Inspection on 26/03/09 for Howard Court Nursing Home

This inspection was carried out on 26th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Howard Court Nursing Home 05/11/07

Howard Court Nursing Home 18/12/06

Howard Court Nursing Home 05/10/05

Howard Court Nursing Home 28/07/05

Howard Court Nursing Home 20/01/05

Howard Court Nursing Home 15/07/04

Howard Court Nursing Home 11/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Howard Court Nursing Home 9 Burlington Road Ipswich Suffolk IP1 2EU     The quality rating for this care home is:   two star good 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: Ray Finney     Date: 2 6 0 3 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: Howard Court Nursing Home 9 Burlington Road Ipswich Suffolk IP1 2EU 01473210787 01473233619 sayersa@bupa.com www.bupa.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (CFC Homes) Ltd care home 40 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Howard Court is an established nursing home situated within a residential area of Ipswich, close to the town centre with all its facilities and resources. The home is part of the BUPA care group. The home provides care and accommodation for up to 40 older people suffering from severe mental infirmity. There are 26 single bedrooms and a further seven shared rooms. Communal areas include two lounges and a large central dining room. The home charges between £538.00 and £900.00 per week for the service they provide. This information was given to us in March 2009. Information about the service 40 Over 65 0 Care Homes for Older People Page 4 of 28 Brief description of the care home can be found in the homes Statement of Purpose and Service User Guide, which may be obtained by contacting the manager. 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: two star good 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: A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 26th March 2009 and included a tour of the premises, discussions with people living in the home and members of staff. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day of the inspection we were given every assistance from the acting manager and staff team Care Homes for Older People Page 6 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 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 Care Homes for Older People Page 7 of 28 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. Through the comprehensive admission process people choosing to live at Howard Court can be confident that their needs will be met. Evidence: The manager stated in the AQAA, All prospective residents undergo a pre-admission assessment to ensure the home can meet any identified need and the placement will be appropriate. A sample of four care plans examined all contained appropriate assessments. The assessments contained very good assessment details using BUPA tickbox sheets. The level of need is indicated and the next action to be taken. The details are sufficient to guide staff to ensure care plans and risk assessments are developed to meet the persons assessed needs. Care Homes for Older People Page 10 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 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 can expect their healthcare needs to be identified and met although they can not be confident that personal care will be delivered consistently as they would wish. Evidence: The manager stated in the AQAA,All residents have comprehensive Personal Care Plans individual to their identified needs. Records examined confirm there are a range of care plans in place that have been developed from the initial assessments. The care plans contain a good level of detail and they are descriptive and informative about the level of support required by the individual. Records examined confirm that care plans are reviewed monthly and updated comments are added. The sample of care plans examined had some variation in the quality of information they contained, but all care plans generally inform staff on how best to support people. Parts of some of the handwritten care plans, however, were not legible and it was difficult to understand some of the instructions. Although overall the care plans were appropriate, some improvements may be necessary to Care Homes for Older People Page 11 of 28 Evidence: ensure they are clear for all staff to understand so that people receive care in a consistent manner. Records examined contained risk assessments that identify the hazard, who might be harmed and how, what further action is necessary to reduce the risk and then identifies the revised risk. The range of risk assessments in place include moving and handling, skin integrity and falls. Records examined contained evidence of input from a range of healthcare professionals. Records are maintained with details of health visits including chiropody, District Nursing services and doctors visits. The manager stated in the AQAA, Any pressure ulcers are recorded. The information is collated within BUPA Care Homes and the information is used to identify trends and inform the purchase of appropriate equipment. On the day of the inspection information relating to processes around pressure areas was discussed with the acting manager. The minutes of a staff meeting were examined, which was held following the recent safeguarding alert relating to pressure sores. The minutes give details of the guidelines to be followed that were discussed with staff at the meeting. The processes include a full body check, identifying appropriate matresses or cushions for anyone at risk and monthly evaluations. All those with any pressure sores to have a relevant care plan and all were to be referred to the Tissue Viability Nurse, all to be reported to the manager, family to be informed, photographs to be taken , dressings changed and recorded. The acting manager said that the processes were now more robust and staff were all aware of their responsibilities in this area. Daily records examined that are completed by staff contained very basic information such as no problems, good/bad day or whether there were any continence issues. Through discussions the acting manager demonstrated an awareness that this is an issue that