Inspection on 02/11/09 for Orchard Lodge

This inspection was carried out on 2nd November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Orchard Lodge 36 Baskerville Road Sonning Common Reading Berks RG4 9LS     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: Ruth Lough     Date: 0 2 1 1 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 29 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 29 Information about the care home Name of care home: Address: Orchard Lodge 36 Baskerville Road Sonning Common Reading Berks RG4 9LS 07855261889 01613709080 nageeb@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Nageeb Aubdool The registered provider is responsible for running the service care home 11 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 1. The maximum number of service users to be accommodated is: 11 2. 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) Date of last inspection Brief description of the care home Orchard Lodge is a small private family run care home that can offer support to 11 residents who have a primary need of dementia. The home is situated in a quiet residential area of Sonning Common and is able to access the local healthcare and community facilities there. The home does not have a lift to the first floor which means that some of the residents must be able to manage stairs safely and independently. Care Homes for Older People Page 4 of 29 Over 65 0 11 Brief description of the care home Current fees range from £462.70 to £700.30 per week. Residents are charged separately for hairdressing, toiletries, and some activities as and when they occur. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the registration of the service in July 2009 with a new provider taking responsibility for the home. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The Annual Quality Assurance Assessment from this service was returned prior to the inspection process and had been completed satisfactorily. Care Homes for Older People Page 6 of 29 The registered manager was present when we visited the service on 2nd November 2009, between 10:10 and 18:15. During the day the records for care planning, recruitment, and administration of the service were assessed. Three of the people using the service were involved with the inspection process. We met with 5 staff and 2 relatives who were present in the home. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the 6 people who are in receipt of support that we contacted, we received 3 responses at the time of writing this report. 5 staff were also contacted through surveys, of which 4 responded. From this inspection of the service here were a few areas that will need to improve as to protect and support the people living there and three requirements were made to reflect this. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 29 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 29 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 29 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 people who use the service have their needs assessed before they are offered a place in the home. Evidence: The people who responded to the commissions surveys indicated that they felt they were provided with enough information about the home to assist them making a decision to live there. A recently admitted resident and their relative gave good information about their experience of being introduced to the service and the support they had to help decide the home would be appropriate for them. They stated that they were given the opportunity to visit and use the service during the day on several occasions. We looked at two residents care records to see if the process of the assessment of individuals needs is thorough enough to be able to identify if the home can meet Care Homes for Older People Page 11 of 29 Evidence: them. Only one had been carried out before the service was re-registered under the new provider. From what information was available, it was evident that the prospective resident is requested to complete an Admission application form where they are asked to provide information which includes their medical and health status, what support they think they may require, and any significant contact details for their next of kin. They are also asked to provide some personal life history to give staff a better understanding of them. There is also a pre-admission assessment carried out by a senior carer or the homes care manager which covers a brief overview of what their needs may be. Both records showed that for these new residents that the basic information had been obtained. However, the process could be improved by the assessment including seeking a greater depth of information, expanding on evidencing of how the home will be the appropriate place for them to live. This is particularly relevant to the mental health needs of the person as the home states that it specialises in providing support for people with dementia. Through discussion with the registered manager it was apparent that all the record keeping templates for the assessment, planning and delivery of care is under review and should be implemented within the next few weeks. Care Homes for Older People Page 12 of 29 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 people who use the service can be assured that their personal care needs will be met and they will be supported to obtain any health consultations and treatments they may require. Evidence: The residents and the relatives involved in the inspection process were complimentary about the care and support provided. Additional comments were, Very happy, all my needs are met. One relative put that, Couldnt ask for better. A resident stated in a returned survey as to what the service does well, Get help when I need it, look after me. Another put, Looks after residents well, The two sampled care records showed that there are key topics of planned care and they have implemented several risk assessments such as for general, nutritional and Care Homes for Older People Page 13 of 29 Evidence: manual handling needs of the person concerned, that are used in conjunction with them. The content of some of the risk assessments show better detail of how the care and support is to be provided than that which is included in the care planning itself. The nutritional assessments that were seen were not detailed enough as they did not provide an analysis tool to identify any risks that can be used in the care planning. We were informed that there is a new assessment and care planning document tool and processes intended to be introduced in the next few weeks. However, it was recommended that they look at implementing a recognised