Inspection on 09/02/09 for Rosemount Residential Care Home

This inspection was carried out on 9th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosemount Residential Care Home 21/07/09

Rosemount Residential Care Home 09/01/08

Rosemount Residential Care Home 11/06/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosemount Residential Care Home 48 Old Exeter Street Chudleigh Newton Abbot Devon TQ13 0JX     The quality rating for this care home is:   zero star poor 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: Judy Hill     Date: 0 9 0 2 2 0 0 9 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. 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. 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Rosemount Residential Care Home 48 Old Exeter Street Chudleigh Newton Abbot Devon TQ13 0JX 01626853416 01626852398 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mariarod Care Homes UK Ltd Name of registered manager (if applicable) Ms Rosemarie Anne Noon 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 physical disability Additional conditions: Date of last inspection Brief description of the care home Rosemount Residential Home is registered to provide accommodation and care for a maximum of twenty people who are elderly and who may have dementia or physical disabilities. Rosemount is situated close to the centre of the Chudleigh and is a short walk from the shops and other local amenities. Information about the service is available from the home in a Home Handbook and copies of inspection reports can be obtained from the home or are available on the CSCI website. Care Homes for Older People Page 4 of 31 care home 20 Over 65 0 20 20 20 0 0 Brief description of the care home The current fees are 350 pounds a week and extra charges are made for the services of a professional Chiropodist and Hairdresser, toiletries, entertainment, newspapers, taxis and items of a personal nature. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection ended with an unannounced site visit that was carried out by one inspector and an Expert by Experience on 9th February 2009. An Expert by Experience is a person who is not directly employed by the Commission for Social Care Inspection but commissioned through a voluntary organisation, in this care Help the Aged, because they have either experienced living in a care home or been close to someone who has. The Expert by Experience spent over three hours in the home talking to the people who live there. He also made observations about the premises and about the way the staff work with people. The Expert by Experiences report has been incorporated into this report. Care Homes for Older People Page 6 of 31 The information contained in this report was gained from an Annual Quality Assurance Assessment that had been completed and returned to the Commission by the registered service provider, the Home Handbook, the previous inspection report and information received about the service since the last inspection. Information was also gained in conversation with the registered service provider and some of the people who live and work at the home. Records were seen, including residents needs assessments, risk assessments and care plans, staff recruitment and staff training records, medication administration records and a record of complaints. The premises were inspected during the site visit and a meal was sampled. What the care home does well: What has improved since the last inspection? What they could do better: Although the home has a Home Handbook, some of the information that has been included in it is not accurate. There is no Statement of Purpose or Service Users Guide. This means that prospective and current residents and their representatives do not have the written information they need about the service provided. The people who use the service are not directly involved in their care planning and reviews. This means that their individual wishes and needs may not be taken into account. Several of the people who use the service told us that they would like more and varied activities, both inside and outside their home, to be provided. Negative comments are not well received or dealt with appropriately and this could place the residents at risk. Care Homes for Older People Page 8 of 31 The staffing levels need to be reviewed to ensure that there are enough staff on duty to meet the social, occupational and recreational needs of the residents, as well as their physical and personal hygiene needs. The provision of staff training needs to be reviewed to ensure that the staff have the skills they need to meet the needs of the people who use the service. An annual quality assurance programme needs to be established which includes gaining feedback from the people who live at the home, their families, their professional representatives and the staff. This is to enable the people who use the service and their representatives to influence how the service is delivered. 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.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 31 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 31 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 may use the service and their representatives do not have the information needed to choose a home that will meet their needs. Evidence: Rosemount Residential Care Home does not have a Statement of Purpose or Service Users Guides. There is a Home Handbook and this contains some, but not all of the information that is required or recommended to be included in the Statement of Purpose and Service User Guide. Some of the information that is included does not provide current and prospective residents and their representatives with an accurate description of the service provided. For example, some of the people we spoke with told us that the outings and some of the activities listed on page four of the Handbook did not take place. We discussed this with Mrs Noon and she confirmed this. We looked at some of the written individual needs assessments that had been carried Care Homes for Older People Page 11 of 31 Evidence: out by the placement authorities and the home prior to the admission of new residents. These were seen to provide the information needed to form the basis of a plan of care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical and personal care provided is generally good. The people who use the service are able to make decisions about their lives and daily routines but are not directly