support for up to sixty-two residents. The home is purpose built and is situated in a cul-de-sac off a busy residential/shopping area of Walton Vale Liverpool. The home is well served by public transport (bus and rail) and a motorway network is approximately ten minutes away by car. The home is built on two levels, is centrally heated and well maintained. A passenger lift and stairways access the first floor. There is a well-kept garden to the rear of the home. The home is staffed 24 hours each day with both trained nurses and care staff. A representative of the owner visits at least monthly to report on the Care Homes for Older People Page 4 of 30 Brief description of the care home running of the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is no stars. This means that people who use this service receive poor quality outcomes. We (the commission) made an unannounced visit to Grace Lodge on 3 February 2009. We spoke with the temporary manager, with people who live in the home and visitors. We read records kept in Grace Lodge about care, staffing and health and safety to make sure people live in a safe place and are being looked after properly. This visit was just one part of the inspection. We also looked at other information we had about the home. Before the visit, the home manager (who has since left), was asked to complete a questionnaire (Annual Quality Assurance Assessment) to give us up to date information about Grace Lodge. We sent our questionnaires out to people who live in the home, their families and staff in order to find out their views. Other information we had received since our last major Care Homes for Older People Page 6 of 30 inspection, such as notifications and complaints were also reviewed. As part of the inspection we were accompanied by an expert by experience who is someone who has experience of using care services. The expert helped us to get information to make judgements about the quality of life experienced by people who live in Grace Lodge. What the care home does well: What has improved since the last inspection? What they could do better: There has been a recent safeguarding alert in Grace Lodge because some peoples health and welfare has been placed at risk. This was due to shortfalls in general standards of support including for pressure care and nutrition. The temporary manager has taken action by giving staff guidance about how to support people properly and safely in this. Care plans have been re-written and standards of care are being monitored. Much of the training for staff was out of date. They now need training updates in mandatory training (such as patient handling) and service specific training (such as dementia, nutrition and pressure care), so they have the skills to write and follow care plans properly and give people the support they need and keep them safe and comfortable. We found a member of staff was not following medication procedures properly. When giving out medication, this person handled tablets and left them unattended. This could pose a risk of the wrong person taking them by mistake. Records show that medication training is out of date and staff who give out drugs will need updated training to give them the knowledge they need to do this safely. Staff need instruction in report writing as some records contain comments which show lack of respect for a persons dignity. There needs to be more discussion with people about social activities and outings for people who live in Grace Lodge. Although some activities are taking place, these were not always the things that people like to do. Some people told us that they are not happy with the activities on offer. One person said she was bored. Eleven people were playing bingo during our visit and appeared to be enjoying this; however one person said she doesnt care for bingo. Another person said she plays bingo sometimes but there isnt very much going on to interest her. More attention needs to be given to the way mealtimes are managed. The expert by experience saw poor presentation of Care Homes for Older People Page 8 of 30 meals, unclean utensils, lack of choice, and lack of record keeping where people are refusing or not taking their meals. This means they could become hungry later and would need to be offered an alternative. The home is being monitored by health and social services following a safeguarding alert. The recent shortfalls in standards in Grace Lodge show a lack of awareness of safeguarding vulnerable people and the duty of care to protect the health and welfare of people who live in Grace Lodge. Staff will need updated training in safeguarding to give them knowledge about the indicators of abuse and how to report suspected abuse to relevant agencies for investigation. Some areas of the home, appliances and equipment were not clean during our visit and staff showed lack of awareness of infection control measures. The building needs to be thoroughly cleaned and maintained to good standards through regular checks and staff should receive updated training in infection control. The was a lack of evidence that environmental risks are being managed through monitoring and risk assessing accidents. Also, there needs to be regular checks on bedrails to avoid the risk of injury through entrapment and staff should receive training in use of bedrails. 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 30 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 30 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. Staff from Grace Lodge check peoples needs before they move in to make sure these can be met at the home. Evidence: We looked at the care files of four people who live at the home and saw these contained detailed checks of peoples needs. These had been carried out by homes staff, before the person moved in to Grace Lodge. These records have details of peoples health, personal care needs, mental health and social support needs. This gives staff plenty of information on which to base a care plan before each person moves in. In this way staff will know that the service and facilities available in Grace Lodge can meet the persons needs. To ensure that people who are due to move in (and their family representatives) will have plenty of information before making a final decision about moving to Grace Lodge, they are given a service