Inspection on 07/04/10 for Orme House Residential Home

This inspection was carried out on 7th April 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orme House Residential Home 10/06/09

Orme House Residential Home 17/06/08

Orme House Residential Home 04/07/07

Orme House Residential Home 06/07/06

Orme House Residential Home 04/10/05

Orme House Residential Home 24/05/05

Orme House Residential Home 04/08/04

Orme House Residential Home 30/04/04

Orme House Residential Home 11/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Key inspection report Care homes for older people Name: Address: Orme House Residential Home 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF     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: Julie Small     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 41 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: Orme House Residential Home 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF 01502574068 01502574068 sandy@sahadew.fsnet.co.uk Noneavailable Anglia Care Homes Ltd care home 19 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1 The home may accommodate one person, whose name was made known to the commission in June 2005, who is over 65 years and requires care by reason of dementia. Date of last inspection Brief description of the care home Orme House is registered as a care home providing personal care for 19 older people aged over 65 years. One of whom has dementia. Care assistants staff Orme House on a 24-hour basis. One of the registered proprietors, Mr Sahadew is also the registered manager. The layout of the home is on 3 floors with level access provided in most areas by means of a shaft lift. Rooms 5, 6 and 11 are not accessible by the shaft lift. A stair lift can be used to access rooms 5 and 6, but to access room 11 the occupant needs to use stairs. Single bedrooms and shared accommodation are available. The home looks out to Kirkley Cliff, a busy one-way thoroughfare. Kensington Gardens, with its many attractions and sea front. Parking is on the road. The deputy manager told us that the fees for the home were £364 per week. Care Homes for Older People Page 4 of 41 Over 65 1 19 0 0 1 0 0 6 2 0 0 9 Brief description of the care home Care Homes for Older People Page 5 of 41 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place Wednesday 7th April 2010 from 09:45 to 17:45. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The deputy manager was present during the inspection and the requested information was provided promptly and in an open manner. During the inspection health and safety records, staff training records and the recruitment records for three staff members were viewed. The care of four people that live at the home was tracked, which included care plans and medication records. Further records that were viewed are detailed in the main body of this report. Observation of work practice was undertaken and three staff members, two visitors and five people who lived at the home were spoken with. Care Homes for Older People Page 6 of 41 Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and it was returned to us. Five staff, ten service user and one health professional surveys were returned to us before the inspection. Care Homes for Older People Page 7 of 41 What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose and service user guide must be updated to show factual and up to date information about the services that are provided at the home, in areas such as activities and the CQC (Care Quality Commission) contact details. People must be provided with needs assessments that are undertaken prior to moving into the home and care plans must detail how peoples individual needs and preferences are to be met. Peoples care plans must be regularly updated and reviewed to reflect their changing needs. Guidelines for PRN (as required) medication, which is prescribed to assist people with their behaviour, must clearly identify at what points of their behaviour the medication should be administered. Medication records must clearly show why the medication has been administered. Peoples care plans must identify the support that people require with their behaviour. An activities programme which is meaningful and of interest to people must be provided. It is recommended that people and their relatives and/or representatives are advised of the complaints procedure to make sure that they are aware of how to make a complaint about the service that is provided at the home if they wish to. There were several areas of the environment that needed to be improved to ensure that people were provided with a safe, hygienic and comfortable place to live in, such as offensive smells must be eliminated, toilets that were out of use must be made good, the back gate must be secured and the broken furniture in the back yard must be removed. Staff must be provided with manual handling training to ensure that they support Care Homes for Older People Page 8 of 41 people in a safe manner. Staff to be provided with regular refresher training to ensure that they are kept up to date with the responsibilities of their roles. Staff must be provided with appropriate supervision to ensure that they are supported to do their job and to meet peoples needs. The managers duties must be recorded on the staffing rota. Regulation 26 visits must be regularly undertaken and the reports kept at the home for inspection. Notifications of deaths, accidents and any other incidents which effect peoples well being must be made to us without delay. 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 41 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 41 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. People who use this service can expect to be provided with information about the services that they are to be provided with, however, they cannot be assured that the information is up to date. People cannot be assured that their needs and preferences are fully assessed prior to them moving into the home. The home does not provide an intermediate care service. Evidence: The service user survey asked if they were provided with enough information about the home before they moved in so that they could decide if it was the right place for them, three said that they did not know, four answered yes and three answered no. There was a notice displayed in the entrance hall which stated that people that lived at the home and visitors could request a copy of the homes statement of purpose and service user guide and a copy of each document was present for peoples reference should they wish to look at them. Care Homes for Older People Page 11 of 41 Evidence: We viewed the homes statement of purpose, which included information such as the aims and objectives of the home, referral, admission, staffing arrangements, staff training, the managers and providers qualifications and a summary of how people could make a complaint if they were not satisfied with the service that they were provided with. It was noted that the document was written 2004 and there was a note which stated that it had been reviewed March 2007. There were some areas of the statement of purpose which needed updating to show current information that people needed about the services that were provided at the home, for example the staff training was listed in the document, such as fire safety, manual handling and COSHH (Control of Substances Hazardous