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Inspection on 31/03/10 for Holmwood Care Centre

Also see our care home review for Holmwood Care Centre for more information

This inspection was carried out on 31st March 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home offers pleasant accommodation for people to live in. People are accommodated on three floors and a passenger lift assists people with mobility problems to access all areas of the home. There is a pleasant garden area for people to use when the weather permits with easy access from the home. People are encouraged to personalise their bedrooms with items that are familiar to them so it allows them to place their own identity on it. Choices of meals are offered and food is well presented. the home can cater for special diets including individual preferences, dietary and cultural needs which, means people should receive food that they like.

What has improved since the last inspection?

From the last key inspection in August 2009, there appears to have been no progress and given the concerns found at the recent inspections, and information received from the multi agency safeguarding team the service has shown no improvement.

What the care home could do better:

The home must ensure that they have sufficient staff skill mix on duty calculated on the dependency needs of the people living in the home. To ensure that peoples health and personal care are not compromised. The arrangements for domestic and laundry cover should be reviewed to provide sufficient cover for the seven days. This will assist in maintaining the care hours in looking after the residents in the home. The management and organisation of medication to ensure that people living in the home receive their prescribed medication correctly. Look at systems for passing on information to staff about changes in the residents health and welfare. To ensure that all staff understand the health and personal care needs for people that they are looking after. The health and social care needs of people who use the service need to be promoted and staff need to act upon outcomes of assessments and instructions from health professionals to ensure people are not placed at harm through neglect of care. Review the complaint procedure to ensure complaints are recorded and followed up fully, and where applicable referred to the relevant authorities. To assist in protecting the people living in the home. Complete a review of the activities to ensure that they are person centred and people have a choice of what they wish to do.

