Inspection on 02/07/09 for Merrie Meade

This inspection was carried out on 2nd July 2009.

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

Other inspections for this house

Merrie Meade 15/12/09

Merrie Meade 13/10/09

Merrie Meade 09/07/08

Merrie Meade 18/07/07

Merrie Meade 16/06/06

Merrie Meade 20/10/05

Merrie Meade 05/04/05

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Merrie Meade 3 Watergate Road Newport Isle Of Wight PO30 1XN     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: Janet Ktomi     Date: 0 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Merrie Meade 3 Watergate Road Newport Isle Of Wight PO30 1XN 01983520299 01983520299 merrymeade@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Merrie Meade Residential Home Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 31 The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Merrie Meade is a registered residential home and provides long stay care and accommodation for older people with mental frailty and illness associated with dementia and long-term care/support and accommodation for younger adults with mental health needs. The older people are cared for in the purpose built extension, which provides a suitable environment for their care needs. The younger people are accommodated in the main building. Merrie Meade is a large detached two-storey property with a two-storey extension, set in reasonable sized grounds with a Care Homes for Older People Page 4 of 40 Over 65 0 0 31 31 Brief description of the care home summerhouse and two storage sheds, one of which is available for use by people who live at the home. The home is located on the outskirts of Newport within walking distance of the town centre shops and amenities. There is off road car parking to the front. Residents accommodation is provided on both floors. All but two bedrooms are for single occupancy, many have en-suite facilities. Separate communal facilities are provided for each service user group. There is a lift in the extension to provide access to the first floor. There is also ramped access into the garden leading from a side entrance of the ground floor. The home is owned by Merrie Mead Residential Home Ltd and managed by Ms Janice Gibson. Care Homes for Older People Page 5 of 40 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: This report contains information gained prior to and during an unannounced visit to the home undertaken on the 2nd June 2009. All core standards and a number of additional standards were assessed. Compliance with the four requirements made following the previous inspection was also reviewed. The home was previously inspected in July 2008. The visit to the home was undertaken by two inspectors and lasted approximately six hours commencing at 11.30am and being completed at 6.30pm. The inspectors were able to spend time with the staff on duty and were provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the registered manager completed an Annual Quality Assurance Questionnaire (AQAA), information from which is included in this report. Information was also gained from the notifications of incidents in the home and from Care Homes for Older People Page 6 of 40 safeguarding investigations being undertaken by the Isle of Wight Social Services. During the visit to the home the inspector was able to meet with and talk to people who live at the home, the registered manager and staff on duty. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: Two requirements are repeated from the previous inspection. The homes failure to comply with these requirements has meant that people have continued to be placed at risk. The registered manager was required to have the necessary qualifications for managing the care home by January 2009. The registered manager stated that the provider would not agree to fund the Registered Managers Award and she had therefore not been able to achieve this. The registered manager stated that she had now registered for leadership and management in care award however she has not commenced this and it is still not clear if the provider has agreed to fund this. The registered managers continuing failure to have the necessary qualifications to manage the service is continuing to place people at risk. The home was also required following the previous inspection to ensure that all staff undertake mandatory and service specific training to ensure that they have the necessary skills to meet the needs of people living there. The registered manager stated that the provider has not allocated a training budget and therefore she has been unable to ensure that staff received all the necessary training. The registered manager has now booked staff on training and requested invoices to be sent to the provider. Care Homes for Older People Page 8 of 40 This requirement has not yet been met and people are therefore being cared for by staff who do not have the necessary skills and training to ensure that all their needs can be safely and fully met. People are therefore continuing to be placed at risk. The responsible person must ensure that people receive a nutritional intake that is suitable for their needs and provided at regular intervals. Unless people have clearly stated that they do not want a meal then one must be prepared for them. People in the younger adults part of the home must complete a menu to confirm that they want a meal and if they do not then no meal is prepared for them. People who forget to complete the menu therefore do not get a main meal. This issue was also referred to the Isle of Wight Safeguarding team for consideration with the ongoing safeguarding investigation at the home. The responsible person must ensure that all people living at the home have the opportunity to join in a programme of activities arranged by or on behalf of the home to provide mental and physical stimulation and enjoyment. People must be consulted about what activities they wish to have available. The younger adults were enjoying a range of activities but this was not the case for the older people living at the home. The lack of stimulating activities places people at risk that their mental and physical health will deteriorate. The responsible person must ensure that a visit to the home to assess the quality of the service provided is undertaken every month. A report of the visit must be provided to the registered manager. These visits are called regulation 26 visits. These have not been occurring and therefore the provider has not been ensuring the quality of the service people are receiving placing them at risk. It was apparent during the inspection visit and from information from the safeguarding team that the relationship between the registered manager and the provider has broken down such that they are no longer talking to each other and are not working together to address the safeguarding concerns or the requirements that have been made. The failure of the registered people to work together is placing people at significant risk. The safeguarding team have stated that people living at the home and staff are being negatively affected by this situation. The registered manager and the provider must ensure that they have a positive working relationship and that they are working together to ensure that people living at the home are not at risk. 