to Health), however, in the staff training records that were viewed there was no evidence to show that the staff had been provided with COSHH training. The statement of purpose provided the details of the previous regulatory commission (Commission for Social Care Inspection), which needed updating to show the current regulatory body (Care Quality Commission) and our contact details, should people wish to contact us. The service user guide was viewed and included information such as the aims and objectives of the service , provider details, terms and the services and facilities provided at the home, such as the weekly activities programme that was provided. However, the activities listed in the document included knitting, sewing, bingo, singing, TV, music, videos and arm chair exercises, peoples records that were viewed and discussions with staff and people that lived at the home did not show that the programme of activities were provided. The document also included the CSCI (Commission for Social Care Inspection) contact details and needed to be updated to include CQC (Care Quality Commission) contact details. The care of four people was tracked, which included viewing their care records. Two of the care records that were viewed held needs assessments that had been completed prior to their admission, which provided the information about the individual needs of people. Two peoples care records did not include needs assessments, which identified their assessed needs and preferences. Each held an admission assessment, which was completed on the day that the person moved into the home, however, there was no evidence to suggest that they had been consulted with about their needs. The AQAA stated we ensure that, all the residents admitted to the home are assessed prior to admission. A health professional survey said that the homes assessment arrangements usually ensured that accurate information was gathered and that the right service was planned for people. Care Homes for Older People Page 12 of 41 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. People who live at the home cannot be assured that their care plans will be regularly reviewed and updated to show how their changing needs and preferences are met. They cannot be assured that their health care needs are fully met, that they are protected by the homes medication procedures and processes and that their privacy is fully respected. Evidence: The deputy manager told us that they had been using the care plan templates which had been provided to them by Suffolk County Council Adults Services Outcomes and Quality Monitoring Team. However, they said that they had downloaded an alternative template, from Mulberry House, which they were planning to use. The AQAA stated a comprehensive care plan is drawn prior to providing care. People that lived at the home that were spoken with told us that they felt that their needs were met. The service user survey asked if they were provided with the care and support that they needed, eight answered always, one answered usually and one answered sometimes. Care Homes for Older People Page 13 of 41 Evidence: Staff that were spoken with had a knowledge of the individual needs of people. Five staff surveys said that they were always provided with up to date information about the people that lived at the home. The survey asked if the ways that they passed on information about people who lived at the home between staff worked well, three answered always and two answered usually. The care of four people was tracked, which included viewing their care records. The deputy manager told us that they felt that the success that they had achieved with individual people was not recognised, such as how a person had previously stayed in bed all day, now got up and joined people in the communal areas of the home and where a person had refused to eat the food provided at the home now enjoyed meals at the home. As a result of the deputy managers comments we asked for the names of three people and they were selected for our case tracking methodology which was used during the inspection. The care records showed information such as the persons preferred form of address, their next of kin details, their medical history, their doctor, allergies, their date of birth and when they moved into the home. The care records that were viewed held care plans, which showed how their needs were met. The care plans included information of the areas of care that people could attend to independently and they did mention the information that had been provided by the deputy manager. However, the lack of information provided at the assessment stage of the people moving into the home and the minimum information provided in the care records, the actual changes and progress of peoples well being were not sufficiently detailed to show the work that had been undertaken by the staff at the home to improve peoples lives. The care plans had not been signed by the people that lived at the home or by their representatives to show that they had been consulted with and agreed with the contents of their care plans. Not all care records were signed and dated by the staff that had completed them, which did not identify at what point in peoples care that they had been written. It was noted that there were several areas of improvement in the care plans that were required to ensure that peoples needs and preferences were appropriately met and that their changing needs were addressed. For example when identifying the support that two people required with their person care the care plans stated needs assistance, this did not identify the specific support that each person needed and preferred. The care plan of one person had not been updated to show their recent health diagnosis and the care that they required to meet their changing needs. We had been told by the deputy manager that a persons relative had died, however, their care plan did not identify the changes in their family and how they should be Care Homes for Older People Page 14 of 41 Evidence: supported through the bereavement process. A persons care plan did not identify the support that they required and preferred to meet their needs with regards to their behaviour and they did not cross reference to the medication records in relation to PRN (as required) medication prescribed to assist them with their behaviour. The care records that were viewed held risk assessments such as manual handling, nutrition and skin viability. One persons skin viability assessment stated that there was no risk of pressure areas, however, on the day of the assessment a district nurse visited the home to assess the person for pressure relief equipment. There was no reference to this in the persons care records and how and when their needs had changed. One persons care records indicated that they had been malnourished when they had moved into the home, their care plan stated that they needed encouragement to eat and that a record of their food and fluid intake was to be kept. There was a clear record of the persons food and fluid intake, which was viewed, and their weekly weight charts had showed that they had gained weight. However, the staff that supported the person may have benefited from a more detailed care plan which identified how the person was to be encouraged to eat. The persons care records showed the health care appointments that the person had attended and how