Inspection on 31/03/09 for The Orchard Nursing Home

This inspection was carried out on 31st March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Orchard Nursing Home 27/11/08

The Orchard Nursing Home 02/10/08

The Orchard Nursing Home 18/04/08

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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: The Orchard Nursing Home 189 Fairlee Road Newport Isle of Wight PO30 2EP     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: Sheila Gawley     Date: 3 1 0 3 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 27 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 27 Information about the care home Name of care home: Address: The Orchard Nursing Home 189 Fairlee Road Newport Isle of Wight PO30 2EP 01983520022 01983528788 orchard@barchester.com www.barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Mark Sims Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Orchard Nursing Home is a care home registered with the Care Quality Commission (CQC) to provide nursing and personal care for 40 service users in the older person category. The home is situated in a residential area within easy access to Care Homes for Older People Page 4 of 27 Over 65 40 0 2 7 1 1 2 0 0 8 Brief description of the care home local facilities. Accommodation is provided over two floors with a shaft lift that allows access to all parts of the building. All the bedrooms are single and have en suite facilities. There is a well -maintained garden to the side of the home and ample parking at the front of the building. Barchester Healthcare Homes Ltd owns the service. The manager for the service has commenced the registration process with the Commission. Care Homes for Older People Page 5 of 27 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This site visit as part of the inspection process was carried out on 31/03/09. Sheila Gawley was the lead inspector and a second inspector Mr John Vaughan, accompanied her. The home had a site visit from the pharmacy inspector Geraldine Yates on 25/03/09. The findings of both of these visits and reference to the random inspection of 27/11/08 are all included in this report. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home and any documents required on the day were made available. We were in receipt of any eight surveys from people who use the service, some filled in with the help of relatives, five from staff members and one from a visiting professional. People who use the service, relatives and staff were spoken to on the day. Comments Care Homes for Older People Page 6 of 27 in the surveys and discussions on the day were mainly very positive. People who use the service spoken to stated that they are happy in the home and that they enjoy the food and activities. All appeared happy, were well dressed and the atmosphere in the home was relaxed. The relatives spoken to expressed satisfaction with the care on offer in the home and they stated that there have been improvements in the home of late. Staff spoken to on the day stated that they were happy working in the home and that the management was supportive. 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 27 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 27 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. Pre admission documentation is in place and efforts are made to assess individuals prior to admission. The improvment seen on the last inspection could not be tested on this occasion. Evidence: There is a statement of purpose and a service user guide in place and Barchester Healthcare provide a website that people can access for information. The service user guide was seen in peoples rooms. There is one person in the home who has been admissied since the last inspection. There is pre admission assessment documentation in place. As this person was admitted from abroad the assessment documentation was faxed to the previous care service and they completed it. Areas assessed included moving and handling, diagnosis, medication, fluid intake, communication and mental state.The person had a general practitioner (GP) and physiotherapy review on admission. The person was spoken to and she stated that she was happy here. She was unclear about what documentation she was given on admission and was unsure Care Homes for Older People Page 10 of 27 Evidence: about what to do in the event of a problem or complaint. These standards will be tested more fully at the next inspection when more admissions will mean a greater number of preadmission assessments and processes to sample. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Needs are assessed, recorded in a plan of care and those needs are met with respect and dignity. Medicines are handled safely in the home. The requirement of the last inspection has been met. Evidence: The AQAA states that the home provides access for staff to tools and documents required for the planning and delivery of personal care, for monitoring the delivery of that care, for monitoring the health and wellbeing of the people who use the service and for documenting contact with health and social care professionals. All people who use the service have a plan of care, which is drawn up following full assessment. Four care plans were inspected and these contained information on health, personal, and social need. Care plans are individualised and include a photograph, personal details, preferred name, named nurse. Plans are in place to record needs in communication, personal hygiene, continence, fluid intake, mobility, transfers, nutrition and social interests including hobbies, and spiritual and cultural needs. In one care plan an updated nutritional assessment following a dietitian Care Homes for Older People Page 12 of 27 Evidence: assessment was seen, GP