Inspection on 22/02/10 for Madeleine House

This inspection was carried out on 22nd February 2010.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Madeleine House 09/11/09

Madeleine House 19/10/09

Madeleine House 26/08/09

Madeleine House 24/06/09

Madeleine House 11/07/07

Madeleine House 24/08/06

Madeleine House 23/11/05

Madeleine House 05/05/05

Madeleine House 10/12/04

Madeleine House 09/06/04

Madeleine House 20/11/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Madeleine House 60 Manor Road Stechford Birmingham West Midlands B33 8EJ     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: Sue Scully     Date: 2 2 0 2 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: Madeleine House 60 Manor Road Stechford Birmingham West Midlands B33 8EJ 01217861479 01217850621 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.anchor.org.uk Anchor Trust Name of registered manager (if applicable) Mrs Linda Jayne Bryant Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 41 Physical disability - over 65 years of age (PD(E)) 41 Dementia (DE) 10 Date of last inspection Brief description of the care home Madeleine House is registered to provide residential care for up to 41 residents who are over 65 years of age and require assistance for reason of old age and physical Care Homes for Older People Page 4 of 28 Over 65 0 41 41 10 0 0 0 9 1 1 2 0 0 9 Brief description of the care home disability. This includes ten residents who can be accommodated for reasons of dementia care. The Home is owned and managed by Anchor Trust. It is a modern two storey building set back off the road in its own grounds with adequate off road parking to the front of the building. It is well maintained internally and externally and is run as one unit. 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: The focus of inspections undertaken by the care quality commission (CQC) is upon outcomes for the people who use the service. This means they tell us if the agency is meeting their needs and if the agency is flexible to enable them to maintain their independence. We also assess the homes capacity to meet regulatory requirements, minimum standards of practice and focus on areas that need further development. As part of the inspection we involve people using the service, by this we mean we talk to people about their experiences of the service provided. We involve staff, management and other social care professionals to seek their views about the service. Comments that have been made are included in the main body of the report. We also discuss peoples care and look at care files focusing on outcomes. In addition to this, information is looked at during inspections such as policies and procedures, and the general operation of the home in relation to meeting peoples needs. Care Homes for Older People Page 6 of 28 The manager assisted us throughout the inspection which was completed over one day by two inspectors. Two complaints had been received before the inspection which as part of the inspection process we sampled records relating to the concerns raised information is contained in the main body 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: The home must ensure that information from the pre admission assessments is transfered in to peoples individual care plans so their needs can be met in full. Care plans need to identify when needs have changed and these must be updated to ensure staff have the information they need to look after people safely. Risk management plans must detail action staff take to minimise the risk to the individual and identify if the risk management plan are working . This will ensure alternative arrangements are made if the risk does not. The homes needs to complete an assessment of the dependence of people living in the home to see if the staffing levels are adequate to meet peoples needs. A risk assessment plan must be completed for the one person identified during the visit. This will ensure this person is kept safe. The current manager needs to take a more proactive approach to ensure when tasks have been delegated that they are completed satisfactorily. Care Homes for Older People Page 8 of 28 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. Peoples needs are assessed before they are admitted to the home, and have the opportunity to visit if they choose. Evidence: People are visited by a senior member of staff to collect information about the persons care needs whether they are in hospital or in their own home. People and their representatives have the opportunity to visit the home to help inform their choice about whether the home will suit them. Part of this assessment is to determine if the person is willing to stay in the home and this ensures the home is not depriving anyone of their liberty. We looked at the information collected for one person before they were admitted to the home. There had only been one person admitted since our last inspection. The home has its own pre-admission assessment form which is added to by a baseline assessment completed within a number of hours of admission. Not all the written Care Homes for Older People Page 11 of 28 Evidence: information collected is used to develop the care plan for example a person that had specific night time arrangements explained in the assessment did not have this information in their care plan. This means this information was lost and unless the care staff looked at the pre admission assessment would not know this information so this need was not met. The manager needs to ensure the information in the pre assessments is transferred into a care plan. 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. Peoples care records do not always reflect the care given. People can be assured that their medication will be given safely and has prescribed. Evidence: We looked at four care files, which included medical information, risk management and the daily needs of the people using the service. While there had been some improvements in the recording of information there were still gaps that would mean not all the peoples needs were being met. For example, one person had lost weight over a period of two months. While the home was recording this information it was not until the request from the individual that medical attention was sought. This was 2 days after the request was made. Another file said the person was suffering with severe headaches, they had a medical condition that would cause the headaches, however the home had not sought professional help to manage pain relief for the individual. Risk management plans do not show the triggers to peoples challenging behaviour. For example one person may shout at staff and become confrontational, the risk assessment says staff are to reassure them and give them time calm down. Care Homes for Older People Page 13 of 28 Evidence: The plan does not say what to do if this does not work. For one person information was recorded over three monitoring tools which gave a fractured record of what was a significant series of events. We looked at the communication records. This is where team leaders discuss issues or concerns before the next team leader takes over each day. We then crossed referenced the recordings with information in peoples care plan, alert sheets, and medical records. We found an incident where a relative had asked for a message to be passed on to a person living in the home, staff had decided against passing on this information depriving them of information about when their relative would be visiting. We found records about people becoming aggressive