Care Home: 16 Cleeve Hill

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What the care home does well The home was found clean, warm, and homely and the residents looked relaxed and well cared for. The atmosphere at the home on the day of inspection was friendly, staff were helpful and informative and were seen interacting with residents in a respectful and dignified manner. Staff showed awareness and sensitivity in the way a person with challenging behaviour was supported on the day of the visit. The home has an effective communication system that enables staff and supporting services to deal with the challenging needs of people living there both within and outside the home. This was clear documented evidence of when an individual presented with difficult issues and how staff managed the situation. The home manager told us in their Annual Quality Assurance Assessment the longterm knowledge, experience and skill of staff enables them to communicate with the people living at the home to provide them with quality care. During the inspection observation and review of various records led us to believe that there is a high quality care planning system which is person centred and specifies how identified needs were being met. The care plans were regularly reviewed to accommodate the changing needs of the persons living at the home. The home ensures that aids and equipment are provided to assist staff with meeting the needs of the service user where applicable. We are also able to say after observing lunch that good and nutritious meals are provided for residents in a relaxed atmosphere and are not hurried. People living at the home who are not able to feed themselves are fed in a sensitive and dignified manner. What has improved since the last inspection? There is an on-going refurbishment at the home since the last inspection. For example, the bathroom had been refurbished and a new bath and hoist mechanism installed. What the care home could do better: To reduce potential drug error all medication administered to residents must be signed for. It would be better if a risk assessment is put in place in relation to an individual with challenging needs in order to minimise the impact of the person`s behaviour on those around them. We believe that staff would benefit from training update on challenging behaviour to provide them with ongoing knowlegde that they need to support people when that need arises. We recommend that a lockable metal safe is installed at the home to enhance the security of residents` monies and other valuables. Key inspection report Care homes for older people Name: Address: 16 Cleeve Hill 16 Cleeve Hill Downend South Glos BS16 6HN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Grace Agu     Date: 0 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: 16 Cleeve Hill 16 Cleeve Hill Downend South Glos BS16 6HN 01179570839 01179709301 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust care home 5 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: May accommodate up to 5 persons aged 18 years and over. May include persons aged 65 years and over Date of last inspection Brief description of the care home I6 Cleeve Hill is a home for 5 people; it is part of the Aspects and Milestones Trust. The home was opened twelve years ago as part of a programme of developing residential community care, for former patients of Stoke Park Hospital. 16 Cleeve Hill is a mature bungalow, which has been renovated and extended to provide accommodation on one floor. It is located on a busy road in a residential area of Downend: shops, post office, library and other amenities are approximately two hundred metres away. There are regular bus services to the centre of Bristol and there is easy access to the motorway network close by. The home provides residential care for people with learning difficulties. There are a variety of daily activities for service users which are supported by the staff and day care support services provided by Spectrum, (which is part of Brandon Trust), and the local day centres. The home has a vehicle in order to enable service users to fully Care Homes for Older People Page 4 of 28 Over 65 5 5 Brief description of the care home access community facilities. Fees range from 098 - 106 per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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 was an unannounced visit which was undertaken as a part of key inspection over eight hours and was undertaken to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. Two support workers were met on arrival and we met with Ms Jane Ireland later. A brief tour of the building was undertaken to look at the general maintenance of the home to ensure that it is comfortable for the people who use the service. We spoke with one resident, and two staff menbers. A number of records were viewed. Care Homes for Older People Page 6 of 28 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 Care Homes for Older People Page 7 of 28 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policy and procedure for admission of a prospective service user is robust to ensure that the individual(s) make a positive choice of moving to the home with assurance that their needs will be met. Evidence: There have been no new admissions to the home since the last inspection and the individuals have lived together in the home for several years. Whilst there were no admissions, an admissions policy is in place to ensure that the legal requirements are met. If a vacancy arises the home has a brochure in place, policies and procedure which promote opportunities for the individual to have visits to ensure that they are able to live with the existing residents and pre assessments of their needs are undertaken to ensure that the home is able to meet them. We looked at one residents care plans and we noted that measures put in place met Care Homes for Older People Page 10 of 28 Evidence: specific assessed needs of the person, staff members we spoke with on the day were aware of their roles and responsibilities and how to support the individuals living in the home. The home has a Statement of Purpose, which has information about the services provided at the home, for example, how to make a complaint and any support that would be given in relation to the individuals health. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers care and support throughout service users lives and towards the end of their life however, medication administration practices need to improve in a specific area. Evidence: People living at 16 Cleeve Hill have been at the home for twelve years since the home opened. One residents files was viewed and contained comprehensive and detailed information, which was person centred and holistically focused. The information recorded was to assist and equip staff with providing support in areas of personal, emotional, social and physical care based on the residents individual circumstances. Other information noted in the care file included, personal profile, support for daily living, choices I can make, places I like to go, things I enjoy, personal statement, other likes and dislikes, annual medical and social services reviews. This information will provide staff with the knowledge required to meet the individuals needs. THe residents file viewed contained details of their needs and how these needs were Care Homes for Older People Page 12 of 28 Evidence: being managed. Following our observation on the day in relation to the persons agitation we noted from the file that there had been a number of entries in the daily dairy about this persons agitation especially at night and in the early hours. The manager told us that it was a normal pattern for the individual however the district nurse had been consulted in relation to a recent sore which may be the cause of the increased agitation and challenging behaviour. It was agreed that the home undertake a risk assessment and develop a specific care plan on how to manage the persons behaviour at those times in order to protect the health and safety of the person and other residents. We also agreed that staff training on challenging behaviour needs to be updated to provide more knowledge and better understanding in relation to managing and supporting the individual and others at those challenging times. The individuals files showed evidence of visits from the District Nurses to administer injections when the registered manager was not available. The care file was regularly reviewed and annually. There was evidence of visits from other health professionals to include General Practitioner (GP) Consultant Dentists, Occupational Therapists, Physiotherapists and Opticians. One resident spoken with stated that they were happy at Cleeve Hill, the individual stated that staff are respectful and supportive. Staff met on the day were noted assisting the residents in a sensitive and dignified manner taking into consideration their individual personalities. While there was no relative on the day we are aware from our previous visits that the relatives have not expressed any concerns in relation to the care and services provided at the home. Each resident had handover notes completed by staff on each shift and individual diaries for all daily activities. There was evidence of risk assessments in place in relation to bathing, washing, mobility, personal hygiene and walking to the local shop in the care file of the individual reviewed. Staff spoken with demonstrated knowledge and understanding of individuals needs, including support for the persons emotional wellbeing. The home has a medication policy, repeat prescriptions are completed and sent to the surgery on a monthly basis and the local pharmacist supplies the drugs after collecting the signed scripts from the surgery. The MARS (Medication Administration Records) Care Homes for Older People Page 13 of 28 Evidence: were computer generated however two doses of given medication were not signed to ensure that the medication error was prevented . The manager stated that this was not a normal practice and that she would ensure that this unsafe practice is not repeated. Staff files examined showed evidence of basic medication administration training. We will look at this area in the next visit. Staff spoken with demonstrated knowledge of the importance of keeping all information about residents confidential. Staff also demonstrated knowledge and understanding of how to support the resident when terminally ill and at the time of death. The home has a Death and Dying policy. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides meaningful activities for the residents, enables them to maintain contact with the local community, families and friends and ensures that residents enjoy good meals at their chosen times. Evidence: Activities provided for the residents at the home have not changed. Four residents attend various activity sessions provided by Brandon Trust, daily and regularly. One resident attends day centre at Blackhorse RAC five days a week. There are a variety of daily activities for residents which are supported by the staff, day care support services provided by Brandon Trust and the local day centres. The home has a minibus to enable residents to fully access community facilities. The residents have daily dairies detailing the activities undertaken by them inside and outside the home and any other issues that staff may need to know about the care needs of the residents. The dairies are completed by the day care staff from Brandon Trust and staff working at the home. On the day of inspection, one resident had left for the day centre another individual was seen being taken to attend different outside activities, two others went out later Care Homes for Older People Page 15 of 28 Evidence: at different times of the day. One resident spoken with stated that she enjoyed her day out. One day services support worker who had been out with a resident was noted reporting her observation in relation to the residents unusual behaviour to the staff at the home. Her observation was discussed and documented in full to enable staff to make a decision about how to manage the behaviour and how best to support the person. The residents are also supported to enjoy trips outside the home. For example one resident was taken to Wye Valley garden centre on 4/8/09. Staff told us that the residents enjoyed a holiday in Devon in May and June 2009 and another holiday is planned in October for three residents The staff member told us that other places of interest were visited by the residents whilst in Devon to maximise their holiday. There was evidence of family and friends visits in the visitors book. Residents have a choice of meals and are supported to participate in preparing the weekly menu based on the level of their understanding. The kitchen was found clean, the fridge and freezer temperatures were regularly recorded. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents are supported to exercise their legal rights and are confident that the home is able to protect them from abuse, information in relation to the complaint procedure needs to be updated. Evidence: There was no recorded complaint since the last inspection. One staff member spoken with demonstrated awareness of how to support residents to make a complain if they wished to. One resident spoken with stated that she would tell the manager if she was not happy. The home has a procedure on how to make a complaint and this was in a picture format for easy understanding however information in relation to how to contact the Care Quality Commission if people were not satisfied with the outcome of their complaint to the organisation was not current. The manager stated that she would ensure that the information is updated. We reminded the manager that we had made this observation in our previous visit under the Commision for Social Care Inspection. We expect this information to be updated for the reasons stated above. We noted that in each residents room the home had provided the following information to enable the relatives and advocates to understand measures the organisation has taken to protect the interest of people living at the home. These include Mental Capacity Act 2005 booklet. Deprivation of Liberty Safeguards, Care Homes for Older People Page 17 of 28 Evidence: Safeguarding Adult Policy, Getting Older - futures and Advocacy Service. Staff have attended training on Protection of Vulnerable Adults and are aware of the policy and procedure in relation to protection of the residents from abuse. Staff are also aware of the Whistle Blowing policy to enable them to report any malpractices without fear of reprisal. The home has a policy on safeguarding people from abuse, the South Gloucestershire Council policy and guidance on protection of vulnerabe adults from abuse and No Secrets guidance from the Department of Health. There was documentary evidence that individual rights have been explained to the residents and where residents are unable to make choices or decisions, it was explained how they would be supported to make choices. The manager stated in discussion that two new staff members have joined the team at Cleeve Hill. One staff member was deployed from a sister home owned by Aspects and Milestones. The other individual was a previous employee of the home. This person went through a thorough recruitment process in line with the Organisations policy. In both cases the induction process evidenced safeguards in place to protect the individuals living at the home. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a well-maintained environment where residents feel happy and safe to to live in. Evidence: 16 Cleeve Hill is a mature bungalow, which has been renovated and extended to provide accommodation on one floor. It is located on a busy road in a residential area of Downend: shops, post office, library and other amenities are approximately two hundred metres away. There are regular bus services to the centre of Bristol and there is easy access to the motorway network close by. The home provides residential care for people with learning difficulties. The home was found to be clean, warm, tidy and free from unpleasant odours. Residents met at the home looked well cared for and were sitting in the lounge and enjoying each others company before and when some of them returned from Day care activities. It was pleasing to note that the bathroom had been renovated, a new bath installed including a new hoist mechanism. The manager told us that there is an ongoing discussion in relation to installing a shower in the bathroom area to provide the residents with another option in the event of break down of the bath. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure of the home offers protection to the residents at the home, There is adequate numbers of staff who are competent to meet the needs of the residents. Evidence: There is a recruitment policy and procedure at the home to ensure that only appropriate, suitable and experienced staff are recruited at the home. A full report in relation to two staff members who recently joined Cleeve Hill had been covered under Standard 18. One of the appointed staff members spoken with stated that she was issued a job description to ensure that she is aware of her role and responsibilities even though she had previously worked at the home. She had a full induction and was provided an induction pack which had information on Health and Safety. The staff member also attended Five days training on all aspects of health and safety and one day Values training. The person has been booked on Boots training on the Assessment and Care of Medicines (advanced module). A review of the training record evidenced that staff have attended manual handling updates on 03/08/09 and 04/08/09 including safe moving of an individual using Care Homes for Older People Page 20 of 28 Evidence: specialist equipment. Other training attended include, appointed persons first aid, assessment of diabetes, supporting people with sight and hearing loss, epilepsy awareness, fire safety and person centred planning. Information on manual