and dietitian visits are recorded to demonstrate attention being focused on helping a person to lose weight. This care plan also had in place a short-term care plan for the care needed by the individual following surgery and showed evidence of review following discontinuation of the short term plan. In another speech and language referral and assessment in relation to choking and aspiration was seen. It was also recorded that the person had declined to have the recommended pureed diet. The ongoing need of a person who had a specialist chair supplied recently was discussed with a registered nurse and the manager. They may consult with the occupational therapist if the situation is not resolved by the provision of a new sling. There was evidence of monthly review and people who use the service and relatives are involved in this process. Plans contain a weight and nutrition profile. Three fluid charts were inspected and two all were up to date and totaled. One chart for a person whose care plan states clearly that her fluid intake be limited to one litre of fluid frequently had less than this. This was discussed with a registered nurse on duty and she stated that this person is reluctant to drink and that she sleeps for long periods sometimes from 6:30 pm on through the night. The nurse stated that she allocates one person on duty to offer frequent drinks to this lady and that she is under GP review. This was seen in the professional visits section of the care plan. A discrepancy identified at the random inspection of 27/11/2008 regarding the recording of flushes following administering of medication via a percutaneous endoscopic gastric (PEG) tube was not evident on this occasion. A register nurse was observed flushing the PEG tube and the fluid chart was up to date. Risk assessment is in place and covers falls, mobility, balance, tissue viability, environmental hazards, moving and handling, scalding, aspiration. Actions to be taken in relation to any identified risk were clearly stated.The privacy and dignity of people who use the service is respected and staff were observed offering care in an encouraging and appropriate manner. A specialist pharmacist inspector assessed the safe handling of medicines on 25 March 2009. This was because a number of medication errors had occurred in the home since the last inspection. We looked at the medication records and medicine supplies for 6 people, the care plans for 3 of these people, the policies and procedures for medication handling and talked to staff. Most people who use this service have their medicines given to them by the nursing staff. Staffs competency to handle medicines safely is assessed annually. Written procedures are available to the staff to provide guidance and to enable medicines to be handled consistently by all staff. Care Homes for Older People Page 13 of 27 Evidence: One person, of the six sampled, was looking after some of their own medicines when we visited. This persons competency to do this had been assessed but the risks to themselves and other people living in the home had not been assessed, nor any plan produced to minimize any risks identified. This was drawn to the attention of the manager and a risk assessment and management plan had been put in place by the 31/03/09when we completed the inspection process. Clear records were kept to show when people were given their medicines. If they were not given their medicines the reason why was clearly recorded and all of the reasons given were appropriate. These related mostly to medicines that were prescribed to be given only when needed. The records showed when people were given these medicines and why. Care plans were available for staff to refer to. Some care plans for managing medical conditions and medication, such as when required medication, were inadequate with a lack of detailed information on appropriate use and monitoring. This was drawn to the attention of the manager and the care plans had been reviewed, to include the reason for the medicines being prescribed and when to give it, by the 31/03/09. From the records and medicine supplies we could see that people were being given their medicines correctly. A full and detailed audit of medication handling is completed annually. Smaller audits are completed weekly by the manager. These are targeted at those areas of practice that have been identified as giving rise to problems in the past. All medicines were stored securely so as to protect the people who use the service. Medicines were stored at the correct temperatures and were thus fit for use. Storage of medicines was neat and tidy, with no excess stock being kept. Detailed records were kept of medicines in stock as part of the homes medicine usage audits.Medicines that are liable to misuse, called Controlled Drugs, were stored in a cabinet that complies with the law and were recorded in a bound register. We checked a sample of these medicines and they were found to be in order. The homes staff check these medicines regularly so that any problems can be identified and dealt with promptly. Care Homes for Older People Page 14 of 27 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. There is a varied activity programme in the home.There is good communication and residents and relatives meetings are in place. A nutritious diet is served in comfortable surroundings Evidence: The routines of daily living are discussed with people who use the service on admission and individual preferences are recorded. People spoken to on the day stated that they were happy with the lifestyle in the home. There were several relatives in the home as a residents and relatives meeting was taking place. Seven relatives were spoken to and they stated that there are many activities in the home and feel the