Inspection on 18/12/09 for Hillview Nursing Home

This inspection was carried out on 18th December 2009.

CQC found this care home to be providing an Adequate 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillview Nursing Home 25/02/09

Hillview Nursing Home 26/02/08

Hillview Nursing Home 31/05/07

Hillview Nursing Home 22/06/06

Hillview Nursing Home 15/12/05

Hillview Nursing Home 20/07/05

Hillview Nursing Home 13/01/05

Hillview Nursing Home 10/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Hillview Nursing Home 34-36 Berrow Road Burnham-on-sea Somerset TA8 2EX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Alison Philpott     Date: 2 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Hillview Nursing Home 34-36 Berrow Road Burnham-on-sea Somerset TA8 2EX 01278783192 01278785445 hillview@almondsburycare.com www.almondsburycare.com Almondsbury Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Shirley Anne Ruane Mrs Julie White Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The following bedrooms should not be used for service users who require the use of a hoist or wheelchair to mobilise or staff assistance with regard to moving and handling; Rooms 2, 10, 17, 22, 23 and 26. The maximum number of service users who can be accommodated is 40. The registered person can provide the following category of service only - code N to service users of either gender whose primary care needs on admission are in the following category : Dementia Code DE. Date of last inspection Brief description of the care home Hillview Nursing Home is situated approximately 1 mile from the seaside town of Burnham On Sea. The home is registered with the Care Quality Commission to provide nursing care for up to 40 people not less than 65 years of age who have dementia. Social Services have a block booking for some of the beds at the home. The home has Care Homes for Older People Page 4 of 28 2 5 0 2 2 0 0 9 0 Over 65 0 Brief description of the care home a Social Services Quality Rating. Hillview is owned by Almondsbury Care Ltd. The Responsible Individual is Mr K Smith. The home currently has a manager designate. Fees are £539 to £811 per week. Additional charges include, hairdressing, chiropody, newspapers/magazines, personal items and staff escorts to appointments. Any Free Nursing Care element awarded is incorporated into the fees and is not refunded to the service user. Care Homes for Older People Page 5 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: This unannounced key inspection was conducted over two days, 18th and 21st December 2009 (total of 9.5 hours). On the day of the inspection, 32 residents were living at the home. The manager designate was available throughout the inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection, were made available to us. We were able to meet with residents and staff. As part of the inspection we received seven completed surveys from residents and their representatives, two completed surveys from health professionals and one completed survey from staff. The term we, used throughout this report, refers to we the Commission. Care Homes for Older People Page 6 of 28 The preferred term for the people who live at the home is residents. This is used throughout the report. We would like to thank all involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care plans are currently being developed. The care plans viewed during the inspection were not clear or fully completed. The home needs to make sure that information is recorded clearly so that staff have information to follow so that they can meet peoples needs appropriately and consistently. (A requirement relating to care plans and risk assessments was made at the previous inspection and this timescale has not been met). We observed that the home is not consistently recording the application of prescribed creams. This needs to be improved to evidence that residents are receiving the correct treatment. We observed that there are no indicators in the home that the client group had dementia. The home does not currently provide an enabling environment for residents. The home must look at how they are going to improve the signage, colour coding for orientation, and install recognisable names/memory boxes to aid residents cognitive skills. The home must ensure that the back garden is completed, so that there is sufficient space for all residents to access outside areas. Staff files viewed did not contain all of the required information. The home must ensure that all checks are carried out to protect people from the risk of harm. Care Homes for Older People Page 8 of 28 The home is registered to provide care to forty people with dementia care needs. Some of the residents present challenging behaviour. Staff have not undertaken training in dementia care or managing challenging behaviour. This means that staff may not be able to meet residents needs appropriately or protect themselves and other residents from risk of harm. 