involved in care planning or reviews. Evidence: Individual care plans focus mainly on the physical needs of the residents, including personal hygiene, and how these needs can be met. They are well supported by individual risk assessments, which again focus on the physical aspects of care and records, which monitor the residents physical well-being and personal hygiene. The people who use the service are not directly involved in drawing up or reviewing their care plans, although some consultation does take place with some of their families and professional representatives. The residents told us that they were able to take baths whenever that wanted to and records showed us that most of the residents are helped by the staff to take baths Care Homes for Older People Page 13 of 31 Evidence: several times a week. We observed that all of the residents were clean and well dressed in freshly laundered clothing. Although several residents are incontinent, none of the obvious signs were detected during our site visit, which tells us that care of continence is very good. Rosemount is registered to provide care for people with physical disabilities. Two of the residents use wheelchairs but most of them can walk independently, albeit in some cases with the assistance of a walking frame. One person said that she would like to walk more for exercise but that she needed help from a carer and that this was not always available. The residents medication is administered by trained care staff. We looked at the storage facilities and these were suitably secure. We also looked at the medication administration records and these were clear and up to date. The staff administering medication do not know what all of the medicines that they are administering are used for and possible side effects that they need to look out. It would be good practice to keep this information with the medication administration record sheets for easy reference. Feedback from the residents tells us that they are generally happy with the way the staff treat them. They said that they are able to go to bed and get up in the morning when they choose to. Some people said that they liked to wake naturally while others preferred to be woken at a time of their choosing. One resident said that the staff sometimes bring her a much appreciated cup of tea when they come to wake her. There are four double bedrooms at the home and although nobody objected to sharing a bedroom, some of the people spoken with did indicate that they would prefer a bedroom of their own. Care Homes for Older People Page 14 of 31 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. Although the residents are able to exercise some choice on their daily lives, their social, occupational and recreational needs are not being met. Evidence: Although the residents rights to make decisions in some aspects of their daily lives are respected. The care planning practices, which exclude direct consultation and input from the people who use the service, do not given sufficient weight to their social and psychological wishes and needs. We discussed the impressive list of activities listed in the Home Handbook with service provider and some of the residents and established that most of the activities included are not actually provided or facilitated by the registered provider and never have been. Only one group outing was arranged last summer and the staffing levels are not high enough to enable the staff to take the residents out regularly on a one to one basis. One musical entertainer visits the home weekly and another monthly. Activities including bingo, craft afternoons, skittles and games are organised and Care Homes for Older People Page 15 of 31 Evidence: facilitated by the staff. Dispute this several residents told us that they were bored and that there was nothing to do except watch the television. Rosemount does not have a garden, but does have a courtyard which can be accessed from the lounge. There is a roof terrace but this is not accessible to the residents for reasons of safety. The registered provider told us that a minister visits the home to provide Communion but only once every two or three months, not all of the residents we spoke with were aware of this. Mrs Noon told us that a voluntary car service will take people to and from a local Church on Sundays. The residents are able to receive visitors at any time in the privacy of their bedrooms or in the communal lounge. A professional chef is employed to prepare the residents breakfast and evening meal and to cook the residents lunch. A choice of two set dinners and puddings is always offered at lunch time and the staff ask each of the residents which they would prefer. We asked the residents for their views about the food provided and received nothing but praise for the quality of the meals. On the day of the site visit the choice of dinners was chicken pie or toad in the hole with fresh and frozen vegetables and gravy, followed by treacle sponge and custard or strawberry whirl. Fresh fruit was provided on a side table for the residents to help themselves to. The Expert by Experience ate a meal with the residents and confirmed that his meal was tasty, suitably hot and well presented. None of the current residents needed any help to eat their meals and very little food was left on the residents plates. We were told that the home is currently catering for two people with diabetes. The home also provides a Meals on Wheels service to seven people living in the community. Care Homes for Older People Page 16 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are not dealt with appropriately and this could place the residents at risk of abuse. Evidence: A summary of the complaints procedure is displayed in the hall. The registered provider told us that she had not received any complaints in the last twelve months. However, the Commission received a complaint from the family of a former resident. This was forwarded to the home and responded to by the registered person. During the site visit we spoke with a number of residents and although most of the comments we received were very positive, some negative comments were made by several people. We fed some of the positive and negative comments back to the registered provider and found her response to the negative feedback, and about the person she thought had made them, unnecessarily defensive and hostile. Policies and procedures are in place to protect the residents from the threat of abuse and the staff have received training on the Protection of Vulnerable Adults. However, we are concerned that the service providers response to negative comments, including a subsequent letter forwarded to us from a relative of the person she attributed the negative comments to, could leave the residents at risk of abuse. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Considerable improvements have been made to the Rosemount but there is still work to do to bring the presentation of the home up to a good standard for the people who live and work at there. Evidence: Rosemount Residential Care Home is a large end of terrace house that is situated close to the centre of Chudleigh. The home has limited of street parking space but is within five minutes walk of the town centre car park. There is a very small garden area but this is not directly accessible to the residents from their home. There is also a roof terrace, but we were told that this area was not safe for the residents to use unaccompanied. There is a large open plan lounge that leads through to a large dining area. This room is attractively decorated and comfortably furnished. The residents bedrooms are on the ground floor and the first floor and there are two staircases, both with stair lifts to aid the residents mobility around the home. None of the residents spoken with expressed any difficulty getting around the home apart from one resident who said that she needed the assistance of a care worker for safety when Care Homes for Older People Page 19 of 31 Evidence: walking and that she would like to take more exercise by walking along the corridor but there were not always enough staff on duty to help her. During the site visit we visited most of the rooms in the house and found them to be clean. Some of the residents had personalised their bedrooms, but other bedrooms appeared a little stark. The home has four double bedrooms, all of which are currently occupied. We asked some of the residents if they minded sharing a bedroom. One resident told us that she would prefer to have a bedroom of her own, others said that they did not mind sharing. As residents should only be required to share a room if they have made a positive chosen to do so, single rooms should be offered to people sharing as and when they become vacant. The home has ample communal bathrooms and toilets and these are conveniently situated. It was observed that a cup hook had been placed on the outside of one of the bathroom doors. This was removed at our request as it could be used to lock a resident inside the bathroom. Most of the bathrooms and toilets did have suitable locks, which can be used from the inside of the room and opened by the staff from the outside in an emergency. There is an ongoing programme of maintenance and although there is still work to do, the presentation of the home has improved since the last inspection. The laundry and kitchen are both suitable for the needs of the home. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are clearly very caring, but the staffing levels and the provision of staff training could be better. Evidence: We looked at staff recruitment records and safe practices are being used to employ new staff. We were told that induction training is provided and records were seen to support this. Records were seen which show that on-going training is provided, although there are gaps in the provision of some of the health and safety related training, such as infection control, basic food hygiene, and first aid and in the provision of specialist training, for example in dementia care. We were given a copy of the rota and this showed that there are usually two care staff on duty from 7am to 9pm. In addition to this there is either the assistant manager or a third care worker on duty from 8am to 4pm. A Chef is employed for 5 hours a day and a cleaner for three hours a day. One waking night carer is employed from 9pm to 7am. Three members of staff live on Care Homes for Older People Page 21 of 31 Evidence: the premises and we were told that they take it in turns to provide sleeping in cover. We were concerned that the care staffing levels appear to be low given the number and needs of the people who use the service and some of the residents said that they felt that the home was a little short staffed at times. Most of the residents were very complimentary about the staff saying, I am very happy with the way they look after me here, no complaints, they teat me well, the staff know what they are doing and are very nice, so caring, all the staff are very nice. We were told that five of the fourteen care staff had completed a National Vocational Qualification in Care and that a further two were working towards gaining this qualification. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The good management practices are being undermined by the registered providers reluctance to involve the people who use the service in planning their care and quality monitoring. Evidence: Mrs Rosemarie Noon is the registered owner of Rosemount and she is also the manager of the service. Mrs Noon has completed her National Vocational Qualification in Care at Level 4 and her Registered Managers Award. She has completed a communications course with the NVQ and attended a training course on the Mental Capacity Act. Mrs Noon is very experienced in the provision of care and has attended training to update her practical and theoretical knowledge. However, she may benefit from further training in person centred planning, quality monitoring, dealing with complaints. There is no effective quality assurance or quality monitoring system in place, which Care Homes for Older People Page 23 of 31 Evidence: seeks the views of the people who use the service and their professional representatives and the staff. The home had sent surveys to the relatives of some of the residents but few had been returned. The Commission sent surveys to the home for the staff and the residents to complete and return. None were returned by the staff and Mrs Noon phoned us to say that she would not be distributing the surveys to the residents. The AQAA tells us that the home does not handle any of the residents money and that people coming into the home are encouraged to arrange for a family or legal representatives to manage their financial affairs. This is recognised as an example of good practice. The day to day supervision of the staff is good and the staff rota tells us that there is always a named person in charge when the registered manager