user guide which includes a copy of the complaints Care Homes for Older People Page 11 of 30 Evidence: procedure. In this way they will have information about the service, staffing and accommodation and will know about their right to complain if the service is not to their satisfaction, and how to go about this. Care Homes for Older People Page 12 of 30 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. Frail and vulnerable people could be placed at risk if staff do not have the guidance they need in care plans to support each person properly and safely regarding pressure care and nutrition. Evidence: Each person living in a care home should have a care plan which is based on their needs, to guide staff about how to support them properly and safely. We looked at the care plans of four people who live at Grace Lodge. At the time of our visit, the care plans were in the process of being re-written by staff, following a safeguarding alert about shortfalls in general standards of care for a number of residents of Grace Lodge. Gaps in care plans had been identified about how people should be supported with, for example, nutrition and pressure care. The care plans previously in place were not giving staff enough guidance in this, resulting some very frail people being placed at risk through insufficient support and treatment. Improvements have been made in recording how pressure care for each individual is managed. This made it easy to track the action taken by staff, for example, to monitor and support peoples pressure areas. Care Homes for Older People Page 13 of 30 Evidence: We saw clear records of the progress of treatment and the current condition of pressure areas. The acting manager said she has given staff instructions about how monitoring and treatments are to be recorded in care plans in instances where skin breaks develop. A number of residents had lost weight and were waiting to be seen by a dietician. Although residents are weighed every four weeks, in the months before our visit, there was little proof that action having been taken where significant weight loss has been recorded. For example, a persons care plan recommended referral to the dietician and, according to records, it was several months before the referral was made. In the months between, the persons care notes show ongoing weight loss. The acting manager told us about the ways in which the person is being supported with nonprescribed nutritional supplements until such time as appropriate professional support can be obtained. The persons weight and pressure areas continue to be monitored. The care planning format being put in place, if filled in properly and based on the full range of peoples needs, will give staff plenty of guidance about how to support them. The process of re-writing care plans for all people living at Grace Lodge was continuing to avoid people being placed at risk in the future. The care plans for those most at risk had been prioritised and their new care plans were satisfactory at the time of our visit to the home. However these had not been fully implemented at that time. All residents of Grace Lodge are registered with local GPs and records are kept in the care plans of medical visits and treatments, as well as treatment from other services such as chiropodists. There is a system for managing residents prescribed medication and for the two people whose medication was looked at, their prescribed drugs were in stock and the medication administration records were up to date. One person living at the home has an allergy to penicillin stated on the check of their needs that had been done before they moved in. This information has not been transferred to their care plan or medication administration record which means she could suffer adverse effects if the drug was to be prescribed and given to them. The expert by experience who came with us on this visit to the home saw a member of staff who was giving out medicines to handle a tablet and to leave some medication on the dining table instead of giving it out when the person was ready to take it. It is unsafe to leave medication unsupervised as a person who is not prescribed the drug may take it by mistake. We discussed this with the manager who said it is not in keeping with the procedures in place which staff should follow when giving out medication. We found that peoples dignity was not always being respected in the terms used in some of the records which are written by staff in Grace Lodge. When writing about the Care Homes for Older People Page 14 of 30 Evidence: people who live in the home, staff should respectful towards them and be careful to be factual and non-judgemental. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in some activities. However meals are not always well presented and people are not always given the choices and alternatives they need to make sure they receive a varied nourishing diet to keep them as healthy as possible. Evidence: An activities co-ordinator is employed at Grace Lodge. They arrange daily events and these are recorded in individual activities diaries. Eleven people were playing bingo during our visit, but one person said she doesnt like bingo, another said she would like more things to do. Visitors were calling in regularly during our visit to the home and the expert noted they spent time in private with their relatives. They told her a hairdresser visits every week and they were satisfied with the condition of their relatives clothing as it is returned to them clean and in good condition after laundering. When people move in to Grace Lodge, their religious beliefs are written in their care plans, and for those who prefer, they are visited regularly by ministers from local churches. Care Homes for Older People Page 16 of 30 Evidence: To find out about how people are supported with the food, the expert watched the meal being served and eaten in the first floor lounge. There were six members of staff in this area to serve meals and help any residents who need this. The expert thought the meal was poorly presented but tasted better than it looked and was hot when served. She saw that people were offered a drink of tea or coffee before the meal but were not given a cold drink with their meal or medication. She noted that people who needed help with their meal were given