handling and residents individual risk assessments are recorded in the folder and are easily accessible to all staff. As discussed under Standard 7 we require that staff training on challenging behaviour needs to be updated to provide more knowledge and better understanding in relation to managing and supporting one individual and others at those challenging times. All staff administering medication to residents have received training. Five Support Staff have achieved National Vocational Qualification (NVQ) at level 3, and one staff member is working towards National Vocational Qualification (NVQ) at level 3, The manager stated that she is planning to book all staff on the Protection of Vulnerable Adults for abuse refresher training to ensure that staff are up to date in relation to protecting people living at Cleeve Hill. On the day of inspection, there was an adequate number of staff members on duty to meet the needs of the residents. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from good leadership and management, its practices fully protect the health and safety of residents. Evidence: 16 Cleeve Hill is a stable home in relation to the category and care of the residents accommodated at the home. The registered manager is well qualified, experienced and competent and has managed the home for many years. On the day of inspection, the manager was visiting another home within the organisation but had to return to Cleeve Hill to participate in the inspection process. The manager stated the she had been appointed the manager of the home she was visiting and that another manager had been appointed to manage Cleeve Hill. However the manager advised that she would remain at Cleeve Hill until the new manger has received full orientation. The registered manager, as usual, demonstrated knowledge of her role and Care Homes for Older People Page 22 of 28 Evidence: responsibility in relation to managing a home with the category of residents. This was evidenced in her interaction and care given to the residents with complex and challenging needs. Residents responded in the affirmative when asked if the manager treated them with respect and would listen to their concerns. The two staff members met on duty stated that the manager is approachable and listens to any concern that they may have. The staff member would report any bad practices to the manager to ensure that residents are protected. One of the new staff members stated that she was made to felt at home when she returned to the home after a long time and that there is a good atmosphere at the home. There are regular staff meetings to discuss the needs of the residents, day to day running of the home and feedback from the manager in relation to medication changes. The staff members we spoke with along with supervision records confirmed that they have received regular supervision. In relation to health and safety there was a gas safety check on 05/03/09. Portable appliance testing is due in August 2009. The Liability Insurance is current. The manager stated that the five yearly periodic inspection of electrical installation safety was undertaken on 30/07/09 and she is awaiting receipt of te certificate. There was appropriate storage and risk assessment of substances hazardous to health. The two hoists at the home were serviced in June 2009. Accidents to residents were recorded and were reviewed to ensure that the individuals are adequately protected and to prevent further occurrences. The fire logbook was found up to date and well maintained. There is evidence that staff have attended regular fire drills. The maintenance book is also up to date. The home has policies and procedures to include Managing Incidents of Aggression, Complaints, Confidentiality Whistle Blowing and Death and Dying. However these policies were last reviewed in 2005/2006. We expect the organisation to keep the policies and procedures under regular review to ensure that staff are well informed of any changes in the policies. Care Homes for Older People Page 23 of 28 Evidence: Quality Assurance within the home is undertaken using the Aspect and Milestones quality assurance audit tool for managers. This tool enables managers to work in pairs to visit each others home to audit the key standard. Following the audit the auditor writes a report on their findings and the recommended action plan is sent to the Area Manager for authorisation. Other tools used for reviewing the quality of service include care plan reviews, staff meetings General Practitioner (GP) medication reviews, personal development plans for staff and supervision. Residents monies were reviewed and it was noted that the amount recorded in the book corresponded with the amount found in the individual pockets in the cabinet. Whilst we recognise that there have been no incidents in relation to theft of residents monies, we recommend that a lockable safe is installed at the home to provide better security for the monies and other valuables. All residents information was securely locked away. Care Homes for Older People Page 24 of 28 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 30 18 Ensure that staff receive training on challenging behaviour. 31/12/2007 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Undertake a risk assessment 31/08/2009 in relation to one individuals challenging behaviour. To minimise the impact on the persons health and the health of others around them. 2 9 13 Ensure that all medication administered are signed for on the Medication Administration Record Sheet. To prevent medication error. 31/08/2009 3 30 15 Ensure that staff receive updated training on challenging behaviour. To provide with enhanced understanding of an individual with behaviour that challenges. 31/08/2009 Care Homes for Older People Page 26 of 28 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 38 Install a lockable metal safe at the home to enhance the security of residents monies and other valuables. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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