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 40 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 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider has failed to inform the registered manager that she has voluntarily agreed not to admit new people whilst a safeguarding investigation is being undertaken by Isle of Wight Social Services. The homes statement of purpose and service users guide does not fully inform people about the service they can expect to receive. All people who have been admitted to the home have been assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. Care Homes for Older People Page 11 of 40 Evidence: The registered manager explained the homes admission procedure and the preadmission assessments for people living in both parts of the home who had been admitted shortly before the inspection visit were viewed. The inspectors discussed admissions with care staff and with some people who live at the home. The service users guide and other information available to prospective service users or their relatives was discussed with the registered manager. Information in staff and service user comment cards is also considered. The registered manager informed us that she was in the process of updating the Statement of Purpose and the Service User Guide to reflect the current service provided in the home. She is planning to produce one Statement of Purpose and two separate Service User Guides; one for the service provided to older people and one for the service provided for younger adults. Seven comment cards were received from people who live at the home, four stated that they had had enough information about the home before they moved in and three that they had not. The commission had written to the provider in June 2009 requesting that the home voluntarily agree not to admit people to the home during a safeguarding investigation being undertaken by the Isle of Wight social services department. The provider had responded to the commission on the 25th June 2009 confirming that the home would not be admitting new people and stated that they had instructed the registered manager not to admit new people. The registered manager was unaware of this when the home was inspected on the 2nd July 2009 and stated that the provider had not informed her that the home should not be admitting new people. The registered manager stated that if an initial inquiry from either social services or from a person or their family indicates that the home would be able to meet the persons needs the home will invite the person or their relatives to visit the home to view the facilities and room available and arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where appropriate members of the persons family and professionals involved in their care. Copies of social services assessments were seen in care plan files viewed. The registered manager explained the homes admission procedure and was clear about the level of care needs the home can accommodate. We looked at the files of five older people who use the service and found that they had pre-admission assessments in place that were dated prior to the date that they moved into the home. This showed that peoples needs were assessed before the home offered them a service. Care Homes for Older People Page 12 of 40 Evidence: Pre-admission assessments were also viewed in the younger adults part of the home and admissions were discussed with people who live in the younger adults section of the home. People in the younger adults confirmed that prospective service users for that part of the home are able to visit the home prior to moving in. People also confirmed that the manager has met with them prior to moving in. Care plans for people in the younger adults section of the home contained social service care manager assessments and pre-admission assessments completed by the manager. Care staff stated that they generally had sufficient information about new people. Five staff completed comment cards and stated that they always (2), usually (2) and sometimes (1) had enough information about the needs of the people they care for. When they did not have sufficient information they felt that this was due to the manager not being given the information by health staff or relatives, this means that peoples needs may not be met. The service can provide respite, short stay or day care within the older persons part of the home if a suitable bedroom is available. The home does not provide an intermediate care service. Care Homes for Older People Page 13 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which a person receives, are based on their individual needs. Medication is stored correctly. People are treated with respect and their dignity and privacy is maintained although this could be improved for the younger adults with the provision of walk in shower facilities to promote independence and people should not be denied meals if they have failed to order them. Evidence: Seven care plans were viewed, two for people living in the younger adults part of the home and five for people in the older persons part of the home. The people whose care plans were viewed had been living at the home for varying lengths of time. The inspector discussed with staff and people who live at the home how care needs are met. The arrangements for the storage, administration and records relating to medication were viewed. Information in the homes AQAA and from safeguarding investigations and comment cards received are also considered. Although a requirement was not made about care plans following the previous inspection undertaken in June 2008 the report noted that the care plans in the Care Homes for Older People Page 14 of 40 Evidence: younger persons part of the home contained more detail than the older persons care plans and that one persons care plan and risk assessments had not been updated following a significant change in their care needs. A safeguarding investigation was undertaken in November 2008 and this identified that care plans were not consistent or up to date and had omissions such as body maps. A further safeguarding investigation is currently occurring and this has identified that in March 2009 a persons care plan contained no mention of moving and handling equipment, weights had not been completed and there was no reference to a special diet a person should be receiving. We looked at the files for five older people living in the home. These showed that each person had a care plan in place which related to the needs identified in their preadmission assessment and included further needs highlighted during the time the person had lived in the home. Care plans described the care and support each person needed and were all reviewed on a monthly basis. Comment cards from three older people added comments that the home does well with looking after the weaker ones, good care. Within the care plans there were risk assessments that were clearly written identifying potential risks and describing what measures needed to taken in order to reduce the risk occurring. These were also reviewed on a monthly basis. From observation on the day of the inspection visit we found that staff working in the home supported service users according to the care plans and risk assessments. This showed that staff were aware of the plans and risks assessments for each person they were supporting. Three older people completed comment cards and stated that they always (2) and usually (1) receive the care and support they need. Care plans also contained nutritional assessment plans, which had recently been introduced into the home. These identified the dietary requirements of people living in the home and described what support they required in ensuring that their nutritional needs were addressed. The home had also recently introduced pressure care assessments which identified where