assistance by a member of staff sitting beside them and one member of staff was encouraging people to eat. There were no records available to show how much food people were eating or whether they were refusing to eat. This means there is no record that people are eating enough to make sure they remain healthy. There is a daily menu with alternatives offered; however it is not clear how people are told about what they are having for the meal. Some staff were seen giving people meals without consulting them. The expert thought that the meal was not a pleasant experience for the people living at Grace Lodge because staff did not take time to speak with residents very much. A person who lives at the home told the expert she did not have a choice of what to have for breakfast and a visitor said the tea served to people in their bedrooms is usually cold. Care Homes for Older People Page 17 of 30 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. There are complaints and safeguarding procedures in place but staff lack the awareness they need to make sure that the people who live at Grace Lodge are protected from harm and abuse. Evidence: There is a complaints procedure which is given to people when they move in to the home. There have been two complaints about staff conduct since our last visit there. The home owners investigated the concerns and have taken action to help ensure there will be no repetition of this in the future. CSCI received a complaint about low staffing levels; however no dates or times were given and it was not possible for the previous manager to investigate this fully. Grace Lodge is being monitored by health and social services staff, following a safeguarding concern about general standards of care. This was regarding people being placed at risk through shortfalls in pressure care management and support for peoples nutrition. A temporary manager is in post who has taken steps to give staff guidance on best practice in support people in this. Care plans have been re-written and there are now clear records of pressure care support for individual residents. Some people are waiting for a visit from the dietician due to weight loss and the acting manager has taken action to ensure their diet is fortified until such time as they are prescribed suitable supplements. Care Homes for Older People Page 18 of 30 Evidence: Although Grace Lodge has safeguarding procedures in place, recent facts we have show that staff lack the awareness they need to protect vulnerable people, by giving them all the care and support they need. Staff will need updated training in safeguarding, to ensure they are aware of the indicators of abuse and how to report suspected abuse to the relevant authorities for investigation. We could see that the temporary manager had taken steps to deal with the shortfalls we found but it would take time to implement these to make sure that staff at the home act correctly to protect people from abuse and poor practice. Care Homes for Older People Page 19 of 30 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. Grace Lodge was built as a care home so it is suitable for the people who live there but some areas are not clean and staff lack awareness of best practice in infection control, so that people living at the home are at risk of infection. Evidence: Grace Lodge was built to be a care home and has single bedrooms on two floors. There is level access to the outside garden and car park and a lift and staircase to the first floor. For residents security, a series of doors locked with key pads separate the reception area, offices, kitchen and laundry from communal areas and bedrooms. There are lounges and dining rooms on both floors and bathrooms and toilets throughout the building. The kitchen and laundry are well equipped and were both clean and well organised at the time of the visit. We were told that two domestic staff are employed every day, one for each floor, and they have a strict cleaning regime to follow. Staff told us they have plenty of cleaning materials and protective clothing and there are procedures for control of substances hazardous to health and the control of infection. We found that some of the floor coverings and curtains need cleaning, particularly in the lounges and dining rooms. The expert told us that in one bedroom they saw the Care Homes for Older People Page 20 of 30 Evidence: bedrails and wheelchair were not clean. We also saw that some bedrails and wheelchairs were not clean and in the dining room the tea pot and drinking beakers were not clean. We have been told by relatives that used cups, plates and dishes are not always removed from residents bedrooms between meals. We saw during our visit that staff are not always following infection control procedures as the expert observed staff throwing a damp sheet and used continence pad on the floor in a bedroom. This lack of awareness of procedure could cause contamination and odour throughout the home. Care Homes for Older People Page 21 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a satisfactory recruitment procedures to make sure that staff are suitable to work with vulnerable people. However, staff training is out of date, which means they could lack the knowledge and skills to support people properly and safely. Evidence: We saw there was a suitable mix of qualified nurses and care assistants on duty during our visit. The staff roster we saw gave a true representation of those staff on duty during the visit. When we arrived at the home there were ten care staff and two nurses, a cook and two domestic staff on duty. The temporary manager, administrator and activities person were also on duty. Senior care staff have national vocational qualifications; these are nationally recognised qualifications for people working in the field of care. The records we saw show that little mandatory training for staff took place in 2008 in Grace Lodge. For example, the last record of patient handling and food hygiene training was in 2007 and two staff are recorded as having medication and nutrition training in 2007. None of the staff are recorded as having attended the courses on dementia or communication. No staff are recorded as having wound care or care planning training in 2008. Historical records show that a range of training was carried Care Homes for