Inspection on 27/04/09 for Heathfield

This inspection was carried out on 27th April 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

Heathfield 03/05/07

Heathfield 10/05/06

Heathfield 13/12/05

Heathfield 21/06/05

Heathfield 02/02/05

Heathfield 07/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heathfield Cannell Green Norwich Norfolk NR3 1TT     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: Jane Craig     Date: 2 7 0 4 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 28 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 28 Information about the care home Name of care home: Address: Heathfield Cannell Green Norwich Norfolk NR3 1TT 01603612768 01603614765 heathfield@norfolk.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Norfolk County CouncilCommunity Care care home 37 Number of places (if applicable): Under 65 Over 65 0 37 dementia old age, not falling within any other category Additional conditions: 37 0 People who need wheelchairs to assist with their independent mobility can only be accommodated in the home in rooms 24, 36, 45 and 73 Date of last inspection Brief description of the care home Heathfield is situated near to the centre of Norwich, in a quiet residential location close to Mousehold Heath. The service is operated by Norfolk County Council, providing residential accommodation for a maximum of 37 older people or people who have dementia. The home is split into six small units, each of which has its own lounge/dining room, lavatory and bathing facilities and single bedrooms. There is also a shared lounge for large group activities. People using the service have access to pleasant, enclosed garden areas. Local bus services pass in the vicinity of Heathfield and the railway station lies within walking distance. Care Homes for Older People Page 4 of 28 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: The last key inspection on this service was completed on 3rd May 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 27th April 2009 by one regulatory inspector. At the time of the visit there were thirty seven residents in the home. We met with some of them and asked about their views of Heathfield. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. Care Homes for Older People Page 5 of 28 In the absence of the registered manager the visit was carried out with the help of two care co-ordinators who were in charge of the home on the day. We also talked to staff and visitors. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the care home does well: What has improved since the last inspection? After the last inspection we made a recommendation that people thinking of moving in should be given sufficient information about the home to help them to make a decision. This recommendation had been acted upon. One of the relatives we spoke to said that they had been given plenty to look at and they had been able to talk to staff as well. We also made a recommendation to further develop the stimulation and activities in the home. There had been some improvements in this area and there were two activity co-ordinators working in the home. However, some of the residents we spoke to said Care Homes for Older People Page 7 of 28 that there was not much for them to do. There had been a number of improvements to the environment since the last inspection. The layout of the home, the decor and furnishings had all been designed to assist people with dementia to become familiar with their environment and to recognise and be comfortable in their own area. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 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 received sufficient information about new residents to enable them to understand their needs. Evidence: New residents and their family were given a copy of the statement of purpose, residents guide and the last inspection report. These documents explained what people could expect from the service and helped to give an indication of what it was like to live at the home. Relatives also told us that visiting the home and talking to staff helped them to make a decision. The previous recommendation to provide sufficient information had been met. New residents had assessments completed by health or social care professionals on their files. Senior staff also carried out their own assessment prior to confirming the admission. This helped to identify any changes and ensure that the residents current Care Homes for Older People Page 10 of 28 Evidence: needs were understood and could be met by the service. The two examples we saw were not completed in full but there was sufficient information in the other assessments to ensure that staff could identify the residents needs. The staff we spoke to said they also attended a handover where the needs and care for the new resident were discussed. Standard 6 was not applicable. Intermediate care is not provided at Heathfield. Care Homes for Older People Page 11 of 28 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 lack of up to date and accurate records and shortfalls in the management of medication could result in residents health and personal care needs not being met. Evidence: We looked at the care files of three residents as part of the case tracking process and others were looked at to check specific issues. Residents had a set of care plans and risk assessments to support them to meet their health and personal care needs. They also had a summary of their care plans in their bedrooms, which helped to make sure that staff had accessible information. There was evidence that residents or their relatives had opportunities to read and agree plans. Relatives were invited to participate in an annual review. Although most care files had been reviewed each month, there were no evaluation notes to show the residents progress towards meeting their goals or summarise the care given. The plans had not all been amended to reflect changes in the residents Care Homes for Older People Page 12 of 28 Evidence: needs. For example, one residents plans for personal care and mobility had not been updated to reflect their increased needs. Their nutritional plan indicated, in February, that the plan should be reviewed weekly if possible but there were no further records. Another residents nutritional risk score and plan had not been changed, even though the records showed that the resident had been steadily losing weight over a number of months. However, senior staff told us