there may be some risk of people developing pressure wounds. We also found evidence in peoples files that issues identified in these assessments had been followed up with actions such as purchasing equipment necessary for relieving pressure. Service users files also contained good personal histories of the people living in the home. These had been completed in liaison with the service users families. In Care Homes for Older People Page 15 of 40 Evidence: discussion with staff it was clear that they were fully aware of peoples personal histories and were able to use the information contained in them to understand service users backgrounds and were able to use the information in initiating discussions with them. The registered manager informed us that she was in the process of making improvements to the care planning format and that in future the same format for care plans in the younger persons part of the home would be extend to the older peoples care plans. Two care plans were viewed for people living in the younger adults part of the home. These were in an activities of daily living format and covered all the necessary areas for staff to be aware of peoples needs. Risk assessments were also seen in care plans as well as information about how peoples health care needs were being met. In one care plan viewed the pre-admission assessment detailed that the person required an eye test however there was no evidence that this had been undertaken. This was discussed with the registered manager who stated that the person had declined an eye test. This had not been recorded in the persons care plan and there was no indication as to what the home intended to do to encourage the person to have an eye test or why they had refused this. Information and risk assessments viewed had been reviewed on a three monthly basis and updated where necessary. Correspondence and records in other service users files showed that health care needs were monitored on a regular basis and that, where needs had been identified, people were supported to access health care services. Records were also kept on file of any visits to health care services and these records identified the reason for the visit and the outcome, together with any follow up action staff in the home needed to take. At the previous inspection concerns were raised about the lack of records to demonstrate that staff in the home were regularly monitoring the weight of people living there. At this inspection we found that peoples weight was being monitored on a monthly basis and that records were kept in order to demonstrate this and to identify any concerns about fluctuations in weight. However, the records showed that only seven of the eleven older people in the home were having their weight monitored. The registered manager confirmed this and told us the reason for this was that the home did not have the equipment to weigh the other four people. This puts people at risk of not having their weight monitored to identify and respond to any changing health care needs. Care Homes for Older People Page 16 of 40 Evidence: Following the previous inspection a requirement was made that medication must not be given in an altered format unless the persons individual GP has agreed to this and that clear instructions are provided and followed to protect people receiving medications. The registered manager stated that she has requested written consent from peoples relatives where service users are unable to swallow tablets such that care staff may crush the medication. following the inspection the registered manager provided additonal evidence to show that GPs had agreed to medication being given in an altered format (crushed). In other respects there were no concerns identified with the homes management of medication with all medication stored correctly and full records maintained. Most staff have completed medications training with information provided by the manager showing that only two staff have not undertaken medications training. Staff spoken with during the inspection confirmed that they had undertaken medications training. As part of the safeguarding investigation a lead health professional has stated that the medication systems were working well. Safeguarding investigations raised concerns about staff training in the use of manual handling equipment and in March 2009 only one staff member had an in date manual handling certificate with five others having certificates that had expired in 2008. All other staff employed at the home had not undertaken manual handling training. The issue of staff training is covered in the staffing section of this report however at the time of the inspection the manager stated that all staff have now completed manual handling training. People living in the younger adults part of the home raised no concerns about privacy and dignity stating that staff respected their privacy. Care staff in the younger adults part of the home stated that the privacy and independence of people living in the younger adults part of the home could be improved if the bathing facilities in that part of the home were modernised and a walk in shower made available. This would enable people to shower without support allowing them to shower when they wish without having to wait for staff availability to assist with bathing. At present the younger adults have access to a shower that is situated over a bath and require support to ensure their safety when stepping into the bath. With one exception all bedrooms are for single occupancy and the two people who share a room have previous informed the inspector that they were happy to do so. Peoples dignity and wellbeing has also been compromised by the procedures in place in respect of meals for the younger adults. The inspectors reported to the local safeguarding team that if a younger adult does not tick the menu list before 10.30 am Care Homes for Older People Page 17 of 40 Evidence: then they do not get a lunchtime meal. The inspector noted in a care plan daily record that a person who usually has a lunchtime meal had not had a meal the day prior to the inspection as they had failed to tick the menu list. People who live in the younger adults part of the home explained the process to the inspector and showed the inspector the menu list in the homes hallway, the list being placed up on the afternoon of the day prior to the menus day. The registered manager stated that the person who had forgotten to tick the list was probably given a sandwich however there was no evidence that they had received any food. If people tick the list and are not present in the home at the time of the meal then it is plated and saved for their return. The fact that some people may forget to tick the menu and that staff would not remind them and they would then not get a main meal places people at risk of not having their nutritional needs met. There are people living in the younger adults part of the home who require a special diet on medical grounds, it was not clear if the rule for ticking the menu would also apply to them and if so could compromise their health. Care Homes for Older People Page 18 of 40 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. Activities and lifestyles for the younger adults are varied and flexible however for the older people there are few activities and stimulation placing them at risk of further mental deterioration. Visitors are welcome at all reasonable times. People are encouraged to make decisions and choices in some aspects of their lives. The home is now more aware of peoples nutritional needs, however the quality of