nutritional assessment tool to be included in the new care planning records. All the risk assessment documents that were seen did not follow the recognised good practice guidance of assessment and planned actions to reduce or eliminate the potential risks to individuals. However, staff are writing very detailed actions in other parts of the care records for staff to follow. Throughout all the daily records with noting the outcomes or experiences that the residents have, staff provide a good picture of the person concerned. A new document tool has been commenced for staff or any visiting healthcare practitioner to record the consultation, treatment or changes in the medical care that they have carried out. This will be helpful in identifying if formal reviews or significant amendments to the planned personal care and support will be needed. The people involved in the inspection both in the surveys and during the visit to the home, confirmed that they thought that they received the medical care and support that they needed. Residents and relatives stated that it was reassuringly positive step that they were able to continue with their own GP managing their healthcare. From listening to activities going on in the home the staff appear to have a good working relationship with the medical practitioners who visit the home and the local pharmacy service who provide the support for medications administered in the home.. We looked at the practices and information for medication administration carried out in the home. We were informed that the service has engaged a new local pharmacy to provide their support for this and is now using a Monitored Dosage System for residents regular medications. They also provided information that they had implemented changes in the security of the medication keys and the storage facilities including a separate cupboard for any controlled drugs they may have to take responsibilities for. The documented medication policy and procedure was also reviewed which supported that the information had been updated to reflect the new medication practices and storage. The documents gave staff information about covert Care Homes for Older People Page 14 of 29 Evidence: administration and supporting people to manage their own medication. However, they have not as yet developed a risk assessment for this or provided staff with sufficient information about homeopathic or over the counter medications that residents may decide they wish to use. They were advised to obtain a copy of The Handling of Medicines in Social Care (Royal Pharmaceutical Society of Great Britain) as to provide guidance as to developing their policies and procedures. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are given the opportunity to exercise choice over their lives and be able to maintain their interests. Meals and menu planning meet their health needs and personal choices. Evidence: The residents and relatives that were involved in the inspection process gave very positive comments about how the staff conducted providing a friendly homely environment for them. It was evident that personal choices and wishes for daily routines, meals, drinks, activities and involvement in what was going on in the home are listened to and supported by staff. Although the depth of this knowledge that staff have about personal choices and wishes is not always reflected in the care planning records. The sampled care records show that information is taken where staff are able about the persons life history, interests and hobbies. Additional information has been obtained by the member of staff who leads the activities in the home and could be found in the separate activities records. Staff are writing well about the outcomes for individuals, their enjoyment and participation in what is provided. Although it may be a better approach to keep all the records together as to assure that all staff include activities as part of the daily care delivery and support that they provide to the individual. Care Homes for Older People Page 16 of 29 Evidence: The residents and staff that we spoke to were very enthusiastic about the Halloween event they had participated in during the weekend before the inspection and they were looking forward to the Firework Night celebration in the next few days. The deputy manager stated that residents were asked about what they wanted to do regularly and that they endeavour to provide activities that interest them. From the records available it was evident that there is a mixture of both practical and mental stimulating activities provided in which they try to appeal to most of the residents interests. Some staff have been trained to lead chair exercises, others take the lead in providing church worship. One relative expressed delight to see that their Mum, had been encouraged and enabled, to take up knitting after 40 years. The Registered Manager stated that there had been a difficulty with the satellite TV contract that was provided in the home and this was in the process of being rectified. Residents still had access to a TV signal although not what they had enjoyed previously. He was also able to outline proposals to purchase transport for the home to improve accessibility for the residents. We looked at what the home has in place for meals and menu planning. The people who returned surveys stated that they usually enjoyed the meals provided. Those who were involved in the inspection process confirmed this. From looking at the documentation and planning for meals there are 4 weekly seasonal menus which included traditional English meals. There was also information to show that personal preferences and dietary needs had been obtained and that residents were able to choose ahead of the main meals what they would like to have and that alternatives were available if they wished to change their mind. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home can be confident that their concerns or complaints will be listened to and acted upon. They can also be reassured that staff have the knowledge and recognise and protect the people living in the home from possible abuse or harm. Evidence: The people who were involved in the inspection were able to confirm that they knew how to and to whom that could complain to should they be unhappy about the service. Additional comments made during the day were that staff would listen and respond well should any dissatisfaction be brought to their attention. They were particularly complimentary about the deputy manager who currently takes the lead in the day to day provision of care and support in the home. Residents living in the home have recently been provided with a copy of the complaints procedure which has been put on display in their rooms. The Registered Manager expressed that this had been implemented to assure that residents and relatives were provided with the details of how to do so more readily should they have concerns. We looked at the homes complaints policy and procedure to see if it provided the necessary detail about the complaints process, timescales that a complainant could expect their concerns to be responded to, and the contact details of the commission. Care Homes for Older People Page 18 of 29 Evidence: From looking at the documented procedure the reader is given very brief basic information about how to make a complaint which could be enhanced to be more user friendly and provide details of the stages of any complaints investigation. The procedure does give a 28 day timescale for the complainant to be informed of the investigation and contact address of the commission. The Registered Manager gave information in the AQAA that the home had been in receipt of two complaints since it was registered in June 2009. From what information was available these were concerns about the home that the local authority reviewed under its safeguarding investigations procedure when they were reported to them within the first few weeks of operation of the service. Additional information provided to the commission shows that the Registered Manager responded appropriately and implemented actions to rectify any deficits identified. Through discussion it was identified that they do not currently record minor comments or concerns that are expressed by residents or others about the service. They were advised to do so as to assist with monitoring trends and for quality assurance purposes. Information given in the AQAA gave the number of care staff that have left the service since June 2009 as 5, which is just below the 50 of the current staff team. All newly employed staff, appear to have been provided with information about protection and safeguarding adults from abuse in their induction training. The topic has been included in the training programme to be revisited by the other members of the staff team. However, it was evident that staff had a good understanding of their responsibilities when they took the necessary steps when they were concerned about missing residents who left the building when faulty door locks were identified. Staff are provided with information about recognising and managing concerns including whistle blowing in the homes policy and procedure and the copy of the local authoritys Safeguarding strategy that is left on display for them to read. However, the homes own policy needs to be updated to reflect the key points of the local authorities processes which may impact on how they manage and refer concerns. Care Homes for Older People Page 19 of 29 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 home is kept clean and comfortable. Parts of the environment and furnishings are tired and shabby and will need redecorating or replacement as to bring the home to a good standard. Evidence: The home is not purpose built but has been adapted and extended from an average family home to provide the current facilities. It has limited personal and communal spaces for residents to use. There is screening in the two shared rooms which remains inadequate to maximise the privacy provided to the occupants of the room. None of the bedrooms have en suites so the occupants must be able to mobilise to the nearest toilet or be comfortable to use a commode in their rooms at night should they need to. There is not a lift to the first floor and upstairs bedrooms can only be used by people who are mobile enough to climb stairs. The new provider has recognised that the environment of the home needs updating with decoration, fitments and furniture as to improve the comfort and well being of the people living there. In recent weeks changes have been made to some of the facilities. Such as accessing new beds for two residents, the removal of a temporary building in the grounds and the replacing of secure fencing around the perimeter of the building. A new lock to the front door ws installed as to the concerns about safety and security were highlighted in the safeguarding investigation about the door and the Care Homes for Older People Page 20 of 29 Evidence: area of the rear garden. However, it was evident that the Registered Manager had implemented changes to eliminate these risks to the residents in the home. Much of the furniture and fittings could be seen to be shabby and in poor condition with chips, dents and laminated surfaces missing which is difficult to keep clean, not pleasant for residents to view and could cause skin damage to them. Two main areas were identified as requiring to be actioned as soon as possible was an assessment of the quality of the commodes and any replacements put in place. Also the heating facility in the upstairs bathroom which appears to be inadequate for keeping the room warm for residents to use. The home does not have a mechanical or separate sluice area and commode pans are cleaned in the laundry room. Concerns about cross infection were highlighted under the previous ownership of the home and protocols were put in place under the advice of the Health Protection Agency to ensure that the best practices were in place within the limitations of having inappropriate facilities. These protocols are still used and we were informed that there will be plans implemented to provide a separate sluice area as soon as possible. A definitive date was not provided. Investment in a new washing machine and tumble drier has assured that any laundry is washed at the appropriate temperatures. The people we spoke to stated that the home was comfortable and homely and kept clean and fresh smelling. This was evident in the bedrooms and communal spaces that were reviewed during the inspection visit to the home. Care Homes for Older People Page 21 of 29 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. That the homes staffing levels meet the current needs of the people they support and the size and complexity of the service they provide. Staff require the necessary training to ensure that they have the knowledge to be able for them appropriately. There are gaps in the supporting evidence that show that staff have been recruited safely and are fit for the roles they do. Evidence: The residents and relatives involved in the inspection thought that the staff were very helpful, kind and supportive. One resident wrote in a survey, The staff are always helpful and happy. I would not hesitate to recommend the home. Observing the relationships and the communication between