Inspection on 24/02/10 for Grange Park Nursing Home

This inspection was carried out on 24th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grange Park Nursing Home 04/05/10

Grange Park Nursing Home 21/10/09

Grange Park Nursing Home 27/10/08

Grange Park Nursing Home 11/12/07

Grange Park Nursing Home 01/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Random inspection report Care homes for older people Name: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF zero star poor service 21/10/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 2 4 0 2 2 0 1 0 Information about the care home Name of care home: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF 0138423991 Telephone number: Fax number: Email address: Provider web address: grange.park@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Grange Park (Dudley) Nursing Home Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 51 Number of places (if applicable): Under 65 Over 65 0 37 0 dementia old age, not falling within any other category physical disability Conditions of registration: 14 0 10 1. The registered person may provide the following category of service only: Care home only: 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, maximum number of places 37 Physical Disability - Code PD, maximum number of places 10 Dementia - Code DE, maximum number of places 14 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 (14) Old Age : Code OP (37) Physical Disability: Code PD (10) Care Homes for Older People Page 2 of 20 2. The maximum number of service users who can be accomodated is: 51 Date of last inspection Brief description of the care home Grange Park is a purpose built care home offering nursing & personal care mainly to older people, though it is able to offer some nursing beds to younger adults. It is situated just outside Dudley town centre and has good public transport links with Dudley and other local shopping centres. There is a car parking area at the front of the premises. To the rear there are patio and lawned areas, bordered by fencing and mature trees in places and presenting a very pleasant outlook. The interior of the home provides single and double occupancy bedrooms on two floors, some of which are en-suite. The ground floor offers a reception area, offices, communal lounges, a dining room, two conservatories, a small smoking room, kitchen, laundry and a range of bathing and showering facilities. Fees stated in the service user guide were £495 per week for nursing care and £395 per week for residential care. 2 1 1 0 2 0 0 9 Care Homes for Older People Page 3 of 20 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit on 24 February 2010, to monitor requirements issued at the key unannounced inspection on 21 October 2009, relating to the safety and well being of people living at the home. This was because the service received a poor, zero star quality rating as a result of our key inspection. This random inspection was unannounced, which meant the home was not given notice of our visit. Two inspectors, including a pharmacist inspector, spent a day at the home from 09:00 to 21:35. We looked at the medication systems, care records, the systems for dealing with safeguarding people, including staff recruitment. We also looked at how people were supported and given assistance to meet their daily needs. We looked at some bedrooms, particularly bedrails. We talked with people living at the home, staff and visitors. The home has had a recent history of instability and a number of incidents reported as safeguarding referrals. The home has had a chequered history but improvements were made and it achieved an excellent quality rating. However improvements were not consistently maintained. The home was purchased in 2006 by the current registered provider. The registered manager left the homes employ in October 2009 but the provider did not notify us of this change as required. The current acting manager commenced employment on 16 October 2009. At the key inspection we issued a requirement that each person must have appropriate and accurate care plans, risk assessments and health care screening tools to maintain their health and well being. The organisation provided us with an improvement plan, which gave assurances of compliance. We were not able to verify the improvements claimed. During the inspection visit we saw that the staffing arrangements were inadequate to supervise and provide care and attention to the total of 43 people accommodated at the home on two floors, in three units. There were eight people on Himley, intermediate care unit, with two care assistants. There were seven people requiring nursing care and 15 people requiring residential care, with diverse needs, with two care assistants and an agency carer. There were nine people with Dementia on Kitwood, with one senior care assistant and one care assistant. There was one qualified nurse to manage the clinical care and the running of the home. There was no senior carer on duty to supervise the care for people needing residential care. The senior care assistant had to leave on Kitwood to assist the nurse administration of medication on the residential unit. This posed risks to the health and welfare of people at the home. The planned staff rota showed that the staffing levels would be further depleted on the afternoon shift, when the total of eight care assistants on duty was reduced to seven, and this including two agency workers. There was also an additional admission to the intermediate care unit due in the afternoon. We assessed the staff rotas with the acting manager and noted shortfalls in numbers of care staff and clinical nursing hours rotad for duty for Friday, Saturday and Sunday, 26 - 28 February 2010. Care Homes for Older People Page 4 of 20 We noted that despite the increased occupancy, with nine new PCT intermediate care beds the number of managerial / clinical hours had been reduced. The deputy manager post with two supernumerary shifts had been removed and replaced with a senior nurse post. At the previous inspection some people living in the home told us that the staff were very busy and there were inadequate