meals is variable and people in the younger persons part of the home may not receive meals if they forget to order them placing them at risk of being hungry and malnourished. Evidence: The inspectors spent time talking with people and observed part of the lunch time meal. The inspectors discussed activities with people who live at the home and viewed information about activities undertaken in daily records and related information in care plans and pre-admission assessments. Information in the homes AQAA is also considered. The registered manager stated in the AQAA that an activities manager has been appointed and this has been a catalyst to develop service users to fulfill their potential, and that people are now accessing a range of in-house and external activities including further education. The three older people who completed comment Care Homes for Older People Page 19 of 40 Evidence: cards stated that the home sometimes arranges activities that they can take part in. The younger adults stated that they could always (2) and usually (2) make decisions about what they do each day. The previous report identified that there had been an increase in activities for the younger adults but that the older people had very few activities. One older person stated that the home could do better in respect of entertainment on their comment card. Care staff comment cards also identified that the home could do better to provide more activities for service users. Although the older peoples care plans contained extensive information on peoples personal histories and the pre-admission assessments contained information about individual interests there was a lack of planned activity for the older people living in the home. There were occasions where people from outside the home would come in to provide hymn singing sessions, but no programme of planned activities. In discussion, the registered manager acknowledged that there was a lack of stimulation for the older people living in the home. Staff working in the home appeared to work very hard, but a lot of their time was taken up with providing personal care and ensuring that people living in the home had enough to eat and drink during the day. The registered manager informed us that she was in the process of arranging for the activities coordinator who worked with the younger people in the home to begin to spend time with the older people in order to develop activities that may be suitable for them. Despite the lack of planned activities and other pressures on their time, staff in the home did try to provide stimulation for people throughout the day through discussion and by using their lunch breaks to support people to go out into the garden. However the lack of planned and regular activities is failing to meet peoples social needs and does not provide enough mental stimulation placing people at risk of further mental deterioration. Staff also commented on the activities provided at the home stating for years we have asked to be able to plan an outing, but have been told that the proprietor will not fund this. I feel that a budget is needed for this type of thing, as it would benefit those who would be able to go out. The younger adults have benefited from the appointment of the activities manager and are now more occupied and engaged in a range of external activities including continuing education and pursuing individual interests such as fishing. Daily records in care plans for the younger adults contained information about how they had spent their time. People the inspectors spoke with stated that they could come and go as Care Homes for Older People Page 20 of 40 Evidence: they wished and that they had to complete a signing out book so that staff are aware of who is in the home in case of emergencies. The younger adults also stated that they could visit friends and relatives or have visitors to the home when they wished. The younger adults part of the home has a small separate lounge area which, whilst not completely private, could be used for more privacy for visitors if required. The registered manager stated that they try to encourage contact with families of the younger adults. The home kept contact information on file for service users families and records showed that families of the older people were kept informed about their relative. Families were encouraged to visit the home at times that were convenient to them and their relative and where staff knew about planned visits they informed service users about them and helped them prepare for the visit. On the day of the inspection visit there was one family member visiting their relative in the home. Staff were welcoming and demonstrated positive relationships with the family member. Most of the older people living in the home had some difficulty in communicating clearly, but staff supporting them demonstrated that they were skilled in communicating with them. Staff spent time ensuring that people were given the time and support to make choices and showed that they placed importance on supporting people to make decisions for themselves wherever possible. Choices were limited to issues such as where people wanted to sit, whether they wanted to go into the garden and what they wanted to eat and drink. Staff ensured that people were supported to exercise some choice but people are not able to make decisions in all aspects of their lives. The younger adults were also seen to be encouraged to communicate and observations showed that they felt able to talk to and discuss things with the care staff on duty. The younger adults stated that they were able to make choices and these were respected. The younger adults were also aware of when their choices may not be acceptable to others living in the home and were fully aware of the policy that people must smoke outside the home. One person informed the inspector that they had been caught smoking in their room that morning and as a consequence had been locked out of their bedroom for the day. The person was not sure when they would be allowed back into their room or what would happen if they needed something from their room. The policy of locking people out of their bedrooms if they may have been smoking in their rooms was discussed with the registered manager who stated that service users had agreed this. Whilst the person the inspectors spoke with was quite relaxed about being denied access to his room and belongings the inspectors identified Care Homes for Older People Page 21 of 40 Evidence: this to the local safeguarding team following the inspection for investigation along with the ongoing safeguarding investigation. The home had recently introduced nutritional assessments for the older service users. This has resulted in the home having clearer information about peoples individual nutritional requirements. Food in the home appeared to be of good quality and served in adequate portions. The menus for the day were written on a board in the lounge so that service users who could read it were aware of what food was available on the day. The day of the inspection visit was extremely hot and we observed that staff were conscious throughout the day of ensuring that people living in the home had constant access to drinks. People in the younger adults section of the home could help themselves to cold drinks that had been left in the lounge as they wanted them. People were also observed requesting and receiving hot drinks and afternoon hot drinks round being undertaken. The mealtime we observed on the day of the inspection appeared a relaxed and enjoyable experience for both groups of