needs to be progressed. The homes processes around the storage and recording of medication were examined on the day of the inspection. There is a Monitored Dose System (MDS) in use in the home. Storage is in three sets of trolleys, one for each area of the building. Storage was secure, including a controlled drugs cabinet for medications that require this level of security and a fridge for the storage of medication or preparations that need to be kept in controlled temperatures. The storage area was clean and tidy. Medicines Administration Record (MAR) sheets examined were all completed appropriately with no omissions. A member of staff spoken with was able to explain Care Homes for Older People Page 12 of 28 Evidence: the processes followed and gave a good account of the system. During a tour of the premises some good interactions and respectful exchanges between staff and people living in the home were observed. A member of staff setting the tables in the dining room was chatting to service users about the colours of the table cloth and generally trying to engage with them and interest them in the activity. Further evidence of good interactions were seen by some of the staff supporting people to eat lunch (see the section of this report covering Daily Life and Social Activities). The manager stated in the AQAA, Privacy and dignity feature highly in BUPA Care Homes customer service programme, Personal Best. Relatives and visitors spoken with on the day of the inspection said that staff are always respectful. However, one member of staff was observed to be carrying out a personal care procedure without closing the bathroom door. This is unacceptable and the acting manager said that she would deal with the issue and additional training would be put in place for the member of staff concerned. Another member of staff was observed brushing someones hair at the table in the dining room, which is also inappropriate. The National Minimum Standards state that arrangements for personal care ensure that service users privacy and dignity are respected at all times and improvements need to be made in this area. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people living in Howard Court can expect to enjoy a lifestyle that meets their wishes and needs. Evidence: The manager stated in the AQAA, We have a structured activities programme tailored to the individual needs and preferences of our residents. The home has two activity co-ordinators to organise activities on a daily basis. Staff maintain a daily diary sheet that is broken down into hourly slots that are completed with the type of activity and who participates. Records show that there are a range of activities that people enjoy including crafts, bingo, topical chats, shopping, singing and menu planning. There is ample evidence that people enjoy the activities and there are records of comments made by service users. A variety of craft work is displayed on the walls, including a Spring/Easter display. People took part in exercises using reminiscence called What I put in my shopping bag. We observed good interaction between the activities co-ordinator and people living in the home. On the day of the inspection the activities co-ordinator displayed an enthusiastic approach and it was evident that he was good at encouraging and Care Homes for Older People Page 14 of 28 Evidence: motivating people to take part in the activities. We observed that people spent a long time sitting in the dining room during the course of the morning, even when there were no activities going on. Six people sat in wheelchairs for long periods of time and were not asked if they wanted to go to the lounge or sit in a chair. Some people were sleeping at the table. There was pop music playing over the loudspeaker in the dining room. It was observed that some people showed signs of agitation. One person became quite aggressive and a staff member failed to recognise this. The person appeared distressed because they believed thay had not been given tea but staff did not respond with appropriate strategies to reduce the anger or anxiety. One person was crying out and another shouting, moving the tables and banging on the tables. During this time staff were collecting cups, serving tea and others were sitting in the dining room writing notes. Overall the activities co-ordinators are to be commended for the way they organise activities and the effort and enthusiasm they put in. However, some staff need to develop a better understanding of peoples needs around the routines of daily living in between organised activities. The manager stated in the AQAA, A full and varied menu is available in the home. The BUPA Menu Master helps us to ensure the menu meets the nutritional needs of the residents. On the day of the inspection the lunchtime meal was prepared and served up on plates, some with gravy and some without. The plated up meals were named for individual service users, which did not give opportunity for choice. One person asked for some more gravy and was told there was none available. Observations of interactions between members of staff and people in the dining room were variable. Staff sat in on meals to assist where required. Some spoke about the meals whilst others did not speak. We also observed staff supporting people in another room, who were unable to eat independently. The standard of support people were receiving was again variable. One member of staff explained to the person what they were having, which was mince, mashed potato and swede. They got down on the same level as the service user, spoke in a calm manner and gave the person time to eat at their own pace. Another member of staff also displayed good interactions with the person they were Care Homes for Older People Page 15 of 28 Evidence: supporting. However, another member of staff stood over the person putting spoonfuls of food into their mouth without telling them what the food was. Other than occasionally saying loudly is that nice there were no interactions between the member of staff and the person being fed. 