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 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information so that people know what facilities and services are available. The home carries out pre admission assessments to identify an individuals needs before they move into the home. Residents may not receive the best possible care to meet these needs as staff have not completed appropriate training in dementia care. Evidence: Hillview has a Statement of Purpose, a website which provides information about the facilities available and a brochure. We looked at two pre-admission assessments that the home had undertaken. These contained enough information for the home to ensure that they would be able to meet the individuals needs. The home had obtained the assessment undertaken by the local authority where appropriate. Care Homes for Older People Page 11 of 28 Evidence: The home invites prospective residents and their representatives to visit the home and meet people to help them decide if they would like to live there. The home is registered for forty people with dementia care needs. We looked at the staff training matrix and found that staff who work with residents with dementia care needs have not completed appropriate training in dementia care. Staff spoken with confirmed that they had not completed training. The home must provide appropriate dementia care training so that staff are able to meet residents needs appropriately and to protect themselves and other residents from risk of harm. Care Homes for Older People Page 12 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. Care plans do not consistently reflect the care being delivered. The home is developing its care plans. Residents have access to relevant health professionals. The homes medication procedures are generally well managed. Staff respect residents privacy and dignity. Evidence: Relatives who completed surveys told us the home employs exceptionally good staff who make up a structured team giving wonderful care and respect to residents at all times and treats each resident as an individual and responds to needs accordingly. We spent an hour observing interactions in the lounge. During this time, staff were observed offering drinks, talking to residents, and providing support. A health professional told us Hillview are replacing and updating all their residents Care Homes for Older People Page 13 of 28 Evidence: care plans. Hillview have asked for my advice and have always kept me informed and up to date with the progress. We looked at three care plans. The care plan of one resident who moved into the home on 30th November 2009 contained blank care plan sheets and risk assessments. A brief nursing needs assessment had been completed but was not dated. When we returned on the second day of the inspection, care planning sheets had been completed and placed in the care plan. These contained person centred information about the individual. The second residents care plan identified that the home needed to maintain nutritional levels. The nutrition assessment for this individual had not been completed and it was not clear how the home had identified that the resident was at risk. The third care plan was in the previous care plan format. This had been typed initially in 2006 and monthly reviews and evaluations had taken place since. The main care plan has not been updated. This makes it difficult for staff to identify residents current needs from the care plan. Staff spoken with were able to explain how they meet residents needs. The home needs to make sure that information is recorded clearly so that staff meet residents needs appropriately and consistently. Two care plans identified that individuals present challenging behaviour. One care plan stated intervention needed from staff to defuse situation. There was no detailed information for staff to follow and staff have not completed training in how to manage challenging behaviour. We looked at a wound care plan. This contained good information about the wound, with photographs and evidenced regular review. A health professional told us Hillview will always alert me to any problems with clients on my caseload and the team manage mental health issues well, particularly with complex cases. We looked at the homes medication and records. The home uses a monitored dosage system. We looked at the Medication Administration Record Sheets. These were fully completed with the exception of the application of creams. The records for these contained gaps. We viewed prescribed creams which were being stored in the treatment room. The creams had been dated on opening. We checked the balance of one controlled drug. This was found to be correct. Trained nurses administer medication. The manager confirmed that the nurses have undertaken training in the administration of medication. The manager told us that the home plans to carry out medication audits. Care Homes for Older People Page 14 of 28 Evidence: On the first day of the inspection, the temperature in the treatment room where medicines are stored was recorded to be 31 degrees. The temperature of the room should not exceed 25 degrees to ensure that medicines are stored appropriately. This was discussed with the manager who confirmed the home would seek advice from the pharmacy and take action as necessary. We observed staff respecting residents privacy and dignity. Staff knocked on residents bedroom doors and waited before entering. A health professional told us I have seen staff making all efforts to maintain residents dignity and privacy whilst the work has continued. Care Homes for Older People Page 15 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 homes activities co-ordinator has plans to further develop activities to meet individuals needs and interests. Meals are balanced and nutritious and individual dietary needs are catered for. Evidence: The home has recently appointed an activities co-ordinator to work thirty hours per week. The home did not have a record of activities that had been undertaken. The manager explained that the home has recently