numbers of staff available. As a result of our findings at the key inspection we issued a requirement to ensure that the registered provider must demonstrate that there were skilled, trained competent staff on duty in sufficient numbers at all times to meet each persons needs. At this random inspection staff told us that morale was low, there were frequently staff shortages and agency staff often did not know peoples needs and preferences. We noted that 30 care shifts had been covered with 15 agency workers from 2 - 21 February 2010. In addition the acting manager acknowledged that there was no documentary evidence of recruitment checks, training from the agency or induction to the home and people living there for the agency workers employed. The looked at a sample of staff files for two permanent staff recently employed, which were satisfactory. We were told that there was no involvement of the acting manager or staff at the home in decisions of people discharged from hospital into the nine PCT (Primary Care Trust) funded beds. This meant the management of the home were not making assessments to demonstrate the home could meet each persons needs. We saw examples of poor outcomes for people living at the home. We observed a person admitted on 22 February 2010 into an intermediate care, for rehabilitation. At 11:15am we saw that this person was in a seriously deteriorating condition, which had not been recognised by the care assistants and had not been reported to the only nurse on duty, who was still in the process of administering morning medication. We required the staff to seek medical intervention, which resulted in the person being taken to hospital as an emergency. We were also concerned about the condition of the bed, which had unsafe bedrails and bedrail bumpers, which may have been soiled from previous usage. The person was nursed in bed, receiving nutrition via a PEG tube. We noted that the PEG site was reddened and inflamed. This had not been noticed, recorded or acted upon. There were no risk assessments or care plans for moving and handling, falls, nutrition, weight management, or oral care. The persons mouth looked dry, and dirty. There were no fluid or position change charts. This meant that the staff had no written instructions about how to provide this persons care putting the person at serious risk of harm to their health and welfare. We also saw documentation for two other people nursed in bed, who looked very emaciated. Care plans had not been updated with changes and there were evaluations, which stated no changes, which did not accurately reflect changes, especially for the person requiring end of life palliative care. Special care records did not demonstrate adequate intake of food and fluids or position changes. One person had developed a grade 4, necrotic pressure ulcer on her hip, unnoticed and unrecorded by staff for a period of 29 days. The nurse described removing a dirty smelly Allevyn dressing and finding the black necrotic wound. Although this person had subsequently been reviewed by the Tissue Viability Nurse, the wound care records did not demonstrate compliance with the written guidance. There were no records to show that these peoples weight had been monitored appropriately. For example the MUST (Malnutrition Universal Screening Tool) had not been used and we established in discussions with the manager and senior nurse neither Care Homes for Older People Page 5 of 20 person had been referred to the community dietician. This meant that they were at risk of lack of adequate nutrition and dehydration causing discomfort and infections. The pharmacist inspector checked the management and control of medicines within the service. Although we found a few issues with medicine management within the home there was an overall improvement. We saw that medication was stored securely, which meant that medication was safe. We saw that medication was neat and tidy, which meant that it was easy to locate peoples medication. We looked at the medication administration record (MAR) charts and found that they were documented with a signature for administration or a reason was recorded if medication was not given. We saw that a medication that had to be given at least 30 minutes before breakfast was being given according to the directions of a GP. We saw that hand written MAR charts were checked and double signed by two staff. We found that other medication records were available. For example, we saw current records for the receipt of medication. The date of opening of boxes and bottles of medicines were recorded. These records helped to ensure there was a clear audit trail of medication. However, we did see a few omissions on some MAR charts. When we checked the medication for one person we found that three medicines had not been signed on one day but the medication had been removed from the container. This meant that there was no record on the MAR chart to show whether the medicines were given or not. We found that sometimes it was not always clear what happened to medication taken out of the home when a person went out with friends or relatives. For example, we saw the use of a code L on one medicine administration record (MAR). The code L was defined at the bottom of the MAR chart as on leave. The medicine was prescribed for the prevention of seizures. There was no further information available to explain what had happened to the persons medicine. It was not clear if it had been given or not. We checked the medicine available in the home and found that there was a discrepancy in the amount left compared to the recorded amount signed for administration on the MAR chart. This meant that it was not always possible to know if people had been given their medicines as prescribed. We found that medicines were not always given to people at the correct time as prescribed by a medical practitioner. For example, on the first floor we saw that the morning medicine round for people did not finish until after midday. We were told by the senior nurse that this was very unusual and that the medicine round had started late because a member of staff was off sick. We were concerned