Inspection on 02/04/09 for Russettings

This inspection was carried out on 2nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Russettings 03/04/08

Russettings 22/11/07

Russettings 23/05/06

Russettings 08/11/05

Russettings 27/07/05

Russettings 28/02/05

Russettings 20/11/04

Russettings 29/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Russettings Mill Lane Balcombe West Sussex RH17 6NP     The quality rating for this care home is:   one star adequate 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: Ann Peace     Date: 0 2 0 4 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 30 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 30 Information about the care home Name of care home: Address: Russettings Mill Lane Balcombe West Sussex RH17 6NP 01444811630 01444811932 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) : Alpha Health Care Ltd care home 45 Number of places (if applicable): Under 65 Over 65 45 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 45. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Russettings is a care home with nursing registered to provide accommodation for forty-five service users within the category OP (Old age, not falling within any other category). The home is located in Balcombe village, close to local shops. The village is situated between Haywards Heath and Crawley town centres. The home consists of three floors, two of which provide service user accommodation and communal space. Both floors are accessible by passenger lift. The establishment was registered with the current provider in January 2003. Alpha Health Care owns Russettings and the Responsible Individual is Mrs Sian Sobti. There Care Homes for Older People Page 4 of 30 Brief description of the care home is a new manager in post who plans to apply to The Commission to be registered. The current fees range from 775 pounds-780 pounds per week. Extra services, which include hairdressing, chiropody are not included in the fee. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the residents who use the service experience adequate quality outcomes. The inspection visit was carried out by Mrs Ann Peace on Thursday 2nd April 2009. Suni Chotai Pharmacist Inspector also visited the home on 2nd April 2009 to assess the medicines management. Planning for the visit took into account information received about the home since the last visit including information from outside agencies, surveys returned to us from residents their relatives and health professionals. On the day of the visit we toured the home, spoke to residents, managers and staff and looked at records relating to residents and the general running of the home. We Care Homes for Older People Page 6 of 30 observed staff directly and indirectly in their interactions with residents and noted that residents were at ease with the staff and staff were friendly, caring and respectful with residents. We sampled six sets of residents records including individual assessments, care plans and medication records. Other records included recruitment and training records, complaints, company monitoring reports and records related to health and safety. We found that some of the records for medication, care and staff training were not up to standard and requirements have been made. We were pleased to note that a new manager and deputy manager have been appointed and commenced work in February 2009. Unfortunately shortfalls in the running of the home and the quality of the record keeping occurred prior to their recruitment. We did note that they had already identified some of the concerns highlighted by our visit but had not had time to address all of the issues, although we did note and were told that the home had improved since they had been in post. 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.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 8 of 30 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 9 of 30 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. A statement of purpose and service user guide is available and is being updated to reflect the new management structure. All residents have a contract/statement of terms and conditions. The majority of pre assessments and assessments are good but some nutritional assessments are not up to standard. Intermediate care is not offered at Russettings. Evidence: The statement of purpose and service users guide which tells people about the service is presently being updated to reflect the new management structure. However the basic information is still available in the foyer of the home. We looked at six sets on assessment records and found that prospective residents are being assessed although some of the nutritional assessments are not up to standard, are not consistent and are contradictory which could lead to residents not getting the nutrition they need. Other Care Homes for Older People Page 10 of 30 Evidence: assessments are in place and show what staff need to know to meet residents needs, these are followed up with risk assessments and care plans. We were told that people had been given enough information about the home home to make an informed choice. Prospective residents and their families or representatives are able to visit the home pre admission and spend some time to see what it is like to live in the home. Intermediate care is not offered at Russettings although respite care is available. Care Homes for Older People Page 11 of 30 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. Residents told us that they are well looked after by a caring team of staff. They said staff listen to them and act on what they say. All residents had an up to date care plan although nutritional assessments and nutritional care plans need to be improved as some are contradictory and could put residents at risk. The home needs to improve on accurate record keeping so that a clear medicine history and profile for residents is available. Evidence: All residents have care plans which had been audited monthly although some problems with nutrition had not been picked up during the audits. All information from assessments had been transferred to care records although some not accurately. Baseline observations were recorded on admission which showed the health status of the resident. Records also showed that information had been gathered on life history, life events, formative years, occupational history, wartime history, hobbies and interests, religion, preferences for food and bed times are recorded as are Drs and other health and social care professionals visits. Care Homes for Older People Page 12 of 30 Evidence: Risk assessments are carried out and include: manual