experienced a difficult time as they have not had an activities co-ordinator in post. Staff at the home have carried out activities where possible. Planned activities for Christmas included choirs, music; organist; Christmas party and buffet; raffle and a trip out to see the Christmas lights. The home was being decorated for Christmas during the inspection. The home has a four week menu. The menu on the day of the inspection was beef stew and dumplings; lamb chops ;and omelette. We spoke with the catering staff who displayed a good knowledge of residents needs and preferences. One resident is a vegetarian; there is always a vegetarian choice available. The chef is due to Care Homes for Older People Page 16 of 28 Evidence: undertake a training course in cooking for people with dementia/feeding at Weston College. The chef told us that the home has plans to introduce a system to enable residents to make choices and display the menu. Care Homes for Older People Page 17 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. The home has a complaints procedure and listens to peoples views. Policies relating to whistleblowing and abuse are available. Evidence: The home has a complaints policy and procedure which is available to people. One relative told us I have always found all the staff very helpful and any problem dealt with immediately. The home had received one complaint since the last inspection. The manager showed us the complaint. The complaint was anonymous and therefore the home was not able to gain further information or respond to the complainant, as they would normally do. Staff spoken with knew what to do if they had any concerns and told us that they had seen the homes whistleblowing policy. The Somerset County Council safeguarding adults stop abuse posters were displayed on the staff noticeboard. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment has been greatly enhanced through extensive refurbishment and redecoration. There are currently no orientation cues in place to provide an enabling environment for the residents who have dementia. A pleasant side garden has been created. The back garden is yet to be developed. The home is clean and fresh throughout. Evidence: The home has been undertaking extensive building work and refurbishment over the past couple of years. The building work is nearing completion. The home now has 36 bedrooms. Thirty two of these rooms are registered for single occupancy. Four bedrooms are registered for double occupancy. The home has two bathrooms and two shower rooms. The bedrooms are well decorated, nicely furnished and comfortable. Residents bedrooms are nicely personalised with their own belongings. A number of bedrooms have electronically adjustable beds. We observed that some of the beds are still low. The manager confirmed that there are plans to replace these. Care Homes for Older People Page 19 of 28 Evidence: At least four bedrooms viewed did not have a bedside lamp. The home should review who may benefit from a bedside lamp and make one available to those residents. Bedroom doors have self closing mechanisms. We observed that a number of doors were slamming when closing which was creating a lot of noise. This was discussed with the manager who confirmed she would speak with the builders to see if they could be adjusted to close quietly. The home is registered to accommodate up to forty people with dementia care needs. We observed that there are no indicators in the home that the client group had dementia. The Registration Inspector had previously discussed with the manager and the director how they were going to improve the signage, colour coding for orientation, and install recognisable names/memory boxes to aid residents cognitive skills. The home must ensure that orientation cues are put in place to provide an enabling environment for residents who have dementia. The kitchen has been completely refurbished and has obtained the five star rating from Environmental Health for the second time. The side garden is now finished. The garden is pleasant with seating, raised flower beds and a water feature. The back garden is still to be completed. This additional space will be needed to accommodate the number of residents who live in the home. A relative told us that rooms are clean and fresh. We observed that the home was clean and fresh throughout. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There appeared to be sufficient staff on duty to meet residents needs. Staff files did not contain all of the required information to protect residents from the risk of harm. A comprehensive induction and training programme is provided for staff. Staff would benefit from training in dementia care and managing challenging behaviour. Evidence: During the inspection, there were two nurse trained staff on duty, nine care staff, domestic staff and catering staff. We looked at the rotas. These showed that there are usually two nurses working during the day; eight care staff on in the morning; eight care staff in the afternoon; and one nurse and 4 care staff at night. In addition to this the home employs maintenance, domestic, laundry and catering staff. The home has recently appointed an activities person who works 30 hours per week. A relative commented sometimes there is a staff shortage at weekends but this is sometimes unavoidable. Staff told us there are occasionally shortages due to sickness but there are usually enough staff on duty to ensure that peoples needs are met. The manager told us that the home is currently