that they were aware of the weight loss and the resident had been referred to their doctor for advice. The lack of up to date information could result in new or temporary staff not having accurate directions to follow. In contrast, some of the plans we saw were detailed and ensured that staff had enough direction to meet the residents needs in the way they preferred. There was an additional set of plans to support residents who had dementia. The plans were pre-printed and there was a separate plan and instructions to cover each area of need that may be associated with dementia. Some of the plans had been added to, to give a description of how the illness affected that resident and how staff could provide care to meet their individual needs. However, most of the ones we saw remained standardised and gave only vague directions, which could, potentially, lead to impersonal or inconsistent care. Not all of the plans were complete. Staff told us that the different standards were because they had not had any training on how the care plans should be implemented and therefore staff had found their own way. We were told by the provider that the care plan format was under review. One of the senior staff had carried out dementia care mapping with a few of the residents, which, she said, had helped to identify points for future care planning. The intention was to further develop the use of this tool to assist with care planning and delivery. In the annual quality assurance assessment (AQAA), the manager told us that residents benefited from a strong partnership between the home and health care agencies. Records we looked at showed that residents were referred to health care professionals whenever necessary. The residents and relatives we spoke with were happy with the care at Heathfield. Residents told us that the staff looked after them if they were not well and took them to hospital. A relative told us that staff understood about dementia care and said, they are light years ahead of the hospital. Another said they couldnt fault the level of care. The service had appointed a dignity champion who was working with staff to ensure that the principles of privacy and dignity were understood and implemented in all areas of practice. A relative told us that staff were, respectful and treat people with dignity. A resident told us that the staff were friendly and she felt comfortable with them. Throughout the course of the visit we saw staff speaking with residents in a Care Homes for Older People Page 13 of 28 Evidence: polite and friendly manner. All personal care was provided in the residents own room and staff said they always made sure that doors and curtains were shut to ensure privacy. Staff who handled medication had received training and they had a full set of policies and procedures for guidance. However, there were some indications that these were not always followed. Medication was stored securely at the recommended temperatures. Most medicines were administered via a monitored dose system (MDS). There were complete records of medicines received into the home and of any returned to pharmacy. Some medication administration record (MAR) charts contained gaps. In some cases the medication had been removed from the monitored dose system, which indicated the errors were with recording. In other instances the resident had not received their medicine but there were no explanations for the omissions. We checked a small sample of medicines not in the MDS and found that the stock accurately matched the records. MAR charts for administration of creams were kept in the residents bedrooms but the one we saw contained long gaps between administration, therefore it was not possible to evidence that the cream had been administered as it was prescribed. There were some handwritten entries on MAR charts. These had been signed but there was no evidence that they had been checked to reduce the risk of transcribing errors. The handwritten instructions were not always an exact match to the directions on the packets, which could result in any special instructions not being followed. Controlled drugs were stored safely and there was an appropriate book for recording. However, we found that two supplies of medication had been entered incorrectly, which indicated that the systems for checking were not effective. The controlled drugs register showed that one resident had received their pain medication a day later than it was prescribed. There was no explanation for this but looking back through the records this was found to be an isolated incident. Care Homes for Older People Page 14 of 28 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. The routines in the home revolved around the people using the service, who said they were happy with their lifestyles. Evidence: We heard several positive comments about the home from residents and relatives. A resident told us that they loved living there and a family member said they were, thrilled with the place. Staff told us that residents were given choices in all aspects of their daily lives. A resident confirmed, They find out what you like and go along that line. One member of staff said that some residents did not have the ability to understand what they were being asked so they gave them visual choices. We observed staff doing this at lunchtime. Another said that they had to make the choices for some residents based on what they knew about their likes and dislikes. Information about residents preferences were recorded on relevant care plans. A family member said that staff did not always work from the information that relatives supplied but said that they quickly got to know the resident well enough. Information about residents social routines and interests were recorded on their assessments. It was not clear how this information was used as there were no care Care Homes for Older People Page 15 of 28 Evidence: plans to assist residents to meet their individual social and recreational needs. Residents and relatives had mixed views on whether there were sufficient, appropriate activities arranged. For example, one resident said, you are left to your own devices for too long. However, another gave us a list of activities they joined and said they were satisfied with what went on. A relative said the level of activities had decreased but another said they had observed quite a few. Records showed that there were usually small group activities going on each unit every day