handling, continence, dependency rating, waterlow for pressure areas risks, nutrition, falls. Other records indicated that the need for cot sides has been risk assessed and consent sought. Day and night time records on the health and welfare of residents are kept. All surveys from residents and their relatives were positive about the home and said they are cared for well by the staff. During the visit all residents spoken to were very pleased with the way they are being looked after and all said that the home had got better since the new manager and deputy manager had arrived. We could see that staff do respond to individual needs, one entry in the records from night staff said that they had been into a residents room and it felt cold so they got another heater and put it in the room. During the visit we heard one resident say to a member of staff who had gone into help with washing that they thought another member of staff was coming to help her, the member of staff was very polite and said that they would get the other member of staff if the resident preferred, however the resident was quite happy to be helped with who had arrived. When one resident was taken into the lounge, before the carer left she offered to get the resident a newspaper and when she came back with it she stayed and talked about what was in the news on that day. We did observe directly and indirectly the interactions between the staff and the residents and noted that staff are friendly caring and professional in their manner, residents were at ease with the staff. Surveys from four GPs did highlight concerns that they found in the home these included the lack of monitoring residents health and poor communication in the home. However these surveys were completed before the present manager and deputy manager were in post. When we asked about these problems we were told that the managers had recently attended a meeting with the GPs and did acknowledge that there had been problems in the past but that they had now compiled an action plan to ensure these problems were dealt with. We were shown the plan. Some concerns in the surveys from GPs were about poor palliative care in the home. We noted that residents who were being nursed in bed looked clean and comfortable and records of their ongoing care were up to date. However this will be re assessed at the next visit to ensure the improvements are sustained. Care Homes for Older People Page 13 of 30 Evidence: Problems identified during this visit included: one residents nutritional assessment was contradictory, it said there was a high risk of malnutrition but the recent care plan audit said no problems although records of weight showed there had been a significant weight loss. The malnutrition screening tool had not been not filled in and there was no record of food intake. The pressure area risk assessment said at risk but there was no care plan. Records showed that another resident was at risk nutritionally and the pressure area risk assessment showed they were at risk and to be nursed on a special mattress which they were. However the assessment said that if this resident did not eat properly and was losing weight that they were to be referred to the GP and dietitian but there were no records that this had happened. From speaking to staff and looking at weight records we could see that this resident was not eating and had lost weight but there were no records to indicate that they had been referred to the GP or the dietitian and although we were told they had supplements there were no records to show this. Also it was identified from daily records that the resident was at risk when eating but there was no care plan to alert staff, also the oral assessment that had been carried out did not highlight a problem. One residents assessment said refer to dentist for loose fitting dentures but the oral assessment had not been filled in, the nutritional assessment said at risk but malnutritional screening tool had not been filled in and there were no records to evidence that this resident had been referred to dentist. The care plan said this resident has their own teeth which was incorrect. We also discussed the variability of pressure relieving mattresses and that as good practice the pump should indicate with a sticker or other label how much the mattress should be inflated according to the residents weight. This indicates that communication has been poor in the home although we could see and were told that this has improved since the new manager and deputy manager have been in post. We could also see that the assessments and care plans are being reviewed to identify these problems and that they would be changed over to a person centered system which should eliminate these problems in the future. We were told that more detailed life histories will be compiled with the help of relatives where necessary. A recent meeting has been held with the local GP surgery that did highlight some Care Homes for Older People Page 14 of 30 Evidence: concerns and an action plan has been compiled to address these issues. Suni Chotai Pharmacist Inspector visited to assess the medicine management in the home. Her findings showed that the home has good storage provision and safe medicine administration procedures. The records kept around medicines movement are good and allow for medicines to be accounted for. Controlled drugs are stored as required but the fixings used for this cupboard may not be compliant with the requirements of the law. The controlled drugs register records did not correspond to the balance in the cupboard. The law requires that true and accurate records be kept of controlled drugs. The home has corporate policies. These policies need to be improved to give guidance at local level so staff can manage the task according to local procedures. There were several gaps on medicine administration record charts with no explanation for this. The manager had already identified this as a concern in an audit he conducted. It was noticed on one chart that allergies were not recorded, this could be potentially serious and must be corrected. There were no guidelines in the care plan on use of medicine prescribed only when needed. This is necessary to give staff guidance on when to use this medicine and for a consistent approach around this medicine. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents told us that the find the lifestyle at the home matches their expectations and they are happy with the social activities offered although some said they would like to go out more. They told us that they are encouraged to exercise choice and control over their lives and are encouraged to maintain contact with family and friends. Residents receive wholesome appealing meals in pleasant surroundings. Evidence: Surveys returned to the Commission told us that residents who live in the home can make choices as to how they spend their day and that staff listen to them and act on what they say. They said that staff do respect their privacy and dignity. They also told us that they were happy with the activities on offer at the home although two did say they would like more outings. They all told us that they were satisfied with the meals provided. On the day of the visit residents we spoke to also told us that they were happy with the activities offered. Records of activities were available and each resident has a separate activity record. The manager told us that when person centered care plans are completed the social care plan would be in more detail so activities can be tailored more to individual needs. Residents who are unable to take part in group activities do have one to one sessions with the activity co-ordinator. The activity Care Homes for Older People Page 16 of 30 Evidence: program displayed on the notice board showed that some of the activities offered are, Life stories, bingo, exercise, ball games, quiz, music and singing, whats in the news, films and flower arranging. The home has theme days when residents and staff celebrate a variety of occasions some recent ones were, A Caribbean day, St Patricks day, Pancake Day and there is an Easter Bonnet competition planned. We saw photographs of some of these events. Pleasant and well-kept gardens surround the home and there are patio areas where residents can sit. Garden furniture is provided and residents told us they do like going outside in the warmer weather. Residents are encouraged to maintain contact with friends and relatives and they are able to receive visitors in private. A new chef has recently been appointed in the home and residents told us that the food had improved greatly and that they always got well-cooked and tasty food. They are asked on a daily basis what they would like from the menu. At the present time the new manager and the chef are planning improvements to the catering service and this includes providing a picture menu for residents who would benefit from it, and keeping more comprehensive food records for all residents to make sure nutritional needs are met and monitored. The chef is qualified but does not have any specialist nutritional training in relation to older people or people suffering from dementia, we discussed this being a necessary skill with the manager who agreed to look into further training for the chef. The dining room and conservatory were nicely set for lunch with damask tablecloths and napkins. The meals served during the visit included minted lamb steaks with potatoes, cabbage and cauliflower or honey mustard pork with rice. This was followed by French lemon tart, fresh fruit salad and ice cream. We tasted the honey mustard pork and the lemon tart and both were well cooked, well presented and delicious. Residents we spoke to said they enjoyed their meals and we observed those who could not offer an opinion and they seemed to enjoy their meals. Care staff were on hand to help and encourage those who needed it and did so in an unhurried and patient manner. Specialist diets are catered for. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents told us that they knew who to complain to and felt able to voice concerns. From what we saw in the home and what residents told us we concluded that residents legal rights are protected. Staff are trained to safeguard residents although some are in need of updating. Evidence: The service has a complaints procedure that is clearly written and easy to understand. Surveys told us that residents knew how to complain and to who. During the visit those residents spoken to said they would feel able to complain if the need arose. The home keeps a full record of complaints and the action taken if appropriate. The records state that 5 complaints have been received in the last twelve months and these were all upheld. We were told that there are no outstanding complaints. A recent meeting has been held with the local GP surgery that did highlight some concerns and an action plan has been compiled to address these issues. Two safeguarding referrals have been made to the local Social Services Department, one was substantiated and the other is still ongoing. The home have followed the correct procedures in keeping relevant agencies informed. When we spoke to staff about the safeguarding procedure they all know the correct Care Homes for Older People Page 18 of 30 Evidence: procedure to take if abuse was suspected in order to protect residents. Training for staff is arranged by the home and we are told that all staff will have received their mandatory training which includes safeguarding by the end of May 2009, we did see posters displayed advertising the staff training events. Records indicated that where equipment that may be used to restrain residents, for example cot sides, risk assessments are carried out and permission is obtained from the resident or representative. When residents were asked if they felt safe at the home they all said they did. Care Homes for Older People Page 19 of 30 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. Residents live in a safe, well maintained and clean environment with their personal possessions around them. They have access to safe and comfortable communal facilities. There are sufficient toilet and washing facilities and residents and staff have access to specialist equipment to maximize residents Independence. Evidence: Since the last inspection we are told that Alpha Care Homes have spent £100,000 improving the home these include, improvements to the external driveway and lighting, new carpets, curtains and furniture, aids and equipment to aid residents and kitchen equipment have been purchased. A recent Environmental Health inspection has been carried out and we were told there were no requirements. The home is pleasant, well lit, has a nice atmosphere and is a safe place to live. During the visit we toured the home and found it to be clean tidy and fresh, there were no unpleasant odours. Residents are encouraged to personalize their bedrooms and some of these bedrooms were visited. All rooms have locks and keys are available if the risk assessment shows that it is safe. There are kitchenettes on each floor where hot drinks and snacks can be made either by residents if able or relatives. A new full time handyman has recently been employed so any work needed is usually Care Homes for Older People Page 20 of 30 