Key inspection report Care homes for older people Name: Address: Holmwood Care Centre 30 Chaddesley Road Kidderminster Worcs DY10 3DJ     The quality rating for this care home is:   zero star poor 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: Christine Potter     Date: 0 1 0 4 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Holmwood Care Centre 30 Chaddesley Road Kidderminster Worcs DY10 3DJ 01562824496 01562822935 admin@holmwood.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Cloud Care Plc Name of registered manager (if applicable) Mrs Gail Elizabeth Gilbert Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: Accommodation to be used for a maximum of 45 nursing places. Category PD is restricted to persons aged between 55 -64 years. The home may accommodate one named service user over the age of 50 years with learning disability (LD). Date of last inspection Brief description of the care home Holmwood Care Centre is a 60-bedded care home situated a short distance from the centre of Kidderminster. The home has 56 single rooms with many offering en-suite facilities, the service can also accommodate people who wish to share a room. Care Homes for Older People Page 4 of 28 1 3 0 8 2 0 0 9 0 0 0 5 Over 65 40 1 60 60 Brief description of the care home Accommodation is provided on three floors with a passenger lift providing access to rooms on the upper floors. Other areas of the home used by people include, lounges, dining room, toilets and bathrooms. Handrails are appropriately fitted to assist people to walk around the home. Ramps are fitted to assist people in wheelchairs to go outside to the enclosed garden. The registered manager for the home is Mrs Gail Gilbert who is a first level registered nurse and many years experience working in care for the elderly. Gail has completed the Registered Managers Award. The home is owned by St Cloud Care PLC and the providers takes an active role in the home and the people who live there. A range of activities are provided for the people living at the home and assist people to maintain links with the local community. Information about the fees are not included in the Service User Guide, for up to date information about the fees please contact the home direct as the fees are based on individual needs and assessments. Additional charges are made for hairdressing, daily newspapers and chiropody. 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. It is recommended that this report is read in conjunction with the previous reports dated the 13th August 2009 and the random inspection report 16th March 2010. The visit to the home was undertaken by two inspectors over part of one day. We, the commission were assisted throughout the day by the deputy manager and staff on duty. The home did not know that we were visiting that day when there were 33 people with nursing needs and 18 people with residential needs living there. This inspection was started following concerns raised by the multi agency safeguarding adults team. The Pharmacist inspector visited the home on the 16th March 2010 and Care Homes for Older People Page 6 of 28 found significant shortfalls with the homes management and organisation of medication and made four requirements for the home to comply with. The last key inspection in August 2009 made a requirement that the home review their staffing levels to ensure that the dependency needs of the people living in the home would not be compromised. The service responded to us in a letter dated 15th September 2009 informing that they were recruiting a nurse for 35 hours per week. Before our visit we reviewed any notifications received about the home, these are reports about things that have happened in the home that they must tell us about. These told us about some medication errors that had occurred and loss of money. There had been a delay with the loss of money being referred to the appropriate authoritys. During the inspection 31st March 2010, we found shortfalls in the home care records, evidencing that they were not meeting peoples health care needs. A Code B notice was served and records taken from the home as evidence for possible enforcement action.. 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: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient information available for people to decide whether Holmwood Care Centre is right for them. There are opportunities for people to visit the home before making their decision. The home carries out assessments of peoples needs before they move in. Evidence: The last key inspection 13/08/2009 rated these standards as good, we have received no information to change our opinion about these standards. We looked at the preadmission assessments for three people admitted since the last inspection. These showed that sufficient information is gathered to enable a care plan to be developed. The home provides written information in the form of a Service User Guide to help people decide whether they wish to live at Holmwood Care Centre. We saw copies of the Service Users Guide in the reception area of the home, and in the residents bedrooms. The home have the ability to have the documents translated and made Care Homes for Older People Page 11 of 28 Evidence: available in other formats including large print, and audio. The Statement of Purpose, Service User Guide and a copy of the homes inspection report are available in the reception area of the home. 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 poor 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 provide sufficient information for staff to assist people to meet individual needs. The management of medication does not ensure that people receive their medication as prescribed. Evidence: The last key inspection 13th August 2009 rated these standards as good. A recommendation was made for the service to review their care plan documentation, as they were recording multiple health and welfare issues into one plan of care for e.g mobility, pain and personal care. Following the key inspection a serious complaint was received and is currently being investigated under the multi authority safeguarding team. The service accepted a voluntary ban on admissions whilst the investigation was being completed. We were informed of a number of medication errors made by the service and the specialist pharmacy inspector visited the home on the 16th March 2010 to complete a random inspection. This identified issues and four requirements were given for the home to comply with, around the management and administration of medication. Care Homes for Older People Page 13 of 28 Evidence: On the 31st March 2010 two inspectors from Care Quality Commission visited the home to look at the care records for people using the service to assist in evidencing the outcome of care provided for people living at Holmwood Care Centre. We looked at four peoples care records in detail and these showed that