advertising for an additional full time Care Homes for Older People Page 21 of 28 Evidence: nurse. We looked at two staff recruitment files. One persons file did not contain a second reference and the application form did not request the persons dates of employment. The second file contained an employment gap between 2001 and 2003. There was no evidence that this had been explored or followed up. New staff spoken with told us that they had completed induction training. The staff training programme includes manual handling; food hygiene; fire; abuse prevention; infection control; mental capacity act; and health & safety. The training matrix had some gaps in infection control training. The team manager confirmed that the training had been undertaken. One person has completed training in end of life care. The home told us there are plans to provide this training in-house. At the previous inspection, we discussed the need to tailor the training to the home, residents and staff. This is so that staff have the knowledge they need to put the training into practice and work within the home. At this inspection, we found that staff have not completed training in dementia or challenging behaviour. The home is now registered for forty people with dementia and we have viewed incidents relating to challenging behaviour. It is strongly recommended that staff complete training in managing challenging behaviour. 14 of the 20 staff have completed an NVQ at level 2 or above. Two staff are currently working towards an NVQ. 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 manager designate is developing systems in the home. The home has quality assurance systems in place. Health and safety procedures protect people from the risk of harm. Evidence: The home currently has a manager designate. The manager is currently applying to register as manager with the Commission. People told us that they are very happy with the management at the home. Relatives told us relatives can always get advice and help at what is a difficult time and the home manager is marvellous, kind, caring and a good manager. A health professional told us manager communicates well with myself and families. Staff told us that they feel well supported and find the manager approachable. The home has recently appointed an experienced member of staff to work as a team Care Homes for Older People Page 23 of 28 Evidence: manager. The team manager will provide support to the manager. Staff told us that they attend regular meetings where they can discuss the running of the home. The last meeting was held in December 2009. Detailed minutes were viewed for the meeting held in May 2009. The provider carries out a monthly visit to the home to monitor quality and speak with people. The last report was available for the visit carried out in November 2009. Families and representatives of residents have set up a supporters group. The group meets regularly and often invites the manager or a trained nurse to give a talk, provide training or take part in discussion. The homes passenger lift was serviced on 11/09/09. Hoists were serviced on 08/07/09. Chemicals and cleaning products were stored securely. Care Homes for Older People Page 24 of 28 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 The home must ensure that 21/02/2010 where risks are identified and assessed a clear up-to-date plan is put in place. The previous timescale of 03/04/09 has not been met. This is so that staff know how to minimise risks and protect residents from risk of harm. 2 7 12 The home must ensure that 21/03/2010 their care plans reflect all assessed needs and updates are recorded. The previous timescale of 25/05/09 has not been met. This is to ensure that staff know how to meet residents needs and changing needs. 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 4 18 There must be a comprehensive dementia care training programme for staff. This training should include care planning and practical care of people with dementia. This is so that staff know how to meet peoples needs appropriately. 21/03/2010 2 7 15 The home must ensure that they develop a care plan in relation to peoples aggression. This is so that staff know how to manage incidents effectively and to protect people from risk of harm. 21/02/2010 3 9 13 The home must ensure that they record when they have applied creams. This is to ensure that residents receive their prescribed medicines. 21/02/2010 Care Homes for Older People Page 26 of 28 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 4 19 23 The home must ensure that the back garden is completed. This is to ensure there is sufficient outside space for residents. 31/03/2010 5 22 23 The home must ensure that 21/03/2010 orientation cues are in place. This is to assist peoples cognitive skills by providing an enabling environment. 6 29 19 There must be a recruitment 21/01/2010 system in place that ensures two references are received prior to commencement of work with people. This is to protect people from risk of harm and abuse. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 12 24 29 30 The home should keep a record of activities and who took part. The home should review who may benefit from a bedside lamp and make one available to those people. The home should obtain a ten year employment history. It is strongly recommended that staff complete training in managing challenging behaviour to protect people from risk of harm. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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