and about a change in medication administration. There was no follow up action or clear recoding of this on the care files. We spoke with the acting manager about the issues recorded in the communication records and suggested that she randomly samples the information records in care plan, medical records, communication records to ensure that information or concerns are not lost and staff are taking an active approach to meet peoples needs. A comment from one person using the service expressed that sometimes they feel staff are rushed as they go about their work and that they should Give the more elderly and more disabled people a little more understanding of how they might be feeling when they are more or less dependent on the staff for nearly everything in their lives. We looked at the medication storage, stocks of medication and the records for four people. The medication was stored securely in the medication room and at the right temperature. Copies of the current prescription are kept and this helps to ensure that the medication dispensed from the chemist is as prescribed. In front of the medication administration records (MAR) there is a photograph of the person and this is an extra check to ensure the right medication is given to the right person. Generally medication is given appropriately and there were few mistakes found on the MAR and the amount of medication left was correct. We found that better checks were needed for people who manage their own medication. This included a food supplement for one person and an emergency medication for another. We also suggested that where people have more than one medication to be given as required that the protocols for their administration should be individual to each drug for clarity. Observation showed us the staff interaction with people living in the home was respectful and peoples dignity was maintained. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot always be assured that activities are available to meet their need and interest. Meals are well presented with a variety of choices being available which meets the dietary needs of the people who currently use the service. Evidence: Since the last inspection the home has employed a new activities coordinator so people living in the home can take part in activities if they choose. Some activities have taken place such as a fire works display, and a 50s music night, but this information was obtained from the comments book the home uses for visitor and family. The care records did not contain information about each individual so we were unable to complete an accurate audit. The manager told us that the activity coordinator will speak to each person and their families to find out what activity each person likes to do. The activity coordinator needs to ensure when activities take place the information is Care Homes for Older People Page 15 of 28 Evidence: recorded so they can see how successful the activity has been. One person told us that they used to listen to folk music, however she had no music in her bedroom and no one had asked her what she would like. People told us that their families are made welcome and we observed several visitors throughout the day. People living in the home are able to choose food they enjoy and meals were well presented on the day of the visit. One person said The meals are lovely well cooked like I use to cook food. Observations of the meal time showed that staff ask people what they want and help people appropriately when needed. Some people have meals in their room and one person does not always eat their meals, staff told us that they check at meal times to see if the person has eaten, but they do not record this they tell the team leaders. Another person had lost weight, the home was weighing the person monthly but it was not until the person requested the Doctor that any action was taken (See standard 7. Another person has meal replacements in addition to meals but there was no confirmation of how this is monitored. (See standards 9) 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 who use the service are able to express their concerns and have access to the homes complaints procedure. People are protected by the homes polices and procedure in the event of any concerns being identified in relation to abuse. Evidence: The home has a complaint procedure that is displayed in the entrance to the home. The home has a complaint book and compliment book where people can record their findings of their visit to the home. Since the last inspection the recording of complaints and issues of concerns has improved. The complaints record includes the concerns, when it was received and what action was taken. We received two complaints before the inspection regarding staffing levels at the home. (See standard 27) The home had received some compliments and these include: The old 50s music went down really well instead of the TV We appreciate you are trying to improve standards. A great night lovely food fire works really enjoyed it. Care Homes for Older People Page 17 of 28 Evidence: Communication of and detailed review reflecting the new approach to be taken as discussed at the relative meeting I would like to compliment the lovely establishment all staff are so pleasant and helpful and the new decoration and crockery in the dining room is lovely. The meetings being held in respect of safeguarding are still current and will not be disclosed in the report. The reporting of accidents have improved, there are clear records and the home keeps us informed. There are still a number of falls happening in the home and the manager needs to look at ways of managing and monitoring these more often to see if there is a pattern and taking appropriate action if required. Training records showed us that staff had undertaken training in the safeguarding of vulnerable people. This means staff are aware of what to do in the event of concerns about individuals. 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. People live in a home that provides a physical environment that is clean and maintained. The environment does not fully support people with dementia or peoples needs that may challenge the service. Evidence: Since the last inspection the home has employed a person to oversee the hospitality of the home (See standard 1). We looked at peoples bedrooms and walked around the home, which was clean and fresh. Peoples bedrooms were personalised and most people spoken with were happy with their bedroom and the home in general. We observed one person sitting in a recliner chair, however this person was unable to get out of the chair and when they tried the chair tipped forward. The manager was informed and a request for a risk assessment to be undertaken was made. Communal lounges were clean and the home had added information to corridors such as staff photos and up coming activities. Some people who live in the home do not go into the communal areas and stay in their rooms, records sampled did not show how this is monitored and there is a risk that people may have an accident and staff would be unaware for some time. When we spoke with the staff team they told us that they Care Homes for Older People Page 19 of 28 Evidence: do look in on people during day. However there is no record to say when the person was last seen by staff which needs to be addressed and included in peoples risk management plans. We were informed that the home had consulted with their dementia lead so the environment becomes more dementia friendly 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. Recruitment