the staff at the home had requested that the doctor refer them to a dietician. A record of a visit from the doctor stated that they had not prescribed ensure to build up the persons weight, however, the food and fluid intake records stated that they had been given ensure three days after the doctors visit. A persons record of falls had shown that a person had fallen and sustained an injury, there was no further information about the actions that had been taken to ensure that the person was safeguarded, apart from a doctors appointment made at a later date. We had also not been sent a notification of the incident which would allow us to identify that the staff at the home had taken the appropriate actions to safeguard the person. Each persons records held a personal appearance sheet, which included information of where they had been provided with support to bath, shower or have a strip wash. The records identified where people had refused to bathe. However, it was noted that the notes on the records were infrequent and it was not clear if the records had not been routinely completed or if people were not provided with the opportunity to bathe regularly. During the inspection it was noted that people looked well groomed and clean. Care Homes for Older People Page 15 of 41 Evidence: The AQAA stated all residents have access to their own GP, dentist, chiropodist and optician as and when needed. Five people that were spoken with told us that they felt that their health care needs were met and that a doctor was called when they felt ill. The service user survey asked if they received the medical support that they needed, eight answered always and two answered usually. A health professional survey said that peoples social and health care needs were usually properly monitored, reviewed and met, that the service always sought advice and acted on it to meet peoples social and health care needs and improve their well being. The survey stated I have undertaken three resident reviews, from them it is obvious that Orme House listen to the views and wishes of the residents, staff will contact the relevant professionals for advice such as health authority, GP etc. and all residents I have reviewed were happy with their placements at Orme House and no concerns were raised by the residents or their families. We spoke with a visiting health care professional who told us that they were often frustrated at the quality of care provided at the home, they could not provide us with specific details at the time, but did say that they felt that the staff required further training in catheter care, such as catheter hygiene, manual handling and the ways that they communicated with people, they said that the staff interaction often left a lot to be desired. They told us that they felt that some staff were better than others, that the deputy manager was very good and always acted on their advice/directions, but they were not confident that other staff would act and pass on the information to their colleagues. We had received information from a relative of a person prior to the inspection who told us that they were concerned about the manual handling in the home and that they had never seen the stand aid that was discussed in our previous key inspection report (10/06/09), for which we had made a requirement that it be repaired should anyone need to use it. We were told at this key inspection that the stand aid had not been broken and we viewed the documentation to show that it had recently been serviced. However, when we spoke with staff about the manual handling training that they had been provided with they told us that they did not know that there was a stand aid in the home. Manual handling training is further discussed in the staffing section of this report. We had received information from two different sources prior to the inspection regarding visits with people that had been undertaken in another persons bedroom on the ground floor, due to the lack of private areas in the home where people could have visitors. We asked the homes deputy manager about this and they told us that they Care Homes for Older People Page 16 of 41 Evidence: had used the room on one occasion when the room was not occupied. They also told us that a meeting had been held in the home and there was insufficient private space where a confidential meeting could be held, so the occupier of the room gave their permission to use their bedroom. We advised that this was this practice did not respect peoples right to privacy and that peoples personal space should not be used for meetings and/or visits by people who were not connected to them or their care. We noted during the inspection that staff knocked on bedroom and bathroom doors before entering which respected peoples privacy and that shared bedrooms provided privacy screens. The AQAA stated all resident privacy and dignity are maintained at all time. A health professional survey said that peoples privacy and dignity was usually respected. During the inspection we observed that the interaction between staff and the people that lived at the home was respectful, caring and professional. We spoke with four people who lived at the home and they told us that they felt that they were treated with respect and that the staff always knocked on their bedroom door before they entered. One person, when asked if they were treated with respect said oh my word yes and that they could not praise them enough. Another person that was spoken with told us that they did not feel that they were treated with respect, however, they could not tell us why they felt this way. A person told us that their preferences had been listened to regarding their night care, however, they told us that the night staff were not always gentle with them when supporting them with personal care. Medication was stored in MDS (monitored dosage system) blister packs in a secure medication trolley, which was attached to the wall in the staff office when not in use. There was a twice daily temperature record attached to the trolley, which showed that medication was kept at an appropriate temperature. We viewed the MAR (medication administration records) charts of four people. It was noted that each held a photograph of the person, which assisted the staff to ensure that medication was administered to the correct person. It was noted that there were omissions on the MAR charts for some of the medication for one person for two consecutive days. It was noted that on other recordings the code for hospital had been recorded. We spoke with the deputy manager and they told us that the person was in hospital during the dates for the omissions. We looked at the MDS blister packs and it was noted that the medication was present, which confirmed that the medication had not been administered. Care Homes for Older People Page 17 of 41 Evidence: A person had been prescribed ensure (a build up drink) to be taken twice a day, however, there were two dates which showed that it had been administered three times. One person had been prescribed PRN (as required) medication for agitation and anxiety. The MAR charts held a PRN guidance which stated that the medication should be administered if (the person) is getting agitated with staff or residents or sitting rocking in chair, that its administration was to be authorised by a senior and only give to (the person) if talking to (the person) is not working. The medication