service users. Food was served by staff according to what individual people had chosen. Staff support was available for people who needed assistance eating and this was provided sensitively and without rush. From observation it was clear that people were supported in accordance with their own care plans and risk assessments. Additional comments were made on comment cards from service users concerning the food in the home. A younger adult stated the food could be better especially deserts and cakes, the sweets especially cakes always seem to be undercooked or rock hard whilst another younger adult stated good food to the question what does the home do well. One younger adult answered the question on what the home could do better with have salad on the menu as an option at lunch and tea time. The older people also added comments concerning the food provided at the home. These being food could be better, with one older person stating always, one usually and one sometimes that they liked the meals at the home. Staff also added comments about the homes meals one stating that meals could be plainer (not so peppery or spicy), and another that meals are not always of an appropriate standard and could be much better. The procedures in relation to the ordering of meals in the younger adults section of the home have been identified in the previous section of the report and may mean that people do not always get a meal. Care Homes for Older People Page 22 of 40 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. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon however there is a lack of awareness of how to make a complaint. The home is the subject of a safeguarding investigation and further safeguarding issues have been identified and reported to the local safeguarding team as a result of this inspection visit. We are not clear that the registered people are taking action or understand why there are safeguarding concerns and unless the provider and registered manager address issues between themselves and work together then people will not be safe at the home. Evidence: Discussions with people who live at the home and staff as well as information in the homes AQAA, comment cards received and records viewed are considered. Information from social services safeguarding investigations are also considered. Of the three older people who completed comment cards one stated that they knew how to make a formal complaint and the other two did not. All stated that there was someone they could speak to informally if they were not happy. Of the younger adults two stated they knew how to make a formal complaint and two that they did not. The manager stated that the complaints procedure was not displayed in the home and it is suggested that a summary of the complaints procedure could be displayed in each part of the home to remind service users and visitors of this information. Care Homes for Older People Page 23 of 40 Evidence: The registered manager stated in the AQAA that the home had received forty complaints in the past year, twenty-six of which have been upheld and all have been investigated within twenty-eight days. We viewed the complaints records complaints had been received from staff and people who live at the home. The vast majority of the complaints were in relation to the younger adults and generally when the behaviour of one service user had upset another service user. These had all been recorded in the complaints book with the manager detailing the action that had been taken to address the issue. Some complaints were also from staff about other staff not always completing their work to the standard expected. The manager stated that if a more serious complaint were received then a complaint form would be completed and this would be investigated in a more formal way. The high number of complaints and the nature of the complaints indicates that people feel able to raise issues with the staff and manager and expect that these will be resolved. Discussions with people during the inspection visit confirmed this and no one living at the home raised any specific complaints and stated that they were confident the registered manager would sort out any issues. From the complaints records we saw that complaints were recorded and responded too. Although many of the older people living in the home were not in a position to follow the formal complaints procedure themselves, there was evidence that staff had recorded complaints for them or, where behaviour and responses had been interpreted as expressions of dissatisfaction with the service, on their behalf. All staff who completed comment cards stated that they were aware of what to do if someone raised a concern about the home. Records on service users files showed that there had been a number of instances of service users being found to have some bruising to parts of their bodies that were unexplained. Staff have recently undertaken moving and handling training and we found that the number of instances of unexplained bruising had decreased since staff had received the training. We observed two members of staff supporting a service user to rise from her chair at the dining table up to her walking frame and then across the lounge to a comfortable chair. The staff used a lifting belt for this and explained to the person, throughout the process, what they were doing. They undertook this task well, with obvious reference to the training they had received and the care plans and risk assessments for this person. Although the registered manager has now implemented a comprehensive training programme people have been placed at risk by the lack of training that staff have had over recent years. Care Homes for Older People Page 24 of 40 Evidence: The home is currently the subject of a safeguarding investigation by the Isle of Wight Social Services safeguarding team. Information from the safeguarding team and that seen during the inspection visit indicate that the home are now taking action to address the issues that resulted in the safeguarding investigation however there does not seem to be coordinated approach from the provider and registered manager. It was identified during the inspection visit and from safeguarding minutes that the registered provider and registered manager have experienced a significant breakdown in their relationship. The registered manager had not been informed by the provider that they had agreed not to admit new people. Information from the safeguarding meeting indicated that staff and people who live at the home have heard raised voices and are aware that there is a disagreement between the registered manager and provider. This situation is not good for staff or people who live at the home and will not ensure the continuing safety of people. Care Homes for Older People Page 25 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes physical environment is generally clean however it does not always meet the specific needs of all the people who live there. Parts of the home such as the bathing facilities in the younger adults part of the home are in need of modernisation to promote the independence and safety of people. The safeguarding inspection has identified some hazards from the environment to people who live at the home. Evidence: The inspectors viewed the home with the registered manager, viewed certificates related to equipment and discussed the home with the people who live there and with staff. information form the homes AQAA and comment cards received as well as from safeguarding meetings are considered. The AQAA identified that the home provides a