each person had an individual plan of care. However, the information and guidance was not being followed correctly with issues identified specifically around wound care, diet and nutrition and pressure relieving care. For one person who was described as malnourished and underweight, with a high risk assessment for developing skin damage from pressure, the records showed that the person lost weight January 2010 to February 2010, the assessment recommended that nutritional supplements were provided. The care record states that this information was given to the doctor, but fails to state what action was taken. We were told that the doctor did not wish to prescribe nutritional food supplements, however this is not recorded in their care records. There was no record in the care records that staff requested that the doctor refer the person to a dietician for advice. We looked at the diet and fluid records for this person and they had not been fully completed. There was no evidence that they were being offered high protein drinks and snacks between meals. The fluid intake was poor and the charts were not being totalled up at midnight. We asked for the list of meals served by the kitchen. We were shown the most recent list dated 27th March and this states small portion for the person, there is no information about the provision of a fortified diet. We found that for people at risk of developing skin damage from pressure, no care plan had been developed to advise staff in how to reduce skin damage. For people where skin damage had occurred a basic wound care plan was in place but failed to give clear information about the size and grade of damage. It gave no record of the type of dressings, and how long the dressing should be left on for. Care records also failed to record if the person had been referred to the specialist tissue viability nurse for advice. For one person we asked the nurse if there is a skin care plan, continence care plan and continence assessment. The nurse looked at the care plan and told us there were none of these care plans and forms available. We were also told that no photographs had been taken of the skin damage which is good clinical practise in a nursing home. When we looked at the person they were on pressure relieving equipment for medium risk, when the assessment recorded that they were high risk. This was discussed with the nurse at the inspection, and she confirmed that this would be upgraded. On the 01/04/2010 we contacted the home to confirm that the pressure relieving equipment had been changed and were concerned to hear that equipment Care Homes for Older People Page 14 of 28 Evidence: had been provided for medium risk, the manager confirmed that this would be changed immediately. We were informed that there was suitable equipment available in the homes store cupboard. For another person their records stated that they have a pressure sore. This had deteriorated following their admission to hospital. However no date or signature was recorded to support this in their care records. The daily records showed that the person had been discharged back to the home on the 16/01/2010, but the care plans and assessments had not been updated to reflect any changes in the persons health care needs. We looked at a photograph of the skin damage which showed a grade four wound, however the persons record stated it was a grade two. The persons records for the management of their diabetes was also poor, and failed to include the individuals normal blood sugar ranges and the levels which the person starts to present with signs of a low blood sugar. The daily records showed where the individual had presented with signs of a low blood sugar, the evaluation on the care plan failed to include this information. One record we found that the record showed a grade two skin break to left calf, no care plan was in place for this. The service had also failed to develop care plans for the persons eye care, incontinence, and moving and handling. This could result in the persons care needs not being met. Copies of information were copied using a Code B notice. The information was shared with the multi agency safeguarding team. We saw one of the people who we case tracked alone and unable to reach the nurse call bell to call for assistance. We also found a complaint where this had been reported to the home by the family. We spoke to staff who told us that morale with staff is low due to the staffing levels. They told us that this results in peoples mouth care and nail care not being done. People are not getting baths as often as they should, e.g daily if people are incontinent. Staff said that they feel able to complain, but feel like nothing is done about it. 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. Improvements have been made and the service is starting to support people to keep up their interests and activities and to be a part of the local community. people are able to keep in touch with family, friends and representatives. They have nutritious and attractive meals, at a time and place to suit them. Evidence: These standards were not fully assessed at this inspection. The last key inspection rated these standards as good and recommended that they review the social, recreational and occupational activities to ensure that activities provided are suitable for all people living in the home. Particular attention being paid to the views and experiences of people regarding social stimulation at weekends. The deputy manager told us that they are currently advertising for a reminiscence therapist for 12 hours in addition to the 16 hours covered by the activities co ordinator. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Outcomes of complaints are not accurately recorded so people cannot be confident they are fully addressed by the home. Evidence: At the last key inspection in August 2009 these standards were rated as good. Since that time we have received a serious complaint which is currently being investigated under the safeguarding for adults multi agency team. Whilst the investigation is in progress, the home accepted a voluntary ban on new admissions. We looked at the complaint records from August 2009, and it would appear from the records shown to us that not all the complaints have been recorded. We were concerned to see another complaint about care provision, the response to this was brief and failed to provide a structured response to prevent this happening again. There has been several incidents of money going missing from the home where their was a delay in referring to the appropriate authorities for investigation. We looked at the monthly accident audits which are completed to observe for any occurrences, or trends, in the nature and type of reported accidents. Care Homes for Older People Page 17 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 physical design and layout of the home enables residents to live