procedures ensure that suitability people are employed to look after people living in the home. People can be assured that staff have been trained in the safeguarding of vulnerable people which means the staff have the information to keep people safe. Evidence: since the last inspection we had received two complaints about the number of staff looking after people on a daily basis. Concerns were raised that there was not enough staff to meet all of peoples needs of the people living in the home had. The concern was that the staffing level did not taken account of how people needs vary. For example some people need a lot of physical help, others need a lot of time to prompt them to do personal care and others are more independent. Although the staffing levels had been increased at the last inspection, the numbers of staff had decreased at this inspection. We appreciate that the numbers of people had reduced but our concern is that the increase in team leaders time appear to be taken off the amount of care assistants available to people living in the home. We intend to ask for assurance that as the number of people living in the home increase so will the staffing levels. With the reduced number of people living in the home the rotas told us on occasions Care Homes for Older People Page 21 of 28 Evidence: there were two team leaders and three care staff on duty. In addition to this the home uses agency staff although they do try and use the same people but it is not always possible. This means that staff were also having to show new staff how to support people. We suggested at the last inspection that the manager undertakes an assessment of peoples dependence level so the home can be sure they have adequate staff to meet people needs. This exercise has not yet been undertaken. The home however has undertaken a recruitment drive and expect people to commence employment once all the necessary information has been obtained. In addition to this the home has now employed a care manager to oversee the care on a daily basis and a new post called hospitality coordinator who will manage the cleanliness of the environment and ensure that the home is welcoming. We looked at training records which showed us staff had received additional training since the last inspection. All team leaders have undertaken training in the safe administration of medication. Care staff have undertaken training in dementia, first aid, up dated manual handling training, infection control, food hygiene and had further training in dementia care. Staff spoken with told us that the home was a lot better then before and training was more available. From information received we were aware that 13-14 people who live in the home stay in their room each day and some people were concerned with providing an appropriate service to the people living in the home. For example, comments sometimes its crazy here and you dont get to do all the things people want, such as baths or one to ones other times its really quiet and you can spend more time with people. We are working better as a team, and the communication is better, although the care plans dont always tell you every thing you need to know. Recruitment records seen showed us that the home ensures people are suitable to work with vulnerable adults by undertaking thorough checks before the person commences employment. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear lines of accountability within the management team ensure peoples need are consistently met. People can be assured that staff are appropriately supervised. Evidence: The current business manager has applied to become the registered manager with the Care Quality Commission. This will ensure there are clear lines of responsibility and easy the process of re registration. Although there have been some improvements in the home there needs to be further auditing of records. This will ensure information is recorded to show how peoples needs are being met. In addition improvements are needed in how staff monitor and review peoples needs when their needs have changed. This is demonstrated throughout the report. Care Homes for Older People Page 23 of 28 Evidence: The manager needs to be more proactive and periodically check information of what staff are recording about people so as to ensure the findings of this inspection are not repeated. (See standard 7). This will mean the manager has full knowledge of how staff are supporting people and take appropriate steps when information has been lost by staff not following up issues of concerns. We sampled the accounts of peoples money at the last inspection which showed that adequate records were maintained. We did not reassess this standard at this inspection. Health and safety arrangements in the home,such as testing of equipment, maintenance records, and manual handling equipment continue to be monitored to ensure people live in a safe environment. The records relating to accidents have improved and the home tells us of any falls, accidents or concerns. However peoples care plans do not show how these are monitored. For example if a person has repeated falls there is no information in care plans to see if it is at certain times of the day or night or whether the falls clinic has been involved. We looked at the staff files which showed us that staff had been supervised regularly since the last inspection. Staff told us that this has helped with their own care practices and they felt more supported. 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 30 18 Training undertaken by staff 25/09/2009 must be monitored to ensure what staff have understood is put into practice. Not assessed at this inspection 19/10/09 This will ensure staff professional development and mean safe working practices at all times. 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 14 Peoples records must show how peoples needs are being met, reviewed and monitored. This will ensure peoples health and welfare is maintained and action taken immediately should any concerns be noted. 30/04/2010 2 7 13 A risk management plan must be in put in place for the one person identified during the visit whose chair tipped when they tried to stand up. This will ensure they are kept safe. 31/03/2010 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 1 3 The manager should ensure that all the information Page 26 of 28 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 available at the pre admission assessment has been transfered into the persons care plan, where gaps appear then instructions should be given to include the information. This will ensure all of the peoples needs are met. 2 12 The home should ensure that records show what activities peoples take part in and have extensive knowledge about peoples social activities and past life experiences. There needs to be specific activities for people with dementia that helps to stimulate them. It is recommended that the home review the staffing levels in the home having listened to what staff are saying about not being able to meet peoples needs. The registered person should take a more proactive approach to ensuring records are maintained and action is taken at the appropriate time. This will ensure people get assistance in a timely manner. The current manager needs to ensure random checks are made where tasks have been delegated to ensure they have been completed satisfactorily. 3 27 4 31 5 33 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). 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. 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!