that sufficient trained staff were not available to ensure that medication could be given to people. This meant that people were at risk of harm because they were not being given their prescribed medication according to the directions of a medical practitioner and also did not ensure that there was an adequate gap between doses. We saw that one person was being given their medication hidden in food or drink also known as covert administration of medicines. We had been informed in the improvement plan that a protocol for the administration of covert medication had been finalised and was available. We saw a letter signed by the persons GP and a pharmacist which stated the medicines could be given covertly in order to prevent the risk of falls. We saw that the medicines available could be dissolved in a drink or in food. This meant that the health and wellbeing of person living in the home was safeguarded. Care Homes for Older People Page 6 of 20 The organisations improvement plan gave us assurances of compliance with the requirement to ensure staff were trained and would diligently follow safeguarding procedures. The acting manager told us that the organisations policies and procedures to inform staff about safeguarding vulnerable people had not been fully implemented. She told us there were no staff signatures to demonstrate staff had been given time to read and have awareness of Safeguard and Protect the multi-agency Procedure to safeguard vulnerable people. We asked about updated Safeguarding training and we were told that the Local Authority training provider was not able to supply training until after January 2010. We were not given evidence to show how many staff had completed safeguarding awareness training. The acting manager told us that her hours were supernumerary but we noted there were no management hours recorded on the staff rotas. She told us the providers decision to remove the deputy manager post with two supernumerary shifts meant that it was difficult to implement the improvements needed. We were told that there were not sufficient hours to maintain and monitor clinical and care practices. We were told that the services of an external consultancy had been engaged to look at the finances and quality of the service. The acting manager told us she had concentrated on improving the medication systems, had also started to assess the competence of nurses and some staff, and had started to take action where she had identified problems. She told us that constraints on managerial time were compounded by having to use a high level of agency staff to cover sickness and vacancies. We spoke to some permanent staff and a number of agency workers. We were told staff morale was low, for example two staff had left because of they were not happy and there were frequently staff shortages. Generally the agency workers were unable to tell us about the people they were meant to be caring for. One agency worker worked at the home on a more consistent basis and had applied for a permanent position and had a better rapport with the people at the home. We discussed information from multi-agency professionals with the acting manager and senior nurse. The information related to the poor attitude they told us they encountered from staff, their lack of knowledge about peoples needs and failures to follow instructions, resulting in deterioration in some peoples health and well being. The senior nurse stated she had not previously been made aware of the concerns. The acting manager stated that she felt some comments were unfair and described relationships with some multi-agency professionals as strained. The acting manager told us that she had started to devised an annual development plan for the home and there were some audits but these had not identified areas of concern as highlighted in this report such as failures to implement important aspects of care planning and care provision for the most frail and vulnerable people. We looked at Regulation 37 notifications. As already highlighted a significant incident recorded as the development of a Grade 4 pressure ulcer had not been appropriately reported to us or the lead agency as a safeguarding referral. There were records of unannounced visits by the responsible individual on behalf of the organisation in compliance of Regulation 26, to monitor the management and running of Care Homes for Older People Page 7 of 20 the home. The reports had not identified the lack of compliance with previous requirements and the homes improvement plan. We have informed the management of the organisation that we will consider what further enforcement action we need to take to secure improvements for the health, well being and safety of people living at this home. We will continue to undertake inspections to monitor the service. What the care home does well: What they could do better: Records must be monitored and improved. Care plans, risk assessments and evaluations must be person centred, up to date, accurate and give clear guidance about how to meet the needs and support each person in the home, especially the most frail and vulnerable people. Appropriate measures must be put in place to minimise the risks of pressure ulcers. Where damage to skin occurs there must be appropriate records to demonstrate the wound care is provided as prescribed by tissue viability specialists. People must be offered foods and fluids to maintain their health and well being, with appropriate weight monitoring; and where there are concerns advice must be sought from doctors and dieticians, without delay. Though some medication practices had improved, administration practices and records, which were potentially unsafe, must be improved. Care Homes for Older People Page 8 of 20 The management must diligently follow guidance to keep people safe without depriving them of their rights. All staff must be provided with suitable training so that they understand how to protect vulnerable people and know where they should report concerns. An Immediate Requirement was issued to the provider to demonstrate that there are skilled staff in suitable numbers to meet all the needs of each person living at the home. There must be appropriate employment checks in place to make sure the people living at the home are safeguarded. This includes agency staff used to provide cover for vacancies and sickness. Robust action must be taken to deal with staff where actions or omissions place people using the service at risk of harm. All staff should receive appropriate induction, training and supervision to support them to develop skills to meet the needs of people living at the home. Equipment such as bedrails must comply with health and safety requirements. All adverse events affecting people living at the home, serious pressure ulcers must be notified to us without delay to show that people are safeguarded. 