had been administered once in the period between 22nd March 2010 to the time of the inspection, and an explanation was recorded on the back of the MAR chart, which was very unsettled. The deputy manager showed us the recording for the day in the staff handover book, which stated (the person) a bit uptight and hit out at (a person). We viewed the persons care records and there were no clear details about the ways that the person displayed aggression and the actions that staff should take to divert their behaviours. We spoke with the deputy manager about the PRN guidance and MAR chart needing further information, for example the guidance should clearly state at what point the medication should be administered and there should be a record of the the specific behaviours that were displayed and the reasons for the medication administration. Since the last key inspection there had been an appropriate controlled medication cabinet purchased. The controlled medication book was viewed, which held a running total of the medication and two staff signatures to show when the medication had been administered. We checked the medication with the running total in the controlled medication book, which was correct. We observed part of the lunch time and evening medication administration round and it was noted that the staff member verbally offered each person their medication and they recorded the administration in the MAR charts when they had seen the person take it. The staff members that were responsible for administering medication were spoken with and they told us that they had been provided with medication training, which was confirmed in the training certificates that were viewed. Care Homes for Older People Page 18 of 41 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home can expect to be supported to maintain their chosen contacts and to be provided with a choice of meals. They cannot be assured that they will be provided with meaningful activities that interest them. Evidence: The AQAA stated resident are undertaking activities as per their choice and ability and activity person attend the home regularly. The deputy manager was asked about the activities that were provided at the home, they told us that the people who lived at the home were reluctant to participate in activities and they gave us an example where they had previously played bingo on a weekly basis and the people that currently lived at the home did not wish to continue with the activity. They showed us a weekly activities programme which was previously used. The deputy manager said that there were regular visiting entertainers, that people attended the local air show in summer and that they visited Kensington Gardens (which was across the road to the home) during the warmer weather. They also said that they had plans to encourage people to plant vegetables in grow bags and flowers in hanging baskets in the back yard. They told us that there was not a dedicated activity coordinator that worked at the home. Care Homes for Older People Page 19 of 41 Evidence: We had received information from a relative of a person that lived at the home who told us that they had not witnessed activities in the home. A comment from the health professional survey that was received was I did not see evidence of a structured activity plan for the residents to participate in. Two people that lived at the home that were spoken with, told us that they preferred to stay in their bedroom, that they preferred their own company and that did not wish to participate in activities. One person told us that the staff often chatted to them in their room and that they had attended a Christmas party. One person told us that there were no activities in the home that they enjoyed, however, they said that singers sometimes visited, which they liked. Another person told us that they were disappointed that there were no activities to participate in, we asked them if they had done anything for Easter, for example, making Easter cards or bonnets and they said that there had been no seasonal activities for Easter. Another person said that they had played connect four with a staff member on the morning of the inspection, which we had observed. They told us that they liked to watch the television, but would like to have more things to keep me busy. A person told us that they attended a local church during the summer, which they were taken to by their friends. During the inspection the television in the lounge was on throughout the day, which no one appeared to be watching and we did not observe the channel being changed for people to watch the programmes that they were interested in. One person went out during the morning of the inspection and they told us that they regularly attended a day centre and used a local taxi company for transport. The service user survey asked if there were activities provided at the home that they could take part in, three answered always, four answered usually, two answered sometimes and one answered never. We viewed the care records of four people that lived at the home and each held a record of activities that they had participated in, which included watching TV, reading, speaking with staff, visiting entertainers and visits from relatives. There was no evidence that showed that people had taken part in the activities that were identified in the service user guide such as chair exercises and bingo. There was no reference to reminiscence activities. People that lived at the home that were spoken with told us that their visitors were always made welcome and that they could visit when they chose to. One person said they (their visitors) are always offered a cup of tea. We observed people entertaining their guests in the communal areas of the home during the inspection. Peoples care Care Homes for Older People Page 20 of 41 Evidence: records that were viewed identified the contacts that they chose to maintain. The AQAA told us that improvements made in the last twelve months included portable phone is in place to allow resident to speak to their relatives in private. People that were spoken with told us that they were always provided with a choice of meals, that they enjoyed their meals and that they were provided with enough to eat. A person told us that if they did not want what was on the menu they could ask for an alternative, which would be provided. They told us that they had told staff that they liked fish and the fish that they liked had been provided on the menu. The service user survey asked if they enjoyed the meals at the home, five answered always, two answered usually and three answered sometimes. During the inspection the lunch time meal was pizza and chips, or mash and fish cakes and baked beans, the deputy manager told us that it was chip day. The evening meal was poached egg and waffles. There was no fresh fruit and vegetables and it was noted that there were no bowls of fresh fruit in the communal areas that people could help themselves to, to enable them to have their five a day (vegetables and/or fruit). During the meal in the dining room, it was noted that people were provided with specialist equipment, such as plate guards, to ensure that their independence was respected. One person was observed to be assisted to eat their meal by a staff member. The staff member was standing by the side of the person and leaning on the table, half way through the meal the staff member sat