Inspection on 12/12/08 for Rosedene Residential Home

This inspection was carried out on 12th December 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rosedene Residential Home 02/02/07

Rosedene Residential Home 06/01/06

Rosedene Residential Home 12/07/05

Rosedene Residential Home 10/02/05

Rosedene Residential Home 02/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosedene Residential Home Rosedene Residential Home 29/31 Westonville Avenue Westbrook Margate Kent CT9 5DY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Eamonn Kelly     Date: 1 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Rosedene Residential Home 29/31 Westonville Avenue Rosedene Residential Home Westbrook Margate Kent CT9 5DY 01843220087 Telephone number: Fax number: Email address: Provider web address: richardraj@rosedenerch.freeserve.co.uk Name of registered provider(s): Name of registered manager (if applicable) Vivenne Conway Type of registration: Number of places registered: Richard Anthony John Raj care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The home provides accommodation and personal support for up to 21 older people. Bedrooms are situated on the ground and first floors. A stair lift connects the floors. There are 17 single and two shared bedrooms. The premises are close to the beach. Car parking is available at the front of the building and on the street. Weekly fees and other charges are available from the manager and are described in personal contracts when residents take up residence. Examples of additional charges are: hairdressing, chiropody, newspapers, limited contribution towards some costs of outings, private telephones, private medical costs including dentistry, Sky TV or Freeview costs. 0 Over 65 21 Care Homes for Older People Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 inspection took place on 12 December 2008. The methodology used to produce the report includes reference to the AQAA (annual quality assurance assessment) submitted by the manager (Mrs Vivienne Conway), meetings with the manager and members of staff and meetings with most residents. The AQAA outlined some of the areas that have been improved for the benefit of residents and areas of practice that need further development. The profiles of three residents were assessed in some detail and the relevant care plans were seen. The inspection included a visit to most parts of the premises. Some records used for supporting residents were checked. The outcomes of the previous inspection report were checked. Checks were also made of information known to the Commission about the service. In keeping with the Care Homes for Older People Page 5 of 28 Commissions policy of looking closely at specific regulations and standards from time to time some emphasis was placed on this occasion on how well the service meets Standards 18 and 29 (protection and recruitment). The previous report contained no requirements. This report contains no requirements or recommendations. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their supporters receive initial advice and guidance to help them assess the facilities and suitability of the home. This includes provision of a residents guide that describes services and facilities. Evidence: Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. They receive a written guide that contains information about services and facilities. New residents receive a personal contract that contains information on the rights and responsibilities of both parties. The manager carries out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers. Some residents have Care Homes for Older People Page 9 of 28 Evidence: support needs associated with the on-set of dementia as well as substantial mobility problems and other disabilities. The care plan record begun at this stage outlines the support needs of the prospective resident and how these needs would be met. A review of two care plans for recently admitted residents provided useful insights into how residents are supported at this stage. Both residents were satisfied with the support given then and subsequently. The manager carries out a pre-admission assessment before all admissions. A checklist and associated notes are taken at this stage that form part of subsequent care plan records. In the case of two recently admitted residents, care plan records showed that their health requirements had been checked in detail and that their specific support needs were identified. In both situations, assessments provided by local authorities were found to be lacking and re-adjustments were required to their original suppport package. Potential residents may not always visit the home prior to taking up residence. However they (and their representatives) are invited to do so. The home occasionally admits residents for respite care. Care Homes for Older People Page 10 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive excellent support on a day-to-day basis to remain mentally and physically active and alert. The objective of the home is to help residents gain and retain their independence. Evidence: Care plan records seen for three residents contained good information about residents support needs and how these are being met. They contained good personal profiles of residents. An outline profile is initially obtained and this is followed by a more detailed profile with the participation of the resident and family members. According to the manager, care plans are an increasingly effective operational tool for staff. The evidence is that members of staff are using care plans to identify the changing needs of residents and record how support should be provided. Residents care plans have a great deal of information about their support needs. In particular, risk assessments in each residents personal file identify the relevant issues associated with his/her continuing support and, in the examples seen, have recently been updated. Care Homes for Older People Page 11 of 28 Evidence: The senior carer completes daily records in respect of important aspects of residents health and changes in health or disposition. These issues are discussed during staff changeover to enable in-coming staff to be aware of