Evidence: carried out promptly which staff told us is a great improvement. We saw maintenance records, they are organized and in good order and all safety checks on all systems up to date. During the visit plumbers were in the home updating some of the plumbing system. Care Homes for Older People Page 21 of 30 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. Residents identified needs are met by the numbers and skill mix of staff and they are protected by the homes recruitment policy and practices. Staff are trained and competent to carry out their roles and we are told that all will have been updated in all mandatory training by the end of May 2009. Evidence: Surveys told us that residents and their relatives are satisfied that the care meets their identified needs, this was also confirmed during our visit. Staffing rotas indicated that there are now enough qualified, competent and experienced staff to meet the health and welfare of residents using the service. Staff on duty on the day of the visit were, the manager, deputy manager both who are qualified nurses, two additional qualified nurses, seven care assistants, one administrator, one chef and kitchen assistant, two cleaners and the handyman. The home recognizes the importance of training and since the manager has been in post more staff training has been organized, also new training equipment has been purchased. Over 50 of care staff hold a National Vocational Qualification of level 2 or above. We saw posters that indicated that all day and night staff will be up to date with Care Homes for Older People Page 22 of 30 Evidence: mandatory training by the end of May this is to include safeguarding. A requirement that this training is carried out and completed has been made. The home has a recruitment procedure that meets statutory requirements. Agency staff are used at the home but the new manager hope that this will be decreased when more permanent staff are employed. Care Homes for Older People Page 23 of 30 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. A new manager has recently taken up post at the home and we could see and we were told that the running of the home has improved since he has been there and that there is now a sense of leadership which had been lacking. There is a quality assurance system in place and action is taken when concerns are identified. Safe employment policies and procedures are in place and staff are supervised. Record keeping needs to be improved in some areas and staff are in need of training updates. Evidence: Until recently there had been a concern of the visiting local GPs that the home was not being managed for the benefit of the residents, however as reported earlier there is a new management system in place which we are told has improved life at the home. Also as reported earlier there has been a meeting with the GPs and an action plan put into place to address their concerns. Care Homes for Older People Page 24 of 30 Evidence: The new manager is very experienced and well qualified to manage the home. We are told that that he will be applying to become registered with the Commission for Quality Care as soon as possible. The new manager and the deputy manager displayed a pro active management approach, for example in the foyer of the home were various booklets telling people about the Mental Capacity Act and the new Deprivation of Liberty Safeguards which came into force on April 1st 2009. We also saw that they were due to attend training on this subject which we were told they will cascade down the to staff to help them understand how it could affect residents. There is a staff supervision system in operation and both the manager and the deputy are working hard to update this. The company does do regular audits and a timetable of these was seen. A senior person makes regular visits on a monthly basis to the home, reports are made and these were available for us to see along with any action that is needed to maintain or raise standards. Regular meetings are held both with residents and staff and minutes were available. During the visit we asked staff and residents about the new management structure and they were all positive about the changes and said the home had improved and life had improved for the residents. We were told that there was now a professional leadership approach in the home that had been missing. Record keeping in the home does need to be improved and two requirements relate to poor record keeping in medication and nutritional assessments. Although staff training has improved the programme has not been fully completed we were told that this will be completed by the end of May 2009. Care Homes for Older People Page 25 of 30 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 30 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 3 13 All residents must have an accurate and up to date nutritional assessment. To ensure residents if identified as being at risk get the proper nutritional care. 31/05/2009 2 8 13 Residents must have up to 15/05/2009 date and accurate nutritional risk assessments and care plans That residents who are at risk are identified so appropriate action can be taken. 3 9 13 To have accurate records in the controlled drugs register. To comply with the law. 30/04/2009 4 9 13 To have records around 15/05/2009 medicine administration that are complete, accurate and true. Care Homes for Older People Page 27 of 30 So that a clear picture is available of treatment history and profile. 5 9 13 To have detailed person centred guidelines on the use of medicine to be given only when needed. To have consistency and give guidance for its use 6 30 18 The chef is to have specific nutritional training for older people and people with dementia. So that residents receive the optimum nutrition for their age and condition. 7 30 18 All staff to be updated in mandatory training. To ensure staff are trained to look after residents to a good standard and to keep them safe. 8 37 17 Residents rights and best 15/05/2009 interests are safeguarded by the homes record keeping policies and procedures. Records required for the protection of residents and for the effective and efficient running of the business are maintained up to date and accurate. 15/05/2009 17/07/2009 15/05/2009 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. Care Homes for Older People Page 28 of 30 No. Refer to Standard Good Practice Recommendations 1 9 To ensure that the fixings used to attach the controlled drugs cupboard comply with the requirements of the law. Care Homes for Older People Page 29 of 30 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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