residents, staff and visiting relatives it was apparent that staff are friendly, open and very supportive to them. The current rota was reviewed to see if there are sufficient numbers of staff at peak times of the day when residents need greater assistance. From what could be seen they is always a minimum of 2 staff on duty with additional staff for the catering and domestic needs of the home during the busiest parts of the day. The duty rota was not Care Homes for Older People Page 22 of 29 Evidence: completely correct as the Registered Manager was indicated to be working in the home but was not initially present during the first part of the inspection visit. We looked at the information the Registered Manager has about the qualifications and skills of the staff employed in the home. We were made aware that at least 5 or around 30 of the current staff team had left over the last few months and this has impacted upon the numbers of skilled staff employed and the training programme. From what information was available only one member of staff has attained an NVQ 3, several others are part way through NVQ 2 although this has halted due to the loss of the NVQ Assessor and training provider. The Registered Manager did provide information that he was seeking training from a new provider to continue with supporting staff to obtain the necessary qualifications that they need. The Registered Manager is a qualified nurse with considerable experience in a mental health provision and emphasised that he is keen to develop staffs knowledge to meet the needs of the residents they care for. The training programme for staff has not yet been fully organised, however they were in the process of taking all the staff team through infection control through a distance learning programme. The recruitment records for 2 staff were reviewed as to establish if a robust process is carried out that protects the vulnerable people living in the home from inappropriate staff caring for them. One member of staff had commenced just over 3 months ago and from looking at these records it was evident that most of the required information had been obtained. However, one member of staff had only one reference which was a personal, not professional, and insufficient information had been obtained about their student status. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The gaps in some of the documentation for the care planning, recruitment and safe working practices does not support that the service is always run in the best interests of the people living there. The new provider is gradually implementing changes to improve the service. Evidence: Residents and relatives were complimentary about the deputy manager and thought that she was very approachable and friendly. They were not able to comment much about the Registered Manager as they felt they were still getting to know him. From looking at the current documentation for the management and delivery of care and the administration of the home there are a number of areas that they will need to improve. There have been number of new policies and procedures put in place, which provide staff with the necessary information they need. However, there are still a few that need to be reviewed and developed further such as those for safeguarding, Control of Substances Hazardous to Health Regulations (COSHH) 1988 and safe Care Homes for Older People Page 24 of 29 Evidence: working practices. The Registered Manager was able to provide information about the planned quality assurance processes including consultation with residents, residents, and visitors. The processes have not been fully implemented but from what could be seen they will involve residents, relatives and staff invited to meetings to discuss how the service is provided. What was apparent through information from staff and residents was that any comments are fed back to the management of the home and changes are gradually being implemented. If the service have to act on residents behalf for purchasing sundries or extras such as hairdressing all these are invoiced to either the individual or their advocate. We were informed that they do not hold any monies for residents and they are provided with facilities of a lockable space in their rooms for their valuables should they require them. The systems for safe working practices were reviewed to see if the home is run in the best interests of the people to live, work and visit the service. A sample of the fire checks and servicing for fire safety were reviewed and showed that fire drills, safety checks and inspections are carried out. From the records held by the cook, it could be seen that they regularly monitor temperatures for fridge and freezers and also that for the cooked food. As previously highlighted the policy, procedures and information for the management of cleaning and other chemicals used in the home under Control of Substances Hazardous to Health Regulations (COSHH) 1988, need to be updated. This is because they did not provide staff with sufficient instruction for safely using these substances, or have the necessary up to date manufacturers information of how deal with accidentals spills. Also the information for general health and safety procedures was minimal. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 29 19 The registered person should not employ a person to work in the home that he has obtained full and satisfactory evidence that they are able to do so. You should ensure that you have obtained satisfactory evidence including professional references from previous employment in a care provision and that the person is able to work. 31/12/2009 2 30 18 The registered person should ensure that the persons employed in the care home receive the training appropriate to the the work they are to perform. You should ensure that there is a staff training and development programme that meets the recognised standards for people 31/03/2010 Care Homes for Older People Page 27 of 29 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 employed in a care service provision. 3 38 13 The registered person should make arrangements for the correct instuction and information for safe working practices are in place as to protect the people who use, work in or visit the service. You should ensure that staff have the necessary up to date information for the management of items used and kept under the COSHH ( Control of substances hazardous to health)Regulations 1988 and for the health and safety practices in the home. 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 31/12/2009 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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