safe, well maintained, clean and pleasant environment with suitable facilities and equipment to maximise Independence. The AQAA also identified that there remains room for improvement in general decoration and service users would benefit from the installation of more showers. Since the previous inspection the home has relocated the office into the younger adults part of the home at the front of the building and this also provides a sleeping in room for night staff in this part of the the home. The previous office is now used as a Care Homes for Older People Page 26 of 40 Evidence: bedroom in the older persons part of the home. This exchange has reduced the number of bedrooms with an en suite by one as the new office had an en suite and the previous one did not. The AQAA also identified that the communal areas in the older part of the building have been redecorated as has the lounge/dining room in the new part (older people) of the home which has also had a new floor laid. The previous report identified that the older persons lounge/dining room had a strong offensive smell and this was no longer the case. Some bedrooms have also had new carpets or washable flooring. The safeguarding team identified that the new washable flooring in the older persons part of the home was not non slip and presented a risk to the people living there. During the inspection visit we were concerned about the flooring in the main lounge/dining area as the registered manager and staff informed us that it was not a non-slip floor. It was laminate flooring with a wooden effect. Risk assessments had been put in place for service users which stated that any spillages on the floor must be mopped up immediately to prevent the risk of people slipping. On the day of the inspection visit we observed that staff were doing this. There had been recorded instances of service users falling on the floor. One person slipped and injured their head in April of this year. The commission has been informed by the safeguarding team that since the inspection visit the floor has now been replaced with suitable non-slip flooring as had been required by the safeguarding team. The communal facilities available to service users in the older persons part of the home and in their own bedrooms were appropriate to their needs and they were able to bring in some of their own furniture to the home if they choose to. Some people living in the home did not have bedside cabinets, locked space in their rooms and/or a key to their room. Where this was the case it was as a result of risk assessments having been put in place which highlighted that there were clear reasons why. The AQAA identified that a new bathroom suite has been installed in one of the bathrooms in the younger persons part of the home. The bathing facilities on the ground floor of this part of the home require modernisation and the registered manager and staff identified that people living in the younger adults part of the home would benefit from having a walk in shower to promote maximum Independence. At present they do have access to a shower but this is located over a bath that they must step into and this presents a risk to some service users who must therefore have staff support to bath or shower. Being able to shower safely would promote independence, Care Homes for Older People Page 27 of 40 Evidence: privacy and dignity. People would also not have to wait for staff to be available and could shower when they wished. Service users and staff added comments about the homes environment on their comment cards. Comment cards from three older people stated that home is always (2) and usually (1) clean. An added comment being that the home looks nice with the new flooring and painted lounge. Staff also commented on the environment and stated the I think that the home could be decorated a bit better ie colours of the walls. Staff informed the inspector that where parts of the home such as the lounge and dining room in the younger adults part of the home had been redecorated they had done this. It was not clear the extent to which service users had been involved in choosing the colours that walls would be painted. The home was clean on the day of the inspection visit and presented no concerns. Cleaners are employed and this is supplemented by some cleaning tasks being in place for care staff when the cleaners were not working. The AQAA and training information provided by the registered manager showed that staff have now attended infection control training and staff confirmed that all the necessary infection control equipment was available to them. There are some access issues for people who require a wheelchair in that the car parking area at the front of the home is laid with gravel and there are steps to access the rear entrance to the home. Level access to the older persons part of the home is therefore only possible via the younger adults part of the home and through their lounge. Care Homes for Older People Page 28 of 40 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. The registered manager has implemented a staff training programme however service users have been placed at risk by the lack of staff training over the past few years. Staff are usually provided in sufficient numbers with service users being positive about the staff who care for them. Evidence: Records relating to recruitment and training were viewed. Discussions with staff and people who live at the home as well as comment cards received are considered along with information provided by the registered manager in the homes AQAA and during the inspection visit. Five staff completed comment cards. They stated that there were always (1) usually (3) and sometimes (1) enough staff to meet the individual needs of all the people who use the service. The inspectors viewed duty rotas and discussed the staffing arrangements with the registered manager. The staff are divided into a team for the younger adults and a team for the older people. The registered manager stated that on rare occasions staff may cover the other part of the home but usually they work in one of the areas. Care staff confirmed this. Staffing levels on the day of the inspection were as those stated on the duty rota and would appear to be sufficient for peoples needs to be met. Care Homes for Older People Page 29 of 40 Evidence: Service users made additional positive comments about care staff stating the staff are very caring and support me well. I have no problems with any of the care staff, adding a big thank you and a pat on the back for all the staff do for me. The older people responded that staff are always (1) and usually (2) available when they need them. Also that staff always (1) and usually (2) listen and act on what they say. The younger adults stated that staff always (2) and sometimes (2) listen and act on what they say. Two younger adults stated that staff always treat them well with one responding usually and one sometimes to this question. Care staff added comments on their comment cards stating that I think the home is friendly, we get on well together, and staff have good relationships with residents. Throughout the day we found that staff worked hard and interacted very well with the people living in the home. They managed to remain cheerful and attentive to the needs of service users throughout the time of the inspection. We observed that people living in the home appeared relaxed in the company of staff and that they appeared able to ask staff for anything they needed. In the home there were task lists for staff to follow in order to ensure they completed all