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 can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. Evidence: The manager stated in the AQAA, We have a clearly defined company complaints policy with agreed timescales for managing complaints. The information that accompanies the policy is prominently displayed in the home. Relatives and visitors spoken with on the day of the inspection said that they were aware of how to make a complaint should the need arise. The acting manager said that they held a meeting for residents and their relatives in December that addressed issues raised relating to some of the problems that the home had experienced in the previous few months. Through discussions the acting manager was able to demonstrate that there is a need to improve communication and said that they are now aiming to have monthly staff meetings to address the issue of communication. The aim is to improve practices and reduce complaints. The manager stated in the AQAA, BUPA Care homes has robust policies for dealing with allegations of abuse or neglect. Staff can not only raise concern within the home they have access to senior staff outside the home and There are well documented procedures for reporting under POVA should the need arise. Care Homes for Older People Page 17 of 28 Evidence: Since the last inspection there have been a number of safeguarding issues. These were discussed with the acting manager. Some of the issues had not yet been finalised but were being dealt with through the local authoritys safeguarding procedures. Since the last inspection, the previous manager has left the organisation and there is an acting manager in post from one of the other homes in the BUPA group who is filling the gap until the recently appointed new manager takes up the post on 6th April 2009. We discussed the safeguarding issues relating to two residents. The acting manager explained that these are still in the process of being investigated and there have been a lot of meetings including some with BUPA regional managers. One of the issues related to a service user with pressure sores. We discussed action plans that have been put in place to ensure similar situations are not repeated. During the process of the investigation BUPAs policies and procedures were followed. One of the improvements as part of the action plan for improvement was more training for staff, particularly around wound care and products for use in wound management. Clinical practices relating to pressure wound management have improved. The acting manager also explained that all staff went through updated safeguarding training following the investigations. Personnel records confirm that prospective employees undergo a Criminal Record Bureau (CRB) enhanced disclosure before commencing work. There is also now an improved system of auditing practices. BUPA has an audit system called EWAT (Early Warning Audit Tool) that should identify possible issues relating to poor practice or abuse. Areas looked at by the auditor include finances, Health and Safety, medication, personal plans, wound management, Control of Substances Hazardous to Health (COSHH) and the homes fire log. The EWAT process looks at 10 per cent of residents files on 10 per cent of medication records on a monthly basis. 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. People can enjoy living in an environment that suits their lifestyle and which is well maintained and clean. Evidence: As previously reported, Howard Court is a large, older style, spacious building which is maintained to a satisfactory standard of repair. Communal areas include two lounges and a large centrally sited dining room. On the day of the inspection we observed that many of the residents spent a lot of time in the dining room. The home has 26 single bedrooms and 7 shared rooms. There are en-suite facilities in 17 of the single rooms and four of the shared rooms. Overall the home was seen to be maintained to a reasonable standard and furnishings were of good quality. The manager stated in the AQAA, We encourage the personalisation of residents individual space with their personal belongings. The standard of decor in peoples individual bedrooms was variable. Some people had ample evidence of personal possessions and their rooms were homely and comfortable whilst other rooms appeared sparse and had little to personalise them. Outside each individual room there is a memory box mounted on the wall containing objects that are relevant to the individual, such as pictures or small objects that represent something that interests the person. Again the quality of the contents was variable and those who had relatives who were involved and supportive were much better. Some had little or Care Homes for Older People Page 19 of 28 Evidence: nothing in the memory box and more effort could be made to make these more relevant to the individuals. The manager stated in the AQAA, We use a specialist microfibre cleaning system that combined with effective cleaning regimes keep the home clean and odour free. On the day of the inspection, overall the home was found to be clean and there were no unacceptable malodours. 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. Improvements to staff practices are necessary if people living in the home are to be confident they are cared for by a competent staff team who can meet their needs. Evidence: On the day of the inspection the number of members of staff on duty was observed to be appropriate to meet the needs of people living in the home. Overall peoples needs were being attended to without undue delay. Information provided on the day of the inspection confirmed that out of a total of 21 care staff, five have obtained a National Vocational Qualification (NVQ) at level 2 and two people are in the process of doing the award. In addition two catering staff have an NVQ award. These numbers fall short of the 50 per cent of care staff with an NVQ qualification as recommended in the National Minimum Standards. During discussions the acting manager recognised that this is an area where further progress needs to be made. In response to what the home could do better, the manager stated in the AQAA, Encourage more staff to complete NVQ training. A sample of personnel records examined contained all the documentation required by regulation. These include BUPA application forms completed appropriately with relevant