in a safe, well maintained environment. Evidence: These standards were not assessed at this inspection given the home was inspected on the 13th August 2009, and there has been liitle change to the environment since then. The main issue was the lift failure, and problems trying to repair this. This resulted in some people being restricted with access around the home and going out. We received two complaints from people which we referred to the home to respond to. Letters were sent out to all relatives and updates with the progress was followed. Holmwood Care Centre is a large detached home providing accommodation for up to 60 people in single bedrooms. The accommodation is on three levels with a passenger lift to assist residents with mobility problems to access all areas of the home. The manager informed us that the lift is scheduled for replacement in the next few months. The home provides three large lounges and a dining room which are decorated and furnished to a high standard with flat screen televisions. There are quiet sitting areas for the residents and their visitors to use. It was recommended that given the size of the home and the number of people being accommodated that the domestic hours for cleaning and laundry were reviewed. At Care Homes for Older People Page 18 of 28 Evidence: the weekends there is only one cleaner covering which could have limitations for the residents if the care hours are used for general cleaning duties. Care Homes for Older People Page 19 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. By failing to provide sufficient numbers and skill mix of staff to meet the needs of the people could result in their health and personal care needs being compromised. Evidence: The last key inspection in August 2009 made a requirement that the home review their staffing levels to ensure sufficient staff are rostered to meet the health and personal care needs of people living in the home. At this time no poor outcomes for people were found. However at this inspection and the random inspection carried out by the pharmacist, we found shortfalls around people receiving their prescribed medication correctly, wound care, nutritional care and care documentation. Staff told us that because of the staffing levels they are unable to provide people with bath and showers as they would like. Mouth care and nail care is overlooked, and people complain that there food is cold due to waiting to be assisted with their meal. When there is only one nurse on shift, peoples medication is delayed when there is an emergency or doctors visit for the nurse to attend to. The deputy manager told us that there were 33 people on the nursing unit and 18 people on the residential unit. Staffing levels for the day were one nurse, one senior and seven carers. On night duty one nurse and three carers. Given the size and layout of the home and the organisation of nursing and residential residents being mixed, the staffing levels are low. Further to this with poor cover at the weekend for Care Homes for Older People Page 20 of 28 Evidence: laundry and domestic cover carers are being taken away from care duties. The last inspection in August 2009 found that the home were following their recruitment procedure. Completing the appropriate safety checks prior to ne staff commencing. These standards were not reviewed at this inspection. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The organisation of the home does not ensure that it is run in the peoples best interests. Evidence: The last key inspection in August 2009 rated these standards as good, and given the contents of the AQAA and the response to the inspection report, were concerned with the deterioration. Following the concerns raised by the multi agency safeguarding adults team, a random inspection was completed looking at the management of medication in the home. This found significant shortfalls and four requirements were made for the home to comply with to improve the management of medication. The quality audit for the home fails to include evidence that residents have been interviewed to monitor the qualityof of the service. Care Homes for Older People Page 22 of 28 Evidence: Since the last inspection their has been a change in the area manager and the format of the regulation 26 visits. All the other areas remain the same as the last key inspection. Care Homes for Older People Page 23 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 9 13 The service must make 30/04/2010 arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for staff to give medicines prescribed when required. 2 9 13 The service must make 30/04/2010 arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. This is to ensure that the care service maintains accurate records of medicines received and disposed of. 3 9 12 The service must make 30/04/2010 arrangements to ensure there is an effective system in place to request, obtain and retain adequate supplies of prescribed medicines so that stock levels are kept at Page 24 of 28 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action a safe level. This is to ensure the amount of medicines stored within the service is a safe level to ensure the health and welfare of people. 4 9 13 The service must make 30/04/2010 arrangements to ensure that all medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. This is to ensure that people get their medicines correctly and that procedures for medicine administration are safe. 5 27 18 Given the size and layout of the home, and the numbers and dependencies of people receiving nursing care, the staffing levels and skills mix are in need of review. To ensure that the health care needs of the nursing residents are not compromised. Remains outstanding 14/09/2009 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 must provide clear directions and guidance for staff to follow. To ensure that people health and welfare needs are being met totally. 30/06/2010 2 7 12 The service must ensure that peoples health and welfare needs are being met. To protect people living in the home 11/06/2010 3 8 12 Regulation 12 1 a 10/06/2011 The home must ensure that when a potential risk is identified for example wound care and nutrition, they demonstrate how these risks are being minimised. To ensure people are receiving appropriate treatment and equipment to assist in preventing deterioration. 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 16 22 Reg 22 1 18/06/2010 The service should ensure that all complaints are recorded and show that they have followed their complaints procedure. To ensure that people fell listened to. 5 27 27 Given the size and layout of the home, and the numbers and dependencies of people receiving nursing care, the staffing levels and skill mix needs to be reviewed. To ensure that the health care needs of the nursing residents are not compromised. 30/06/2010 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!