lifestyle in the home suits their relatives. They commented Mum gets taken out Another stated Mum loves cooking A group of four relatives spoken to stated that life in the home was Brilliant excellent and that there was good communication. They expressed satisfaction with the meeting and feel it gives them the opportunity to discuss any issues they may have. Surveys received commented that activities are enjoyed in the home.Visitors are encouraged and people can choose where to see their visitors. People have choice in daily routines and people spoken to confirmed this. They are encouraged to bring their Care Homes for Older People Page 15 of 27 Evidence: personal possessions into the home. There is an activities coordinator in the home who works full time, Monday to Friday. She has attended a course on Activities for Dementia. The agenda for march was on the notice board and it included pet therapy, cooking, day trip in mini bus, aromatherapy- twice weekly, weekly matinee and monthly sherry morning. There is a tomato plant growing competition ongoing. The home recently held a charity event and raised money for a local hospice.There is a monthly newsletter in place to keep people informed of events and life in the home and an annual satisfaction survey is carried out. There is a varied, nutritious menu in place, which offers choice. The menu for the day was on display. Hot and cold drinks were available in the sitting and dining room. The meal seen prepared and served on the day was appealing and the people who use the service enjoyed it. It was served in an unhurried manner in a pleasant dining room. People spoken to confirmed that they enjoyed the food. Those requiring assistance received it in a respectful manner and attention was given to the positioning and posture of people. One person has new chair and may need to be reassessed, a registered nurse has ordered a new sling which is hoped will rectify difficulties in getting this person into good position for meals. The pureed diets were served in a very appealing manner and could be identified as the foods they were. Care Homes for Older People Page 16 of 27 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. There is a complaints procedure in place and people who use the service and their relatives feel that complaints and concerns would be addressed. Improvement to safeguarding procedures have been made and these must be embedded and sustained in practice to protect people in the home. Evidence: There is a clear complaints procedure which is on display and which is included in the Statement of Purpose and Service User Guide. The procedure clearly identifies whom a complaint should be addressed to and the timescales in which a complaint will be dealt. It displays the Commissions contact details. Relatives and people who use the service spoken to feel that any concern raised would be addressed and that there have been many improvements in the home of late. One newly admitted person was unsure of what to do if she had a problem. There have not been any complaints since the last inspection. There is a training programme in place which includes Safeguarding Adults training. Staff spoken to demonstrated an awareness of safeguarding procedures. Staff were observed interacting with people in a respectful manner. The home has cooperated with a recent and ongoing safeguarding adults investigation which resulted in the prosecution of two former staff members. We await the final outcome of this investigation. Some concerns highlighted during the process have been resolved. Referral to Protection of Vulnerable Adults list has been made. Care Homes for Older People Page 17 of 27 Evidence: The current Isle of Wight safeguarding procedures is in place. The Homes own safeguarding policies and procedure are in place dated 2007, due for review in 2010. A manager from Barchester was present for part of the inspection and she stated that there are updated safeguarding procedures but they are not as yet in the the home. Care Homes for Older People Page 18 of 27 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. People live in a safe , pleasant and well maintained environment Evidence: The home externally and internally is decorated to a good standard. It has a sitting and dining rooms with comfortable good quality furniture, domestic in style. It was neat, clean and free from offensive odours. The specialist equipment required to meet the needs of people who use the service is in place. There are sufficient wheelchairs, hoists and assisted baths and there are grab rails. There are specialist beds to maintain the safety and comfort of those nursed in bed and there is pressure-relieving equipment available. One person was assessed by the occupational health therapist for a specialist chair, a new sling is being ordered to facilitate good positioning. Bedrooms are comfortable with comfortable furnishings and all are ensuite. The bedrooms are personalised according to the wishes of people who use the service. Radiators are covered and people can lock their doors and temperatures are recorded. There are sufficient assisted baths to meet the needs of people who use the service. There are suitable laundry facilities sited away from areas of food storage and preparation. Washing machines have the required programmes. Care Homes for Older People Page 19 of 27 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. There may not be sufficient staff on duty at all times to ensure peoples needs are met. Recruitment procedures are in place to ensure the protection of people Evidence: Staff rota showed that generally there are four or five staff on morning and evening shifts, one or two registered nurses with three or four carers. All of the five staff surveys returned answered usually to the