but not all residents joined in. The AQAA indicated that the service was hoping to further improve the level of individual activities. There was open visiting, which helped family and friends to keep in contact. A relative told us they were always made to feel welcome and could have a meal if they wished. Relatives were kept informed of any changes and we observed that staff contacted family members after a GP had visited the home. The AQAA told us that the manager was looking into how relatives could be more involved with the home if they wished to be. The service was also hoping to introduce outings. All the residents we spoke to said they liked the meals. One said the food was, delicious, and another told us, the Sunday roasts are particularly good. There was a five week rotating menu which showed that residents were offered a nutritionally balanced diet. Residents did not have any involvement in menu planning, which was done centrally for all the county council services, but residents told us that there was plenty of choice. The cook also told us that that if residents did not like what was on the menu they could have something else. The cook had guidance on providing special diets and was aware of the nutritional needs of older people. On the day of the inspection the midday meal looked appetising. Residents ate their meals in small dining areas on their separate units. One resident told us, I could stay in my room for meals but I like to go in with the others. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures applied in the home. Evidence: There was a copy of the full complaints policy on display in the foyer for anyone to use. Although this provided comprehensive information about the complaints process, it was not particularly clear for residents who were cognitively impaired. Each resident also received a summarised version in their residents guide. Residents who we asked said that they could speak to the carers if they were not happy with anything. A relative told us they had reported an incident to the manager and it had been dealt with very well. The AQAA indicated that the manager planned to take a more proactive approach, and ask residents during their monthly reviews if they had any complaints. The AQAA indicated that the service had received 9 complaints over the past year. The records showed that the manager had investigated and responded to each one. In cases where the complaints had been upheld the manager had apologised and told the complainant what action was to be taken. Residents said they felt safe at the home. One resident told us, they are very reassuring people; I have never felt frightened. Another said, I feel comfortable with Care Homes for Older People Page 17 of 28 Evidence: them. All staff received training in safeguarding during their induction and NVQ training but this was not updated on a regular basis. Staff had the Norfolk County Council procedure to refer to and there were a number of leaflets around the home alerting residents, visitors and staff to safeguarding procedures. All the staff we spoke to were aware of the indicators of abuse. They understood their responsibility to report any suspicions, or allegations, to the manager. There had been no safeguarding referrals made by the home. Senior staff said there was a plan to cascade training on the mental capacity act to all staff but this had not commenced at the time of the inspection. Care Homes for Older People Page 18 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and well maintained and the decor and furnishings assisted people with dementia. Evidence: To follow the principles of good care for people with dementia, the home was split into six small units. One of the residents told us that the small unit was very nice and it was apparent that she knew the other residents quite well. The units were painted in different colours to assist with recognition. One of the staff said that they had taken advice on what were the best colours to assist people with dementia. There was discreet signage around the home. In addition to their name, each resident had a picture on their bedroom door. A member of staff said that they tried to make the picture meaningful to the resident to further assist with recognition. The home was well maintained. It had been redecorated since the last inspection and there were new carpets and furnishings. Two bathrooms were in the process of being upgraded at the time of the visit, which, the staff said, would provide residents with more choice of bathing facilities. Safety measures, such as low surface temperature radiators, were in place. The outside areas were secure and gave residents a choice of seating. The patio area had been upgraded by staff and we were told it was very popular with residents. Care Homes for Older People Page 19 of 28 Evidence: At the time of the visit all rooms were being used as singles. Residents who needed moving and handling equipment were accommodated in suitably sized rooms. Residents were able to bring in their own furniture, ornaments and pictures, which helped to make their bedrooms more homely and familiar. Most of the bedrooms we looked at were highly personalised. Residents said they were satisfied with their rooms. The home was clean and tidy and free from unpleasant odours. One of the residents told us it was always, beautifully clean. The AQAA told us that all staff had received infection control training and on the day of the visit staff were observed using good hygiene techniques. There were adequate hand washing facilities around the home and staff had access to protective clothing to minimise the risk of spreading infection. The laundry was adequately equipped for the size of the home. On the day of the visit it was tidy and organised. There were no complaints about the laundry and one resident told us, Our clothes are all washed very well. Care Homes for Older People Page 20 of 28 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. Recruitment procedures provided safeguards for residents and the level of staff training meant that staff had the knowledge and skills to meet peoples needs. Evidence: The staffing rosters showed consistent levels of staff and any gaps were covered by agency staff. The AQAA stated that the same agency was used to assist continuity. Staff said that agency use had decreased recently. However, a relative commented that the atmosphere and the level of choice offered to residents was