down next to the person, which was a more appropriate way of assisting people with their meal. Throughout the inspection people were provided with choices of hot and cold drinks when they asked for them and in the morning and afternoon drinks round. It was noted that there were no jugs of cold drinks that people could help themselves to in the communal areas. We also visited people in their bedrooms and there were no jugs of cold drinks. One person showed us half a cup of a hot drink that they had on their table and said that they got enough to drink. Another person told us that they could get a drink of cold water from the tap in their bedroom if they wanted to, however, it was noted that there was no glass in their bedroom. Care Homes for Older People Page 21 of 41 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to be protected from abuse and to have their complaints acted upon. Evidence: The AQAA said that there had been no complaints received in the last twelve months and stated complaint procedure is in place and all visitors and relatives are aware of that. The homes complaints procedure was viewed which explained how people could make complaints about the service that they were provided with and the actions that they could expect to be taken. The complaints procedure was summarised in the statement of purpose and service user guide. The complaints folder was viewed and it was noted that the last complaint that had been recorded was 2008, the deputy manager confirmed that this was the last complaint that had been received. People that lived at the home who were spoken with told us that they knew how to make a complaint about the service that they were provided with. The service user survey asked if they could speak with someone in the home informally if they were not happy, eight answered yes and two answered no. The survey asked if they knew how to make a formal complaint, five answered yes, four answered no and one did not answer the question. The health professional survey said that concerns were usually responded to appropriately. Five staff surveys said that they knew what to do if a person had Care Homes for Older People Page 22 of 41 Evidence: concerns about the home. The AQAA told us that there had been no safeguarding alerts made in the last twelve months, however, we had been made aware of an alert that had been made by Suffolk County Council Adults Services and by the person who had raised the alert. The alert had been investigated and visits to the home had been undertaken by Suffolk County Council Adults Services Outcomes and Quality Monitoring Team and we had been kept informed of their findings. The AQAA stated all staff have enhanced CRB (Criminal Records Bureau) checks and SOVA (Safeguarding of Vulnerable Adults) training is provided to all staff to ensure that the resident are safeguarded from abuse. The staff training records that were viewed showed that they had been provided with safeguarding training. The deputy manager told us that all the staff had been provided with safeguarding training the month before the inspection, which had been provided by Suffolk County Council. Two staff members that were spoken with told us that they had been provided with safeguarding training and they were aware of the actions that they should take if they had concerns about the safety of people. The deputy manager told us that they undertaken Mental Capacity Act and Deprivation of Liberty Safeguarding training, which was confirmed by the training records that they showed us. They told us that they were aware of how and why they could make a Deprivation of Liberty Safeguarding referral. Care Homes for Older People Page 23 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that they will be provided with a clean, hygienic and well maintained home to live in. Evidence: The AQAA stated we maintain a homely, safe and odour free environment and that improvements made in the last twelve months included redecoration of some bedrooms, replaced carpet in the lounge/sitting room. The service user survey asked if the home was fresh and clean, eight answered always and two answered usually. The deputy manager told us that there was a maintenance worker that was employed at the home who undertook repairs to ensure that the environment was well maintained. A tour of the building was undertaken and it was noted that the communal areas of the home were clean and tidy. However, there were some areas that required attention to ensure that people were provided with a clean, comfortable and safe place to live in. The open plan lounge/dining/conservatory area of the home provided sufficient arm chairs for people that lived at the home, which were lined along the wall. It was noted that the room needed repainting, as the walls were discoloured and the radiator was stained and needed cleaning. There were several chairs and dining tables, all of which had plastic table cloths on them. We sat at one table and it was noted that the table cloth was sticky and needed cleaning. Care Homes for Older People Page 24 of 41 Evidence: There were four communal toilets on the ground floor, all of which were clean. However, the deputy manager said that one toilet was not used, although the door was unlocked and so accessible. There was a damp smell in the toilet and the ceiling was stained from a leak, the deputy manager said that it had come from the neighbouring building. It was not clear if it was safe to switch on the light. A light switch on the ground floor hall had sticky tape over it with a note that it was not to switched on, the deputy manager told us that it was the light switch to a light in a cupboard. We did not check this out as we were not assured that it was safe to use. The wallpaper on the stairs was raised and could easily be pulled off, which did not look attractive. The back yard was accessible by a ramp from the home to the yard, which was suitable for people who used wheelchairs. There were two benches that people could use if they chose to, this area was also used for the people that lived in the home that smoked. There were several unused/broken items of furniture, such as arm chairs and a broken bench in the corner of the yard, between the fence and the external wall of the house, which was a fire hazard. The double gates in the yard could be pushed open and they were not secured. The deputy manager told us about the plans that they had to ensure that the yard area was a more pleasant place for people to use, for example the provision of a shelter for people who smoked and flowers in hanging baskets and vegetables in grow bags. Peoples bedrooms that were viewed were personalised with peoples items of memorabilia, which showed that they could have their personal belongings around them in their personal space. There was a smell of urine in three of the bedrooms that were viewed. A comment made in the health professional survey was Orme House, on the two occasions I have visited, smelt of urine as you walk through the front door. This may be off putting for the visitors to the home. The toilet in a persons en-suite facility was out of use, the deputy manager told us that it did not flush and that the plumber was due in the next two days. The quilt in a persons bedroom was discoloured and stained with dark marks, the manager said that the stains were chocolate and/or pen that the person had used. A wash basin in a persons bedroom did not