question are there enough staff to meet the individual needs of people who use the service. One staff survey also commented that sometimes sickness is not covered and a member of staff on duty stated that a supervision had been canceled the day before as they were short staffed. A further member of staff confirmed that the previous day there had been only one registered nurse and two carers on duty all day. This was evident on the rota. The rota for January, February and March were looked at and each had shifts where there were only three staff on duty, some due to sickness and some not. The manager stated that this is sufficient to meet the needs of the people who use the service given the current numbers but staff interviewed on the day stated that as the majority of people need two staff to offer care then three staff is not enough. The AQAA further states that ten people using the service require two staff to offer care. There is housekeeping, hostess, administration and maintenance support. Care Homes for Older People Page 20 of 27 Evidence: There are recruitment procedures in place to protect people who use the service. Staff files inspected contained all the documentation required to ensure the protection of people who use the service. There was evidence of application forms with employment history, Criminal Records Bureau Clearance and POVA check, two references, identity documentation, and photograph were all in place. When asked on the surveys if staff feel they have the support and knowledge to meet individuals needs four answered usually and one answered always. There were positive comments also on the surveys good relationship has developed between staff and service users, I think the service has improved dramatically as regards organisation, routine and activities and We work as a team. The support systems in place for people returning to work following the recent safeguarding investigation were discussed and for one person there was only records of a two day induction, two further supervision dates were on file. There was not any other information on file regarding support offered. People who use the service spoken to stated that they find the staff helpful. One person who uses the service commented that staff are excellent here . A relative commented Cant speak highly enough about the place, The staff are all wonderful, Activities are brilliant here It is excellent and we are very happy with the home, they communicate well with us. There is a staff-training programme in place which staff spoken to confirmed they attend. Training records were seen in staff files. The training provided includes food hygiene, moving and handling, safeguarding adults, fire, infection control, first aid and health and safety. There are training resources available so staff can access Electronic Learning. Three induction records, two were complete but one had areas not yet signed off. The organisation supports staff to attain National Vocational Qualification Level 2 in Care. Care Homes for Older People Page 21 of 27 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. There is a manager in place who has commenced the registration process with us. The opinions of people who use the service are sought and acted upon. The improvements evident on this occasion must be seen to be sustained. Evidence: There is a newly appointed manager in place and he has commenced his application to register with the Commission. He is awaiting a date for interview. Quality assurance measures are in place and are listed in the AQAA returned to us. The manager ensures that the Barchester audits occur as directed by the organisation. There are monthly organisational visits and audits on nutrition, pressure sores and medication. There are monthly and six monthly audits of care plans. Audits have been undertaken on infection control, health and safety and record keeping. The manager has introduced a weekly audit on medicines. The requirement on medication made on the random inspection of 27/11/09 has been met. Staff meetings are in place and residents and relatives meetings have been introduced which relatives confirmed they find beneficial. Care Homes for Older People Page 22 of 27 Evidence: The home does not hold any monies or manage any bank accounts for people who use the service. Staff supervision is in place and staff have been trained in carrying out supervision, however not all supervision is up to date. Staff stated that they are sometimes short staffed and one staff member stated a supervision session booked for the previous day had been canceled due to staff shortages. That people working in the home are appropriately supervised will be a requirement of this inspection. The registered provider ensures the health, safety and welfare of people who use the service and staff by the provision of mandatory training. Contracts are in place for the maintenance of equipment and utilities. Care Homes for Older People Page 23 of 27 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 24 of 27 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 27 18 The registered person must, 31/05/2009 having regard to the numbers and needs of people using the service, ensure that there are at all times suitably qualified, competent and experienced persons in such numbers as are appripriate for the health and welfar of people who use the service. To ensure needs are met at all times. 2 36 18 The registered person must 31/05/2009 ensure that persons working in the home are appropriately supervised. To ensure practice and performance is discussed and to ensure staff follow policies and procedures in the home. Care Homes for Older People Page 25 of 27 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 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!