Older People Page 22 of 30 Evidence: out in 2006 and 2007; however most staff will need refresher courses to keep them up to date and maintain their skills. We looked at some staff files to make sure that only staff who are suitable to work with vulnerable people are employed at Grace Lodge. The files we looked at showed us that the necessary checks and clearances are in place before people begin work at Grace Lodge. In each file we saw two satisfactory references and criminal records bureau clearances had been obtained, and up to date pin numbers had been checked for nursing staff. Care Homes for Older People Page 23 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the absence of risk management and mandatory training, the health and welfare of people who use the service and staff are not sufficiently protected. Evidence: The previous manager left Grace Lodge recently and a temporary manager has been in post to fill the vacancy. She is qualified in nursing and management and registered with CSCI to manage another home owned by the providers. The vacant managers post had been advertised at the time of the visit. The temporary manager told us she would remain at Grace Lodge until a new manager has been recruited for the home. The home has a quality assurance system which is based on seeking the views of residents and their families through sending out quality questionnaires, and developing the service according to their responses. There were no records available of the latest service review. Some people who live in Grace Lodge are not able to look after their own money and Care Homes for Older People Page 24 of 30 Evidence: to make sure they have regular access to their personal allowances, small sums of money are held for them in safekeeping. To find out how peoples personal allowances are managed in the home, we looked at the records of money held for four people and discussed this with the administrator. There were accounts of credits and expenditure to each persons account and the records balanced with the amount held for each person. We were told that the accounts are regularly audited by an operations manager, and the accounts sheets sent to head office when full. People who have bank accounts are billed in arrears for extras such as hairdressing and newspapers. A series of checks are required on the building and equipment to ensure it is a safe home and place of work. We looked at the certificates and records for these checks and found them to be satisfactory. We looked at the accident book, where falls and incidents to residents and staff are recorded. One accident to a resident had been caused by a bedrail but there was no updated risk assessment in place to avoid a future accident. One person was seen in bed with one bumper missing of the right side bedrail. This persons arm was close to the bedrail and due to the delicate condition of the persons skin on the elbows, could be injured by contact with the bedrail. There were initial assessments in place for the use of bedrails for those at risk of falling out of bed. Safety checks need to be carried out at least weekly. To ensure staff are competent in use of bedrails and the associated risks they could pose, they should be given relevant training. Care Homes for Older People Page 25 of 30 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 26 of 30 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 Work on re-writing care plans must be completed so that every person who lives at Grace Lodge has a full up to date care plan. This will give staff the guidance they need to support people properly and safely. 02/04/2010 2 9 13 Medication training for staff must be updated. This will help to ensure that staff have the skills to support people properly and safely when taking their medication. 02/04/2009 3 12 16 People who live at the home 26/05/2009 must be consulted about their preferred activities and arrangements must be made for these to be provided. This will give people living in the home the opportunity to follow their chosen lifestyle. Care Homes for Older People Page 27 of 30 4 26 13 All parts of the home, facilities and equipment must be kept in a clean and hygienic condition. This will help to prevent infection, toxic conditions and the spread of infection in the home. 02/04/2009 5 30 18 Staff training needs must be 02/06/2009 reviewed and all staff must undertake up to date mandatory and service specific training. This will help to ensure that staff have the necessary knowledge, competence and skills to be able to provide the right care safely for the people who live at Grace Lodge. 6 38 13 Checks of bedrails must be carried out at least weekly. This will help to avoid people being placed at risk of injury through being trapped between the bedrails . 02/04/2009 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 9 To ensure residents are protected when taking their medication, staff should follow the procedures regarding the safe handling of medication by not directly handling medication or leaving it unattended. Staff should receive instruction in respecting peoples dignity when writing reports by recording only factual information about people. 2 10 Care Homes for Older People Page 28 of 30 3 14 Arrangements should be made for residents to be offered choices and alternatives at mealtimes to help make sure that they can have a varied and nutritious diet so they can remain as healthy as possible. Arrangements should be made for residents to be offered choices and alternatives at mealtimes to help make sure that they can have a varied, nutritious diet so they can remain as healthy as possible. Arrangements should be made for residents to receive wellpresented, varied and wholesome meals which are taken in a relaxed and congenial setting. All staff should receive training in infection control and updates in the homes procedures in this. The accident book should be regularly reviewed and risk assessment carried out to avoid any repetition of accidents. Staff should be given training in the use of bedrails so they know how these should be used safely to make sure that residents do not become trapped in them. 4 14 5 15 6 7 8 26 38 38 Care Homes for Older People Page 29 of 30 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. 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