fit with the pedestal and the space between the two was very dirty. The towel rail was unsafe, one of the plastic ends of one part of the metal towel rail was missing, we pointed out to the deputy manager that this could cause injury to a person if they fell onto it. A tap in a person bedroom was continually Care Homes for Older People Page 25 of 41 Evidence: running and could not be turned off. The home provided a large attractive wet room, where people could shower, which was located on the first floor of the home. There was a supported bath on the ground floor. There was also a bathroom on the second floor, however, the deputy manager told us that this was not used. The bathroom held two hoists and a stand aid. At the last inspection we were told that the stand aid was broken and we made a requirement that it be repaired. The deputy manager told us that the stand aid was in working order and that it had not been broken. We had been told by a person that had contacted us with a concern about the home, that they had never seen a stand aid in the home. A staff member that was spoken with told us that they were not aware that there was a stand aid that could be used for manual handling. Manual handling is further discussed in the staffing section of this report. There was another hoist on the ground floor. The deputy manager told us that a hoist was used occasionally for one person and a handling belt was used for another person. The laundry was viewed, which was located in a garage area. We had been told, in the last two key inspections that they were planning to replace the garage doors with a solid wall and window, this had not yet been actioned. There were two washing machines and a drying machine, a broken washing machine was stored in the room, which the deputy manager had told us was to be removed, however, we were told this at our last key inspection. There was a hand wash skin and hand wash liquid in the laundry, however, there were no disposable paper towels for the use of staff to minimise cross contamination. On our arrival to the home, we used the staff toilet and the deputy manager told us that they had run out of disposable paper towels the day before the inspection and they were awaiting a delivery. There was a fabric towel for staff use, however, this was not appropriate for minimising risks of cross contamination. We asked the deputy manager to show us the order for the paper towels and they told us that it was dealt with by the homes provider who would bring the towels to the home when they next visited. On our tour of the building it was noted that there were paper towels in the two communal ground floor toilets and the wet room. During the inspection we observed staff undertaking good infection control procedures, which included wearing disposable gloves and aprons, when working with food, medication and supporting people with personal care. We viewed the training certificates of three staff members and it was noted that they had been provided with infection control training February 2010. Care Homes for Older People Page 26 of 41 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. People who live at the home can expect to be protected by the homes recruitment procedures. They cannot be assured that they are supported by staff who are fully trained to meet their needs. Evidence: The recruitment records of three staff members were viewed and it was noted that the appropriate checks had been undertaken to ensure that the people that lived at the home were safeguarded. The checks included identification, a photograph of the staff member, CRB (Criminal Records Bureau) checks, two written references and their work history, which was included in their application form. Five staff surveys said that checks, such as their CRB and references were undertaken before they started working at the home. The staffing rota was viewed and it was noted that the home was staffed on on a twenty four hour period. The staff on the rota was confirmed by the staffing levels that were seen during the inspection, which was three staff on each day shift, with support from the cook and domestic on the morning shift. The registered managers name was on the rota but there was no indication of when they were on duty. During the inspection we noted that the staff were attentive to the needs of people Care Homes for Older People Page 27 of 41 Evidence: and call bells were answered promptly, this was confirmed by three people that were spoken with. We asked a person that lived at the home if the call bells were answered promptly, they told us that this was not always the case, they said that the bell could be turned off on the ground floor and that the staff attended to them when they had the time. A relative of a person who lived at the home that had contacted us regarding concerns had told us that they had seen staff turn off call bells on the ground floor and say that they would respond later. The service user survey asked if the staff were available when they needed them, six answered always and four answered usually. The AQAA stated the home has 60 NVQ level 2 trained. However, during the inspection we asked the deputy manager to count the numbers of staff who had achieved a minimum of NVQ (National Vocational Qualification) level 2, they advised that some staff had achieved an NVQ level 2 and had then undertaken the level 3 award. There were twenty eight care staff working at the home (this number was taken from the rota) and the deputy manager told us that eleven had achieved a minimum of NVQ level 2 and five were working on their award. During the inspection we observed staff working with their NVQ assessor. We spoke with the NVQ assessor who confirmed the numbers of staff that were working on their award and they told us that they were working with night staff at the home, which showed that the night staff were included in the homes development programme. The home had almost met the target of 50 of staff to have achieved a minimum of NVQ level 2 as identified in the National Minimum Standards relating to older people. The deputy manager had achieved an RMA (Registered Manager Award). Staff that worked at the home were provided with an appropriate induction course when they started working at the home. The staff survey asked if their induction covered everything that they needed to know to do the job when they started, four answered very well and one answered mostly. Two newly appointed staff members were spoken with and they told us that they had attended a Common Induction Standards induction course that was provided by the local authority when they started working at the home. They told us that the content and quality of the course was informative. The training certificates of three staff members that were viewed showed that they had been provided with the previous equivalent (TOPSS) induction course. In the staff room of the home, it was noted that there was a television and a manual handling training video. The deputy manager told us that the staff that worked at the home were to watch the video, which would provide them with manual handling training. It was not clear if the training video was up to date, as it looked old and training materials were currently provided on DVD. We discussed the quality of the Care Homes for Older People Page 28 of 41 Evidence: training and we advised that whilst it was positive that the staff were provided