is not on duty. However, individual one to one staff supervision is not provided. The AQAA identifies that most of the recommended policy documents are in place and that they were updated in May 2007. Exceptions include an Annual Development Plan and policies and procedures on individual care planning and review. Regular service checks are carried out on gas and electrical appliances and on fire detection and fire fighting equipment. Care Homes for Older People Page 24 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4, 5 & Schedule 1 The registered person must 10/04/2008 produce a written Statement of Purpose and a written Service Users Guide. These documents must include all of the information listed in regulations 4 & 5 (including Schedule 1) of the Care Homes Regulations and should also include the information listed in Standard 1. Copies of both documents must be sent to the Commission and each of the people who use the service must be given a Service Users Guide. 2 7 15(1) & 15(2) The registered person must 10/04/2008 ensure that each resident and/or a representative, who could be a family member, is directly involved in developing and reviewing their plan of care. This should include a review of their needs assessment, individual risk assessments and risk management plans and care plans. 3 27 18 The registered person must 10/02/2008 review the care and ancillary Page 25 of 31 Care Homes for Older People staffing levels to ensure that they are high enough to meet the number and needs of the residents. 4 30 18 The registered person must 10/07/2008 ensure that all of the staff receive the training they need to meet the needs of the people who live at the home. This should include induction training, health and safety related training and any specialised training needs identified the individual assessments and reviews of the residents needs. 5 33 24 The registered person must develop her quality assurance programme to enable her to produce a development plan for the service, which incorporates the views of the people who use the service and their representatives. 10/07/2008 Care Homes for Older People Page 26 of 31 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 4 The registered person must 10/04/2009 produce a written Statement of Purpose. This documents must include all of the information listed in regulations 4, including Schedule 1, of the Care Homes Regulations and should also include the information listed in National Minimum Standard 1. The Statement of Purpose must be kept at the home and available to the prospective and current residents and their representatives on request. To ensure that the people have access to the information they need about the home and the service they can expect to be provided. 2 1 5 The registered persons must 10/04/2009 produce written Service Users Guides. This document must include all of Care Homes for Older People Page 27 of 31 the information listed in regulation 5 and should also include the information listed in National Minimum Standard 1. Each of the residents must be given a Service Users Guide. To ensure that the residents have access to the information they need about the home and the service they can expect to be provided. 3 7 15 The registered person must 12/03/2009 consult the residents when preparing and reviewing their individual care plans. If a resident is not considered to have the capacity to contribute, clear evidence should be provided to support this assumption. This is to enable the residents to retain control of their lives. The registered providers must consult the residents about their social interests and make arrangements to enable them to engage in a range of activities both inside and outside their home environment. This is to prevent them from getting bored. 5 16 22 The registered person must 16/03/2009 give each of the residents a written copy of the complaints procedure. All complaints must be recorded 10/04/2009 4 12 16 Care Homes for Older People Page 28 of 31 and dealt with using the homes complaints procedure. To ensure that the residents right to complain is respected and to ensure that all complaints are dealt with appropriately. 6 27 18 The registered provider must review the care staffing levels. to ensure that there are always sufficient staff on duty to meet the physical, mental and social needs of the residents. 16/04/2009 7 30 18 The staff must receive 16/08/2009 training that is appropriate to the work they are to perform. This training must include health and safety related training and specialist training that is based on understanding and meeting the needs of people with dementia. To ensure that they have the skills they need. 8 33 24 The registered person must 16/05/2009 establish and maintain a system for reviewing and improving the quality of care provided at the home. This system must provide for consultation with the people who use the service and their representatives. Care Homes for Older People Page 29 of 31 To enable the people who use the service to influence how the service is provided. 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 9 To ensure that the staff have the knowledge they need to administer the residents medication safely, it would be good practice to keep information sheets that include what each item of medication is needed for it is needed for and possible side effects, with the medication administration records. To ensure that people only share a bedroom if they have requested to do so, single bedrooms should be offered to each of the people who are currently sharing a room when single rooms become available. The registered provider should ensure that the residents are able to maintain a presence in the community by offering them take them out on a regular basis. The registered manager should update her training in aspects of care which relate person centred planning and review, complaints, protection, quality assurance, quality monitoring, communication and dementia care. Formal supervision should be provided for the care staff at least six times a year. This supervision should cover all aspects of practice, the philosophy of care in the home and career development needs. Policies, procedures or codes of practice should be written up detailing the pracices that need to be put into place for individual care planning and reviews and producing an Annual Development Plan. 2 10 3 14 4 31 5 36 6 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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