not the same when the permanent staff were not on duty. The AQAA told us there had been an increase in staffing hours since the last inspection and a senior member of staff said that there were plans for a further increase on the daytime shift. Some staff said that, because of the layout of the building and the deployment of staff, the numbers were not always high enough to ensure that residents who needed help from two staff received support when they wanted it. We were told that this could be an issue in the evening. On the day of the visit there were no obvious signs of staff shortages and a resident told us that when they pressed the bell for staff to come they were usually quite quick. There was a clear recruitment procedure, and staff were recruited with regard to equal Care Homes for Older People Page 21 of 28 Evidence: opportunities guidance. The staff files we looked at were complete and contained all the relevant documents and information. All the required pre-employment checks were carried out to make sure that staff were suitable to work with residents. Any staff who had a prior conviction were assessed to ensure that residents would not be put at risk if they were employed at the home. New staff went through an induction training programme which met the common induction standards of the national training organisation. The programme was very thorough and in addition to guided study, there were some taught sessions and mentoring, which meant that the new employee had opportunities to discuss the training materials and their progress. The member of staff was assessed before being signed off as being competent to carry out their role. The central training record we saw was not completely up to date, which meant we were not able to check exactly what training all of the staff had undertaken. Senior staff said that the mandatory training was up to date and most staff had attended dementia care training at various levels. A senior member of staff had done dementia care mapping and others had completed certificate of dementia awareness. The care co-ordinator told us that these courses had had a positive effect on the staff, who had found them very useful. Other staff said they were undertaking courses relevant to their role, for example, one was taking a course in mental health and well being and one of the staff responsible for activities was doing a related course. The AQAA indicated that over 50 of care staff had an NVQ, which is a nationally recognised qualification in health and social care. Care Homes for Older People Page 22 of 28 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 was well managed and the health and safety of residents and staff was protected. Evidence: There had been no changes in the management of the home since the last key inspection. However, there had been alterations in many other aspects of the service relating to the change in the registration since the last key inspection. This period of change could, in part, be a contributing factor in the shortfalls noted in the health and personal care outcome group. The information we received from the AQAA and during the site visit demonstrates that there is a commitment to further developing and improving the service. There were systems in place for monitoring the quality of the service. For example, questionnaires were sent out annually to residents, relatives and other stakeholders. Care Homes for Older People Page 23 of 28 Evidence: The latest survey was carried out in October 2008. The questions asked on the surveys were well thought out and covered a range of issues and topics that were relevant to the target groups. Over 80 of responses in all areas showed that the quality of the service was good. There was an action plan with timescales and an identified member of staff to take the lead to resolve any areas of concern. In addition to the survey, a family member told us that the manager had held a meeting with relatives to talk about the service and any changes or areas for improvement. Staff meetings also provided a forum for staff to make suggestions about the service. There were some internal audits of procedures but a number of policies owned by Norfolk County Council had not been reviewed for some time and it was not clear whether they still reflected current best practice. Residents who were not able to manage their own finances were usually supported by their families or other representatives. A number of residents had small amounts of money held at the home for safekeeping. The manager had safe systems for recording money handled on behalf of residents. We checked a small sample of records and found them to be accurate and complete. All staff had received fire safety training and the manager held regular practice drills. Fire alarms were tested regularly and other fire safety equipment had been serviced. The AQQA showed that the maintenance and servicing of other equipment and installations were up to date, which helped to protect the health and safety of people living and working in the home. Care Homes for Older People Page 24 of 28 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 25 of 28 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 Care plans and risk assessments must be updated as and when the residents needs change. To ensure that staff provide accurate care. 30/06/2009 2 9 13 Medication must be given as 29/05/2009 it is prescribed and reasons given for any omissions. To promote residents health. 3 9 13 Effective systems must be in 29/05/2009 place for checking the recording and administration of controlled drugs. To ensure residents receive the correct medication and reduce the risk of mishandling. 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. Care Homes for Older People Page 26 of 28 No. Refer to Standard Good Practice Recommendations 1 9 Handwritten entries on MAR charts should be double signed to evidence that they have been checked and match the instructions on the medication container. Staffing levels should be kept under review and calculated with regard to the layout of the building and the needs and dependencies of the residents. The central training record should be brought up to date and any shortfalls in mandatory training should be addressed. Policies and procedures should be reviewed to ensure that they reflect current practice. 2 27 3 30 4 37 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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