the work necessary on each shift. Following the previous inspection a requirement was made that the home must ensure that suitable written references are taken up prior to staff starting work in the home to ensure that they are suitable people to work with vulnerable adults. The recruitment records for new staff were viewed and all the required pre-employment checks including references were in place. Care staff confirmed on comment cards that all pre-employment checks were carried out. This requirement has therefore been met. The home was also required following the previous inspection to ensure that all staff undertake mandatory and specialist training to enable them to meet the needs of the people who live in the home. The compliance date was the 1st October 2008. When the safeguarding team began an investigation at the home in March 2009 they identified that staff had not had manual handling training and that other mandatory training had also not been completed. The registered manager stated that the reason that staff training had not occurred was that the provider had not allocated her a budget to purchase training with and that free training that she had previously sent staff on was no longer available. The registered manager provided the inspectors with the homes up to date training matrix. Care Homes for Older People Page 30 of 40 Evidence: This showed that staff have now completed some mandatory training and that more training to meet both mandatory and service specific training is also booked. The manager is keeping a weekly update of the matrix with that undertaken and that booked but not yet done. Although staff are now receiving training this was not completed by the compliance date and not all staff have yet completed all mandatory or service user specific training. This has placed and continues to place people at risk. From service user feedback it is not clear that staff understand and respond appropriately to peoples needs and from actions that deny access or violate dignity that people have the training and skills to understand and respond sensitively to peoples needs. The training matrix also included information about the numbers of care staff who have an NVQ in Care. Just over fifty per cent of care staff have a qualification, many at level 3 and a further two staff are undertaking an NVQ level 2 with four staff who have an NVQ 2 now undertaking a level 3 qualification. The home recently contracted someone outside of the home to investigate an allegation of racial harassment that had been made. The allegations were investigated and a report made with recommendations. The report found that there was no real evidence of racial harassment, but that there were concerns about the working relationships between night staff and daytime staff. The recommendations from the report were that the home should appoint a night shift supervisor, arrange equality training for all staff and amend the induction training programme to reflect that, at times, night staff would work alongside daytime staff. The registered manager informed us that they had someone in place at present to lead and represent the night staff team and that they are in the process of planning to appoint a night time supervisor. She also confirmed that equality training had been booked for all members of staff. On the day of the inspection visit we observed that there was a member of staff who usually worked nights working alongside two colleagues who work during the daytime. Care Homes for Older People Page 31 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have been placed at risk by the homes registered people. Two of the four requirements made following the previous inspection have not been complied with and this means that people have been placed at risk for a long period of time. Additional requirements are made following this inspection. The registered manager and the provider are not working together to ensure that the home is run in the best interests of the people who live there. Evidence: The homes AQAA, discussions with staff and people who live at the home, records viewed throughout the inspection and observations during the inspection are considered. Also considered are comment cards and other information provided to the commission including that from the safeguarding investigation. The registered manager is registered and is a qualified nurse. However, the registered manager does not have have the necessary management qualification to manage the home. She informed us that she wanted to undertake the qualification but there had Care Homes for Older People Page 32 of 40 Evidence: always been a problem because the Provider refused to pay for her to do it. We had made a requirement about this at the previous inspection that the registered manager must have a management qualification by the first January 2009. This requirement was not met. The registered manager informed us that she has now enrolled herself on the course, but had not yet started it. The registered manager has therefore not ensured that she develops and maintains the skills she needs to effectively manage the home. There is still an issue about whether or not the Provider will pay for the course. The registered manager informed us that she does not manage any budgets for the home as the Provider did not want her to. She told us that this made it difficult for her to plan ahead and to ensure that the home had all the equipment needed for supporting people who live there. One example was that stocks of items required for providing personal care, such as face cloths, would get so low that there would be occasions when the only ones available in the home would be in the laundry and there would be none to use until the Provider next came in and went to the shops to purchase some more. The registered manager also has no training budget at her disposal. This meant that she had been unable to plan and purchase training for staff in the home. The registered manager also told us that the Provider had appeared quite reluctant to spend money on staff training. She also informed us that there were still unpaid invoices for training that had been provided December 2008. In response to requirements we had made in previous inspections, the registered manager had more recently just gone ahead and booked staff training sessions and asked the training companies to invoice the Provider. The registered manager has managed the home since April 2005. She informed us that she still has no contract of employment, no job description and that there are no lines of accountability within the home. The registered manager stated that she does not have control of budgets or knowledge of the finances of the home. This makes it difficult for her to manage the home effectively which has placed people at risk. The registered manager stated that she has raised these issues with the Provider, but the issues have never been resolved. The registered manager informed us that, at the time of our inspection visit, the Provider was not talking or otherwise communicating with her. She told us this had been the case since they had had a safeguarding meeting with Adult Services on the 11th June 2009. Care Homes for Older People Page 33 of 40 Evidence: We had written to the Provider on the 15th June 2009 asking her to agree to not to admitting any more people to the home while a current safeguarding investigation was in progress. The Provider had replied to us on the 25th June 2009 agreeing not to admit anyone to the home during this period. During our inspection visit, the registered manager informed us