changes in residents temperament or health. During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of three residents and how they are supported also indicate a high level of understanding of and respect for clients. Where difficulties occur in the continuing support for some residents, there was evidence that care managers and family members are involved in reviews and any necessary changes in the levels of support. GPs visit as necessary and members of staff sometimes bring residents to GP surgeries. The services of district nurses are routinely obtained. Difficulties in obtaining access by residents to dentists have been oversome. Residents have good access, according to profiles of residents discussed during the inspection and records checked, to local NHS community services. There is close contact with local PCT nurses who, for example, provide and change dressings. Two new residents said they receive very good healthcare support particularly when they were feeling most vulnerable. They also said that carers have a good understanding of the difficulties faced by residents and are skilful in providing the personal support needed. Residents have good access to dentists, chiropodists and opticians according to current care plans. The senior carer explained how medications are administered and how unwanted medicines are recorded and disposed of. MAR sheets are completed at the time of administration. A photograph of each resident accompanies their MAR sheet. In the case of residents receiving respite care, a MAR sheet is completed manually to control and supervise their medication administration. The manager said that only those members of staff who have received specific training are allowed to administer medication and update MAR sheets. Based on the evidence of information in the selection of records seen, members of staff have access to good information about residents support needs and how these are being addressed. There was also evidence of reviews of residents health with outcomes of formal reviews recorded. An important declared aim of support is to help residents remain as independent as possible. This involves encouraging them to move around on their own with any necessary staff observation. Generally for this purpose, residents are encouraged to not use wheelchairs within the premises but they have access to wheelchairs when they go out. Members of staff help residents who have hearing aids to keep them in working order Care Homes for Older People Page 12 of 28 Evidence: and they encourage them to continue using the aids. Records indicate that residents weights are recorded monthly or more often if necessary. GP or dietician involvement is sought where there are concerns. The AQAA outlined how progress has been made during 2008 in, for example, delegating a senior member of staff to deal with audiology matters, improving carers and cooks knowledge of residents dietary needs, acquiring a Skills for Care accredited palliative care training resource and enabling some staff to complete the 12 week distance-learning medication administration course. Care plans seen and discussion of profiles of residents indicate that good end-of-life planning is carried out. This includes more recent improvement in the ways residents wishes are discovered and how these are recorded in care plan records. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive excellent support on a day-to-day basis to remain mentally and physically active and alert. The objective of the home is to help residents gain and retain their independence. Evidence: Residents may receive visitors at any reasonable time and the service encourages this continuing contact. The AQAA states that efforts are continuing to be made to involve residents family and friends in helping with day-to-day activities. Members of staff have a good understanding of each residents personality and disabilities. Where residents have disabilities members of staff communicated well with them. This was the evidence from the care plans seen and observation of residents to whom they referred. The AQAA states that residents and family members are encouraged to say what they feel and to give their views about any issue they feel affects them. Residents gave examples of particular activities promoted by the service. There were a number of examples seen during the inspection that suggested they are helped in a number of ways to remain mentally and physically active. This included staff assisting residents Care Homes for Older People Page 14 of 28 Evidence: on a one to one basis, helping them to walk about the premises including using the stairs and stair lift, provision of books and newspapers, talking to them, providing music and helping residents visit the garden. Care plans have been extended to include activities most likely to interest residents and efforts are made to provide these activities. A notice board outlines planned activities and proposed outings over the coming weeks. Residents referred to the range of activities within the premises and to trips out. They have the use of a minibus and residents spoke of how often this opportunity is used. During the inspection, there was a positive atmosphere and carers were working actively with residents when they were not engaged in household activities. There are several communal areas throughout the premises and residents may choose which area they wish to use. An outline of residents interests, expectations and capabilities is kept in their care plan records. In the preceding section of this report, reference was made to the preparation of a detailed personal profile of each resident and updating of this profile at intervals. During the inspection, three residents spoke of the benefits to them of the way their profiles are developed and of how they are encouraged to keep them updated. Two residents referred to how well staff do in helping them remain mobile, to spend time in lounge areas meeting staff and other residents and to have meals in the dining area. They gave examples of how they are involved in life at the home and how they are helped and encouraged to make decisions about how they use their time. There are a number of activities each