with the training, that manual handling would require some practice with using manual handling equipment, such as hoists. They told us that the staff were to watch the video, complete a questionnaire on the information provided on the video and that the homes manager would be going through the use of equipment with the staff such as the hoists and slide sheets. There had been concerns raised with the safety of manual handling in the home from a health professional that was spoken with and information that we had received prior to the inspection from a persons relative and Suffolk County Council Adults Services. At the previous key inspection we had been told that the homes stand aid was broken and we made a requirement that it be repaired, should it need to be used. At this inspection we were told that the stand aid had not been broken and that it was in working order, which was confirmed in the servicing documentation that was viewed. The deputy manager told us that a hoist was used occasionally for a person and that a handling belt was used for another person. We spoke with two staff members about the use of the hoists in the home and manual handling training. They were not aware that there was a stand aid in the home. One staff member said that they had been provided with manual handling training and another said that they had a one day course and had received no refresher training. We viewed the training certificates of three staff members and it was noted that they had been provided with manual handling training 2006. This means that the training that had been provided was not refreshed and kept up to date. The deputy manager told us the staff that worked at the home had been provided with safeguarding training the month before the inspection, this was confirmed by discussions with the staff that worked at the home. They told us that they had not yet received their certificates. It was noted that the training that was provided was not always refreshed to ensure that the staff were kept up to date with the requirements of their roles and responsibilities. The training certificates of three staff members were viewed, all three had been provided with health and safety and first aid training in 2006. Training that had been provided 2010 was infection control, food hygiene, fire safety and death, dying and bereavement. There was no evidence to show that staff had been provided with training that they needed to meet peoples specific needs such as dementia, nutrition, administering eye drops and catheter care. The deputy manager told us that the staff had completed a Care Homes for Older People Page 29 of 41 Evidence: distance learning course in dementia but had not received their certificates and that the manager had recently attended MUST (malnutrition universal screening tool). Four staff surveys said that they were provided with training which was relevant to their role, kept them up to date with new ways of working, provided them with enough knowledge about health care and medication and that helped them to understand and meet peoples individual needs, one staff survey did not answer the question. Care Homes for Older People Page 30 of 41 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 cannot be assured that the home is managed in their best interests and that their health, safety and welfare is fully promoted and protected. They can expect that their finances are safeguarded. Evidence: The registered manager was not present during the inspection and when they were on duty was not included in the staffing rota. The deputy manager was spoken with and they told us that the provider and the registered manager visited the home on a weekly basis, which was either Wednesday or Friday. The deputy manager told us that when they visited they checked that the home was running as it should be. We asked if the provider undertook Regulation 26 visits to show that they had monitored the running of the home and spoke with people who used the services of the home regarding their satisfaction. The deputy manager was unaware of Regulation 26 visits were undertaken and the reports were not present for inspection. The annual satisfaction surveys that had been completed by people who used at the home and relatives were viewed. The deputy manager told us that they were not yet Care Homes for Older People Page 31 of 41 Evidence: summarised as they had recently been received. The AQAA stated a quality assurance is carried out on a yearly basis are satisfied with the services provided. The deputy manager told us that they were planning to make a registered manager application to us and that they undertook the managerial responsibilities of the home. We had also been told this on the previous two key inspections. The staff that were spoken with referred to the deputy manager as the manager. They were complimentary about the approach of the deputy manager, as was a visiting professional that was spoken with during the inspection. The deputy manager told us that they had achieved an RMA award. The AQAA stated the manager is suitably qualified to run the home. We had received the AQAA and it was noted that the document provided the minimum of information about the service, in areas such as what they did well and how they met the standards in the home. There were several areas that needed to be addressed in the home to ensure that the records were factual and kept up to date and to ensure that people were provided with a good quality of life. The AQAA stated a comprehensive service user guide is in place includes aims and objective of the home and that the improvements in the last twelve months included reviewed service users guide and statement of purpose. The statement of purpose and the service user guide were viewed and it was noted that the documents needed to reviewed to include up to date and factual information about the services that were provided at the home, this is further discussed in the choice of home section of this report. Peoples care plans were not kept up to date to include the required information about how their specific needs were met, this is further discussed in the health and personal care section of this report. We viewed a persons care records and it was noted that they had fallen and sustained injuries, we had not been notified of this event. We had spoken with staff about the support that they were provided with and they told us that they had several deaths at the beginning of the year, two of which were unexpected. We asked for the names of the people and it was noted that we had not been provided with notifications. We spoke with the deputy manager about the unexplained deaths and they explained the actions that were taken and the reasons for the deaths. We advised that we must be notified of incidents to ensure that we are kept informed of events in the home that effected the well being of people and that the home was Care Homes for Older People Page 32 of 41 Evidence: acting appropriately to safeguard people. People were not provided with a meaningful activities programme that they could choose to participate in, this is further discussed in the daily life and social activities section of this report. Staff were not provided with the training that they needed to meet peoples individual needs and to work in a safe manner, such as manual handling this is discussed in the staffing section of this report. Staff that worked at the