that the Provider had not communicated this information to her. Our process for inspection reports is to send a draft report to the service for comments on factual accuracy before we publish the final report. When we publish the final report it is sent to the service and then, later, made available on our website. During this inspection the registered manager informed us that in all the time she had managed the home she had never seen a draft inspection report and so had never been able to comment on them. She said the Provider took the draft and did not discuss them with the registered manager. Also, the Provider took the final version of the report and did not discuss it with the registered manager. The first time the registered manager had ever seen any of our reports on the service she manages was when they were published on our website. The registered manager informed us that there were no Regulation twenty-six reports available in the home. Regulation twenty-six requires the provider to undertake a monthly assessment of the quality of the service provided and to provide a report to the registered manager. The registered manager said that since she had begun managing the home in 2005 there had been only one Regulation twenty-six visit. The registered manager stated that the Provider had delegated this task to her daughter and that the providers daughter undertook one visit. The registered manager told us this had been done very thoroughly however, since then there had been no further visits. The registered manager also informed us that the Provider had once asked her to do the Regulation twenty-six reports and then pass them on to her so that she could pass them on to her daughter so that she could then re-write them herself. The registered manager also told us that on another occasion the Provider had asked her to complete six months worth of Regulation twenty-six visit reports. The registered manager told us she had refused to do this and had heard nothing from the Provider about Regulation twenty-six visits since that time. The failure of the provider to ensure that regulation twenty-six visits and reports are completed and therefore failure to ensure the quality of the service provided has placed people at risk and continues to place them at risk of harm. Two of the four requirements made at the previous inspection have not been met. Care Homes for Older People Page 34 of 40 Evidence: These relate to training and the managers qualifications. Additional requirements are made following this inspection in relation to the management of the home. The commission will be requesting an improvement plan and will consider what other action it should take in response to the management issues at the home and failure to comply with the requirements made following the previous inspection. The home undertakes regular consultation with service users in a number of different ways. There are regular service user meetings in the home for people who are able to contribute in that way. There are individual meetings with other service users who do not like, or are not able to contribute their views in, larger meetings. There are also regular staff meetings and individual staff support and supervision sessions where staff can contribute on an individual basis. In addition there are questionnaires for people who live in the home, their relatives and other professionals who have some involvement with the home. The responses on the questionnaires are then collated and improvements to the service are planned based on the issues people have raised. The inspectors were shown the recently completed questionnaires which the activities person is to collate. The home does not produce a written improvement plan within this process and share it with the people who have contributed to their opinions. This would improve the quality assurance process by ensuring that people are kept informed about what the service is doing in response to the points they raised. The lack of an improvement plan means that the quality assurance is not being used to improve outcomes for people living in the home through a developmental process. We looked at the arrangements for peoples personal money and found that the procedures described are appropriate. The registered manager stated that the provider is no longer the agent for anyone living in the home with a social services receiving officer fulfilling this role for people who are unable to manage their own finances and have no relative to take on this role. One persons finances are managed by a solicitor. The manager will hold small amounts of peoples personal money sent to her on a monthly basis by the receiving officers and service users sign for this money when the manager passes it onto them. We viewed certificates for servicing and safety checks for the equipment used in the home and these showed that equipment has been regularly serviced. On the day of the unannounced inspection visit the home was updating the fire risk assessment as this did not accurately reflect the situation in the home. We were informed that the fire risk assessment had originally been completed by a consultant who had not Care Homes for Older People Page 35 of 40 Evidence: appreciated the issues around evacuation from the older persons part of the home. The home undertakes a weekly check of the fire detection equipment, the records of which were viewed. The failure to meet the training requirements made following the previous inspection has resulted in people being cared for by staff who have not had the necessary training to meet their needs and this has placed people at risk. Care Homes for Older People Page 36 of 40 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 (1)(a) The registered person must ensure that all staff undertake mandatory and specialist training to enable them to meet the needs of people living at the home. The registered manager must have the necessary qualifications for managing the care home. 01/10/2008 2 31 9 (2)(b(ii)) 01/01/2009 Care Homes for Older People Page 37 of 40 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 12 16 The responsible person must 30/08/2009 ensure that all people living at the home have the opportunity to join in a programme of activities arranged by or on behalf of the home to provide mental and physical stimulation and enjoyment. People must be consulted about what activities they wish to have available. So that peoples mental and physical health does not deteriorate due to boredom. 2 15 16 The responsible person must 10/08/2009 ensure that people receive a nutritional intake that is suitable for their needs and provided at regular intervals. Unless people have clearly stated that they do not want a meal then one must be prepared for them. Care Homes for Older People Page 38 of 40 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 So that people are not hungry and receive an appropriate nutritional intake. 3 31 7 The Registered persons must ensure that good working relationships exist. So that people are not placed at risk. 4 33 26 The responsible person must 10/08/2009 ensure that a visit to the home to assess the quality of the service provided is undertaken every month. A report of the visit must be provided tot he registered manager. So that the quality of the service can be assesssed on a regular basis and action taken to ensure that people are safe. 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 10/08/2009 Care Homes for Older People Page 39 of 40 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. 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