day. Some were observed on this occasion. The record of activities displayed closely matched the actual programme. Residents gave examples of outings arranged for them during 2008 and possible outings for 2009. Residents are helped to attend church if they express a wish for this. Some residents spoke of the importance of this help and understanding. Detailed nutritional assessments are carried out and recorded in care plans. The cook keeps written information about residents food intake. Weights are recorded at least once a month. In three instances discussed, residents made good recoveries after they took up residence when their health was failing rapidly at that stage. The lunchtime meal was observed during the inspection. Over lunch, some residents were assisted. Residents referred to choices of meals, to the way meals are served and to how they enjoy the occasion with fully laid tables including linen tablecloths and serviettes. Over lunch, a resident said that she receives attention to ensure she follows a low chloresterol diet. The AQAA referred to improvements during 2008 in providing Care Homes for Older People Page 15 of 28 Evidence: more information for staff on dietary requirements. Individual meals are transported to residents who are unable to leave their bedrooms (or had expressed a real wish to remain in their room). The written statement of purpose, available to new and current residents, says there is a hot/cooked component at most evening meals and, during the inspection, residents indicated they were content with the arrangements. The home provides 3 main meals, drinks at regular intervals and a suppertime drink/snack. Cold drinks are served to residents in lounge areas and bedrooms at regular intervals. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected from abuse by the vigilance and expertise of staff. They are well supported and their views are listened to and acted upon. Evidence: The AQAA states that members of staff, residents and visitors are aware of the complaints procedure and that all comments about the service are welcome. It states that residents and visitors are involved in saying how improvements would be of benefit to them. One way of doing this is through quality assurance questionnaires sent to families, friends and advocates. According to the manager, visitors are closely involved in all aspects of the service and a copy of the complaints procedure is made available in the written guide. Members of staff receive training in matters associated with POVA (protection of vulnerable people) and the manager said she is confident carers would understand if abuse is occurring and how they should report it. She said that she and senior members of staff have a good knowledge of adult protection procedures followed by Social Services departments. The Commission received no complaints about the service during the past year and the manager confirmed that no safeguarding issues are currently in progress. Care Homes for Older People Page 17 of 28 Evidence: The annual quality assurance assessment (AQAA) states that members of staff are aware of all the necessary procedures relating to protection of residents. Specific training on the wider implications of POVA (protection of vulnerable adults) forms part of the improvements in staff training and development being put in place. The commission is advised of notifiable incidents Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for use by frail older people. Residents live in a comfortable and well maintained environment and benefit from the ongoing improvement programme of redecoration and routine maintenance. Evidence: Radiators are covered for the safety of residents. Hot water outlets accessible to residents are temperature controlled and are manually checked, the manager said, each week for safety reasons. The AQAA contained declarations relating to safety checks and associated safety certificates being in place and up-to-date. The AQAA refers to how residents are involved in aspects of bedroom refurbishment and new carpets and new dining room and lounge chairs being purchased. As part of the ongoing upgrading of premises, en-suite facilities are being added where possible. Communal areas and all bedrooms were visited as part of the inspection. Lounges, dining area and bedrooms are decorated and furnished to a high standard. All parts of the premises at the time of the visit were clean, odour free and in a good state of repair. Residents spoken to said they like their bedrooms which are all individual and personalised. The premises are safe and comfortable. Indoor and outdoor facilities are suitable for Care Homes for Older People Page 19 of 28 Evidence: residents. Single bedrooms are comfortable and well furnished. Shared bedrooms are likewise well furnished and are suitable for use by 2 residents. A curved stair lift assists residents to the first floor. Residents are provided with a call bell handset for use in their bedrooms. The service provides a designated smoking area for residents. There is a high level of attention given to maintaining all areas of the premises. The home has a sluicing room (previously a bathroom) on the first floor. Several residents said they enjoy the use of the main communal bathroom with its Parker bath/jacuzzi. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of being supported by an effective staff group. Evidence: Three staff files seen indicated that all new members of staff complete an application form, 2 written references are taken up, CRB checks are completed and induction/supervision/training follows. The manager has an up to date list of staff available showing names of staff, the CRB reference number, date of check and a reference to the outcome. The example of the induction procedure seen showed that the procedure meets Skills for Care standards. Twenty-four hour care is provided. Two members of staff are on duty at night. A senior carer, three care assistants, cook, domestic worker and maintenance person were at the home during the inspection visit. The manager was also present. Members of staff felt that there were sufficient staff on duty to meet the support needs of residents. The support needs of residents are met by the efforts of a skilled group of staff. The manager has developed a procedure of staff apprenticeships for inducting and training new members of staff. Case tracking exercises indicated that residents are assessed in detail before admission, arrangements are made to meet each residents support needs and every effort is made to meet their health and social care needs including Care Homes for Older People Page 21 of 28 Evidence: when needs become critical. This includes, according to the manager, ensuring that staffing levels always correlate to the current needs of residents. The AQAA also states that during 2008 a Skills for Care accredited training resource was obtained to meet the needs of residents and assist staff in meeting these needs. According to the training records seen, most carers have achieved an NVQ certificate and training is provided in all essential areas, for example, first aid, moving and handling, infection control, medication administration, food safety, fire safety and health and safety. A member of staff outlined how special attention is given, for example, to fire safety where staff are made aware of exactly what must be done if fire breaks out. A resident was also aware of the procedures. The induction procedure is part of the apprenticeship scheme in operation. Members of staff met during the inspection had a good knowledge of residents support needs. Care staff are encouraged to obtain NVQ Level 2 in Care and most staff have achieved the qualification or are undertaking it. Examples of formal supervision were seen and these indicated that staff are able to discuss all aspects of how they are supporting residents. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a service that is well managed and that acts in their best interests. Evidence: The service has what the AQAA describes as a structured managment team that helps the owner achieve good outcomes for residents. The registered manager has achieved the registered managers award and has managed the service or worked there for some 16 years. The matron likewise has worked there for a similiar period of time and is appropriately qualified. The duty manager has completed qualifications in care and management and is an experienced member of staff. New members of staff have, where necessary, the benefit of being trained within an apprenticeship scheme. The induction procedure meets or exceeds the standard laid down by Skills for Care, the training body for the care sector. Residents with high dependency needs are supported well. They receive excellent healthcare support. The stated objective is to help residents to remain independent Care Homes for Older People Page 23 of 28 Evidence: even when their physical and mental capabilities are failing. The evidence is that this objective is being met. Some residents look after their legal and financial affairs. In other cases, a trusted relative or solicitor has accepted this responsibility. Where residents are judged to be no longer able to conduct their legal or financial matters, the home has strict procedures for assisting residents and relatives in identifying independent representation. Where additional charges are levied, invoices are presented and receipts for all services are maintained. The manager and matron undertakes formal staff supervision (approximately every 4 to 6 weeks) of which a record signed by both parties is kept. Files were seen during the inspection that indicated all relevant safety checks and associated records are maintained by the manager. The examples seen were PAT (portable appliance tests), fire alarms and equipment, gas appliance tests and stair lift maintenance. As a result of new requirements under fire safety regulations in force from 2007, the manager commissioned a new fire safety assessment carried out by a person qualified to do so. The AQAA contained declarations that all necessary safety checks have been carried out. There was evidence that quality monitoring procedures are carried out. The manager also outlined the advantages accrueing from, for example, questionnaires given to residents and visitors, residents meetings and how the outcomes are followed up and staff meetings to discuss how to resolve issues and improve the lives of residents. As part of updating policies and procedures, the manager outlined how she is using the list shown in the AQAA to check the current availability to staff and to update these as necessary. The manager indicated that progress would be described in the next AQAA. The current AQAA refers to how key-workers work closely with residents and, as part of this, encourage residents to articulate their views and feelings. This procedure also plays a part in putting outcomes from the Putting Our Residents First Survey. Residents help to prepare the monthly menu plan. They help choose the activities they wish to do or continue including outings. There was a restructuring of staff hours to accommodate requests for a wider choice of bathing times. In connection with equality and diversity, the AQAA states that residents wishes and rights are valued. There is reference to progress on implementing the Mental Capacity Act where this might be necessary. During the inspection, the manager was aware of the need to develop a policy on DoL (Deprivation of Liberty) by April 2009 as part of the more general development of policies available to residents. Care Homes for Older People Page 24 of 28 Evidence: There is a useful assessment in the AQAA of current barriers to improvement. The need to achieve improvement within limited funding arrangements is one area analysed. Maintaining a budget for staff training and achieving good staff pay levels to retain staff are regarded as objectives being met. Access to a local church minibus is enabling outings to be continued. The purchase of good food and presentation of meals in congenial settings are regarded also as objectives that must be and are being achieved. The support of residents by the presence of trained staff in sufficient numbers is regarded as essential to the ethos of the service. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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