information, proofs of identity and two written references. Qualified nursing staff have their Nursing and Midwifery Council Personal Identification Numbers on Care Homes for Older People Page 21 of 28 Evidence: record. Staff have a Criminal Record Bureau enhanced disclosure carried out before commencing employment. New staff receive a BUPA Working Guide so that they understand their responsibilities. The manager stated in the AQAA, We perform appropriate CRB, POVA and NMC pin checks for staff. Since the safeguarding issues all staff have received safeguarding training, previously referred to as Protection of Vulnerable Adults or POVA. Personnel records confirm that prospective employees undergo a Criminal Record Bureau (CRB) check before commencing work. One of the improvements as part of the action plan for improvement was more training for staff, particularly around wound care and products for use in wound management. Clinical practices relating to pressure wound management have improved. The manager stated in the AQAA, There is a training matrix specific to the home that identifies the training requirements of the staff. Through discussions the acting manager explained about the range of training provided by BUPA. All staff have completed Infection Control training that consisted of a three month distance learning course using a DVD and completing a workbook. Manual handling training is arranged yearly and is due to be updated in April. The manager said that all staff need to have updated COSHH (Control of Substances Hazardous to Health) training and this is to be arranged. Personnel records examined contained evidence of training around Basic Food Hygiene, Understanding Dementia (A Self Learning Pack), Moving and Handling, Infection Control and Fire Training. Staff have had dementia training that included BUPAs Understanding Dementia course and a course on Alzheimers. Records also confirm that staff have received training around Managing Challenging Behaviour. However, evidence presented in the sections of this report relating to Health and Personal Care and Daily Life and Social Activities indicate that not all staff have a good understanding of managing difficult behaviours appropriately or of what constitutes good interactions with people who have dementia. 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 is appropriately managed in the best interests of people living there. Evidence: Since the last inspection the manager has left and the deputy manager from one of the other BUPA homes in the area has been running the home until a new manager is in post. The acting manager explained that a new manager has been appointed and will be starting within a few weeks. Through discussions, the acting manager was able to demonstrate a good awareness of the action plan for improvements following the safeguarding issues that had arisen in the previous twelve months. It was evident that there were systems in place that had not been followed and there have now been improvements in a number of areas including staff supervision. We examined the minutes of a staff meeting where information relating to pressure sores was discussed and more robust processes are now in place for monitoring and Care Homes for Older People Page 23 of 28 Evidence: dealing with potential problems promptly. The acting manager explained that more regular staff meetings are now taking place to ensure staff communicate better and practices will improve. A sample of personnel records examined all contained supervision monitoring notes. The supervision process in place has improved in the past few months and regular staff supervisions are now taking place. However, some additional progress needs to be made in ensuring all staff are consistent in following good practices (see evidence in Staffing section of this report). The manager stated in the AQAA, BUPA Care Homes has an annual customer satisfaction survey. As reported at previous inspections, BUPA continues to have a comprehensive system for quality assurance in its homes which includes asking service users and their relatives to complete surveys. The manager stated in the AQAA that they have, Regular Health and Safety meetings with a standardised agenda giving staff the opportunity to communicate on Health and Safety issues. The minutes from these meetings go to the regional manager. Since the last inspection the home has had an inspection from Environmental Health, which raised a few minor issues that have now been actioned. There are a number of risk assessments in place relating to Health and Safety issues including Intruders, Use of Lifting Equipment, Bathrooms and Safe Bathing, Use of Wheelchairs, General Cleaning, Control of Substances Hazardous to Health (COSHH) and Use of Evacuation Aids. A sample of Health and Safety documentation was examined and found to be in order and well maintained. This included Gas Safety Certificate, maintenance of the lift and maintenance of lifting and moving equipment. There is a Public Liability Insurance certificate in place. 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 11 12 Staff must ensure that bathroom doors are closed when personal care is carried out This would ensure that the privacy and dignity of service users is respected. 28/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 Staff should ensure that people are supported to relax when not taking part in stimulating activities and should not be left sleeping at tables in the dining room. All staff should be aware of good practices around supporting people who are unable to eat without assistance. More staff should be supported to achieve National Vocational Qualifications. Well qualified staff will have a greater awareness of good practices and people living in the home will benefit from better support. The effectiveness of staff training in place should be reassessed. Staff should receive training that ensures that they understand peoples specific needs around dementia Page 26 of 28 2 15 3 28 4 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and manageing challenging behaviour. 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. 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. 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