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 2. Care Homes for Older People Page 9 of 20 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Pre admission assessments must be more detailed and include all areas of risks and needs, and these must be kept under review. This is so that people can be confident that all their needs can be met. 01/12/2009 2 7 12 To ensure that there are 01/12/2009 health care assessments, risk assessments and care plans, which include all of each persons assessed needs, the active involvement of the person / or representative; and are updated to accurately reflect all changes to health and needs. This is to ensure care for each persons health and well being is properly provided at all times. 3 8 12 To ensure that people with 01/12/2009 poor nutritional intake and / or weight loss are monitored using a recognised screening tool as frequently as required by their risk assessment and care plan. This will ensure that staff take required actions to Care Homes for Older People Page 10 of 20 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action promote peoples health and well being. 4 8 12 To ensure that special care records such as food, fluid balance charts, turn charts, and wound care records are maintained, with care provided appropriately recorded and monitored and updated. This is to ensure peoples health and well being is maintained. 5 9 13 To ensure that all staff who administer medication are assessed as competent and their practice must ensure that people living at the home receive their medication safely and correctly. This is to ensure that the people who use the service are safeguarded. 6 9 13 The records of the receipt, 01/12/2009 administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. This is to maintain the health and well being of people living at the home. 7 9 13 To ensure that all persons living at the home receive 01/12/2009 01/12/2009 01/12/2009 Care Homes for Older People Page 11 of 20 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action their medication as prescribed by their doctor and the Medication Administration Records must be accurately completed to demonstrate either medication has administered or an appropriate code entered to record the reason for non administration. This is to maintain the health and well being of people living at the home. 8 9 13 To ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to monitor and inform the relevant healthcare professionals as needed. This is to safeguard the health and well being of people living at the home. 9 16 22 To diligently record and 01/12/2009 report all complaints, with actions clearly identified to demonstrate robust investigations of all concerns or referrals to other appropriate agencies as necessary; and ensure these records are available for inspection. This is to ensure that the people who use the service are safeguarded. 10 18 13 All staff must receive 01/12/2009 Page 12 of 20 01/12/2009 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action appropriate safeguarding training and the homes and Safeguard and Protect procedures to protect vulnerable people must be implemented and followed diligently at all times. This is to safeguard all persons living at the home from risks of harm. 11 27 12 To demonstrate that the number of staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 12 29 19 To ensure that all staff 01/12/2009 employed at the home are recruited following robust recruitment procedures, with documentary evidence to demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to safeguard people living at the home from risks of harm. 13 31 39 To notify the CQC of any 01/12/2009 changes to the management of the home, including the name, address and qualifications of the person responsible for running the Page 13 of 20 01/12/2009 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action home. This is to safeguard people living at the home. 14 33 24 To implement effective 01/12/2009 quality monitoring systems, which demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety of people living at the home. 15 37 37 To ensure notifications are 01/12/2009 submitted to the Care Quality Commission of any incident that has affected the health, safety or wellbeing of the people at the care home, without delay. This included medication errors. This is to safeguard the health, well being and safety of people living at the home. 16 38 13 Management systems must 01/12/2009 be implemented to ensure the safe use of bedrails, which includes correct fitting, rigorous risk assessments, diligently followed, documented checks and staff guidance and training relating to bedrails. This is to safeguard the health, well being and safety of people living at the home. Care Homes for Older People Page 14 of 20 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The service must make 25/03/2010 arrangements to ensure that all medication is administered at the correct time as directed by the prescriber to the person it was prescribed, labelled and supplied for. This is to ensure that people living in the home are given their medicine safely and correctly. 2 9 13 The service must make safe 25/03/2010 arrangements for medication when people leave the home for social leave occasions. This is to ensure that medication is given to people according to the directions of a Doctor. Care Homes for Older People Page 15 of 20 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 The statement of purpose and service user guide should be revised, updated and reissued to people living at the home in easy to understand formats suited to their capabilities. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. The contract / terms and conditions of residence should be revised, updated and reissued to each person living at the home to reflect good practice guidance issued by the Office of Fair Trading. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. Daily progress records should be revised to ensure all records are accurate, consistent and up to date. This is a previous Good Practice Recommendation, not met at this Random Inspection. Advice from the diabetic specialist nursing service should be sought for any person with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to diabetes. This is a previous Good Practice Recommendation, not met at this Random Inspection. Advice from community dieticians should be sought for all persons assessed to be nutritionally at risk, with records of support and advice offered and that a record be maintained of staff training in relation to nutrition. This is a previous Good Practice Recommendation, not met at this Random Inspection. The Tissue Viability Nurses instructions, that people with pressure ulcers must be referred to the Community Dietician, should be followed so that staff have sound dietary advice to provide each person with a nutritious, high protein diet with appropriate vitamins and essential minerals to promote healing and improved skin condition. This is a new Good Practice Recommendation. The correct pressure setting for pressure relieving mattresses should be recorded in each persons care records with regular documented checks. This is a previous Good Practice Recommendation, not met at this Random Inspection. 2 2 3 7 4 8 5 8 6 8 7 8 Care Homes for Older People Page 16 of 20 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 8 8 Moving and handling risk assessments should reviewed and expanded to include instructions for the level of assistance and named equipment required for all transfers. This is a previous Good Practice Recommendation, not met at this Random Inspection. Activities and access to the wider community, appropriate to each persons abilities and needs, should be available to provide social interaction and stimulation. Inventories of personal possessions should be fully completed, signed, witnessed and kept up to date. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. Food should be provided to meet each persons preference and at an appropriate temperature. This is a previous Good Practice Recommendation, not met at this Random Inspection. Food options and choices for people from other nationalities and cultures should be frequently reviewed with them and their supporters to make sure they are able to have their preferred meals. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. Staff should be given time to read policies and procedures associated with the protection of vulnerable adults, with signatures obtained to demonstrate their awareness and compliance. This is a previous Good Practice Recommendation, not met at this Random Inspection. Plans should be implemented to ensure the environment meets the needs of everyone living at the home in a prioritised timescale. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. Assessments should be in place to ensure each person is provided with equipment that is suitable to meet their needs, such as nursing profile beds, and suitable, adjustable chairs. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. 9 12 10 14 11 15 12 15 13 18 14 19 15 22 Care Homes for Older People Page 17 of 20 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 16 25 The heating in all areas of the home must be maintained at a safe and comfortable ambient temperature for people living there. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. All compromised double glazed windows should be replaced within a prioritised timescale to improve visibility for people living at the home. This is a previous Good Practice Recommendation, not met at this Random Inspection. Assessment and reviews should be undertaken of the cleaning schedules and minor repairs with actions to maintain the environment to an acceptable level. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. The managers hours should be recorded on the staffing rotas to demonstrate managerial and clinical hours worked. This is a new Good Practice Recommendation. There should be signed and dated receipts for every transaction and a clear audit of money used on each persons behalf. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. There should be two signatures for any transactions carried out on behalf of people living in the home. This will ensure that the people living in the home are safeguarded. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. This was a previously unmet good practice recommendation. A structured staff supervision system should be resumed to ensure all staff receive formal supervision at least six times each year to provide them with support and development to meet the needs of people using the service. This is a previous Good Practice Recommendation, not met at this Random Inspection. Regular documented accident analysis should be resumed to ensure that accident records are fully completed, with the unit clearly identified and risk assessments are reviewed and revised in accordance with any changed Page 18 of 20 17 25 18 26 19 27 20 35 21 35 22 36 23 38 Care Homes for Older People 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 needs. 24 38 There should be documented regular checks on a slings, with any remedial work carried out. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. There should be documentary evidence that maintenance is carried out on all lifting equipment in compliance with LOLER Regs. This is a previous Good Practice Recommendation, not assessed at this Random Inspection. 25 38 Care Homes for Older People Page 19 of 20 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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