home were not provided with six supervision meetings each year, as identified in the National Minimum Standards relating to older people, which provided them with the opportunity to discuss the ways that they were working and how they met peoples needs. The deputy manager told us that they were provided with supervision from the homes registered manager and that the staff team were provided with supervision meetings, they showed us a plan that they had completed to ensure that they were undertaken. We viewed the supervision records of three staff members and they showed that one staff member had been provided with one supervision 2010, two 2009, two 2008. Another staff member had been provided with three supervisions 2010, two 2009 and two 2008. Another staff member had received two supervisions 2010, one 2009 and one 2008. We spoke with two staff members and they told us that they were provided with supervision meetings, but they were infrequent. Four staff surveys said that the manager regularly met with them to give them support and discuss how they were working and one said that they often did. Peoples finances were safeguarded where they required assistance with their spending money. The AQAA stated the residents/advocate or their relatives are encouraged to control their own finance. Suffolk County Council acts as deputyship for three residents who does not have a relative. The records of three peoples spending money were viewed, which was kept in the home for safekeeping. It was noted that the running total matched with the stored money and that a record and receipts were kept of all transactions. The home did not provide a safe and hygienic place for people to live in and there were several areas of disrepair and offensive areas that needed to be addressed, this is discussed in the environment section of this report. A requirement was made at the last key inspection which stated that fire safety checks must be regularly undertaken to ensure that people were safeguarded in case of a fire. The fire safety records were viewed during this inspection and it was noted that Care Homes for Older People Page 33 of 41 Evidence: fire safety checks were undertaken on a weekly basis. There was a fire risk assessment in place, however, there was no reference to the evacuation procedures for individual people. We explained to the deputy manager that they needed to clearly identify the actions that staff were to take with each person that lived at the home to ensure that if there was a fire, staff would be aware to how people were to be or not be evacuated. Health and safety records that were viewed included environmental risk assessments and generic risk assessments for staff in areas such as manual handling, dealing with aggression and new and expectant mothers. The hoists and lift were regularly serviced to ensure that they were safe to use. The lock to the cupboard where peoples records were kept had been repaired to ensure that their confidentiality was maintained. Care Homes for Older People Page 34 of 41 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 35 of 41 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 1 6 The statement of purpose and service user guide must be reviewed and amended to provide up to date and factual information and a copy of the reviewed documents must be forwarded to Care Quality Commission. To ensure that people who use the service and prospective customers are provided with the information that they need about the services that are provided at the home. 12/05/2010 2 3 14 People must be provided with a needs assessment prior to moving into the home and they must be consulted with about the care and support that they need. 12/05/2010 Care Homes for Older People Page 36 of 41 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 To ensure that peoples assessed needs and preferences are met. 3 7 15 Peoples care plans must be regularly reviewed and kept up to date. To ensure that peoples changing needs and preferences are met. 4 9 13 The guidance for PRN (as required) medication must clearly show at what points of peoples behaviour it should be administered. To ensure that people are protected by the homes medication procedures and processes. 5 10 12 Peoples bedrooms must not 20/04/2010 be used for visits and meetings for people that are not connected to them or their care. To ensure that peoples privacy is respected. 6 12 16 People that live at the home must be provided with a meaningful activities programme. To ensure that people are provided with the opportunity to participate in 30/04/2010 20/04/2010 30/04/2010 Care Homes for Older People Page 37 of 41 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 activities that they choose to and that are of interest to them. 7 19 13 Broken items of furniture that were stored in the back yard must be removed. To ensure that people are safeguarded. 8 19 13 The gate in the back yard must be secured. To ensure that people are safeguarded. 9 21 13 Communal toilets must be repaired and made good. To ensure that people are provided with safe and clean toilet facilities. 10 24 16 Peoples bedrooms and communal areas must be clean and in good repair. To ensure that people are safeguarded and provided with a clean and comfortable home to live in. 11 26 16 Offensive odours must be eliminated. To ensure that people are provided with a hygienic and comfortable home to live in. 12 27 18 The rota must include when 30/04/2010 the registered manager is on duty Page 38 of 41 30/04/2010 30/04/2010 30/04/2010 30/04/2010 30/04/2010 Care Homes for Older People 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 To ensure that there are appropriate staffing arrangements at the home. 13 30 12 Staff must be provided with manual handling training. To ensure that people are manually handled in a safe manner. 14 31 25 Regulation 26 visits must be undertaken on a monthly basis and the reports must be kept in the home. To show that the provider monitors the running of the home to ensure peoples needs are met. 15 31 37 The registered person must 22/04/2010 notify the Care Quality Commission without delay of death, illness and other events laid out in Regulation 37 of The Care Homes Regulations 2001 To ensure that people are appropriately safeguarded and that the registered person(s) are undertaking their required duties. 16 36 18 Staff must be appropriately supervised. To ensure that they are provided with the 30/04/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 39 of 41 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 opportunity to discuss their development, how they are working and how they meet peoples needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 16 It is recommended that the complaints procedure be revisited to the people that live at the home and their relatives or representatives. To ensure that they are aware of how to make a complaint about the service that they are provided with. It is recommended that disposable paper towels be ordered in a timely manner to ensure that they do not run out, for the use of staff to minimise the risk of cross contamination. It is recommended that training be regularly be updated to ensure that staff are aware of the updated requirements of their role and responsibilities. 2 26 3 30 Care Homes for Older People Page 40 of 41 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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