Care Home: Alexandra Nursing Home

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What the care home does well "The carers look after me very well" and "I am really well cared for" are two quite typical positive comments received during the course of this inspection. The standard of care observed was good and this was supported by a good standard of care plan documentation, medication administration and record keeping in general. Throughout the inspection there was a calm and peaceful atmosphere in the home, care and nursing staff interacted well with each other and with the people who live in the home. This was confirmed in comments received from one health care professional who has experience of the home over several years; "Things are much more peaceful there now and nurses seem much more confident in end of life care". One comment by a relative of someone who had lived in the home paid tribute to "The wonderful lady who did the cleaning with a beaming smile on her face" which is a wonderful tribute to her and to the importance the home gives to maintaining a safe and pleasant environment for the people who live there. The management team have continued to build improved communication within the staff structure and with relatives and people living in the home and have maintained support to the staff team through training and supervision. What has improved since the last inspection? The last report noted significant improvement in the home and this has been maintained and taken forward. As noted above improved training has significantly improved the end of life experience for people living in the home which means that important phase of a person`s life is as calm, peaceful and satisfactory as is possible, without unnecessary disruption due to an avoidable admission into hospital just before the end of their life. The atmosphere in the home is more positive than has sometimes been the case over recent years and the staff team appear settled and well supported. Care plans have been improved in respect of life history and personal preferences records which makes genuinely person centred and individualised care a more realistic outcome for people living in the home. An application for registration with the CQC has finally been made by the manager which is important as it is the way that the fitness of a person to manage a registered care service is formally established. What the care home could do better: There are no specific requirements made following this inspection, which reflects what was a generally positive assessment of the home and the care outcomes now being achieved there. Further progress in the care of people living with dementia will be necessary over the next few years as this is an area where national focus is being directed and where the `bar` is being set significantly higher for services to achieve good care outcome ratings. The improvement in rating following this inspection must not give rise to any reduction in effort or focus on the part of all concerned in the administration, management and care provision of the home. Where standards have been improved those improvements must be sustained and where in the AQAA the home has identified areas where improvements are possible, these must be achieved in a timely way in order to continue to improve and enhance the care outcomes for people living in Alexandra Nursing Home. Key inspection report Care homes for older people Name: Address: Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP     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: Jeffrey Orange     Date: 1 5 0 3 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Alexandra Nursing Home 46 Alexandra Road Hemel Hempstead Hertfordshire HP2 5BP 01442246775 01442216047 alexandra@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes Limited care home 76 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 dementia old age, not falling within any other category Additional conditions: The home may accommodate a maximum of 76 service users requiring nursing care Within the overall capacity the home may accommodate a maximum of 25 older service users requiring personal care Within the overall capacity the home may accommodate a maximum of 26 older service users with dementia requiring nursing care Within the overall capacity the home may accommodate a maximum of 5 service users between the ages of 50 and 64 Date of last inspection Brief description of the care home This purpose-built care home with nursing was first opened in 1999. It consists of three floors that are connected by two passenger lifts. The ground and second floor provides accommodation to service users who require general nursing care and the first floor to service users who have some level of dementia. Each floor has its own Care Homes for Older People Page 4 of 27 Over 65 0 76 26 0 Brief description of the care home dining room and two lounge areas. The home is built on a sloping site and the main reception; kitchen, laundry, hairdressing salon and garden lounge are located on the lower ground floor at the rear of the building. There is off-road car parking provided both at the front and rear of the home. The home is located close to shops and other amenities including public transport. The Home has a Statement of Purpose and Service Users Guide, both of which are available to prospective service users along with copies of previous inspection reports by the Commission for Social Care Inspection CSCI. Weekly fees range from £ 578 - £ 636 including nursing care contributions for block-purchased Social Service beds. The maximum fee for privately funded beds is £995 excluding nursing care contributions. These fees were current at March 2010. Additional charges apply for hairdressing, chiropody, private dentistry, newspapers and personal toiletries. 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: 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: We last inspected this service on the 7th April 2009. This unannounced key inspection was carried out during the course of one day by two inspectors. Where the report refers to we it recognises also that it was carried out on behalf of the Care Quality Commission (CQC). The inspection began early in the morning which provided us with an opportunity to observe the morning routine of the home and the care experience of people living there as they got up, had breakfast and prepared for the day ahead. During this inspection we spoke to people living in the home and specifically made sure we spoke to some people who had lived in the home for some time and others who had only recently moved in. This gives us a range of views from different perspectives. Care Homes for Older People Page 6 of 27 We spoke to some members of the care and nursing staff teams as well as to the manager and her deputy and looked at some key records including those for medication administration, nursing care monitoring records and care plans. We had some very positive discussions with the manager throughout this inspection and discussed a recent visit to the home by the UK Border Agency. We checked recruitment records for some recently recruited staff and some staff supervision and training documentation. This enabled us to make a judgement about how well the record keeping and administration of the home supported and protected the health, safety and well-being of people living there. We have sent surveys to a number of people living or working in Alexandra Nursing Home, where these have been received back we have used them to inform this report, any received after this report is finalised will be recorded and used to inform the future regulation of the home. We have received an Annual Quality Assurance Assessment (AQAA) from the home in March 2010, the AQAA is a self-assessment document that sets out how well care outcomes are being achieved for people living in the home and also includes some useful statistical information, for example about staff training. This report also draws on any information we have received about Alexandra Nursing Home since the last key inspection in April 2009. This could be information received from people associated with the home in some capacity or other, from notifications of significant events affecting people who live in the home or from health and social care professionals who have dealings with the home and the people who live there. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: There are no specific requirements made following this inspection, which reflects what was a generally positive assessment of the home and the care outcomes now being achieved there. Further progress in the care of people living with dementia will be necessary over the next few years as this is an area where national focus is being directed and where the bar is being set significantly higher for services to achieve good care outcome ratings. Care Homes for Older People Page 8 of 27 The improvement in rating following this inspection must not give rise to any reduction in effort or focus on the part of all concerned in the administration, management and care provision of the home. Where standards have been improved those improvements must be sustained and where in the AQAA the home has identified areas where improvements are possible, these must be achieved in a timely way in order to continue to improve and enhance the care outcomes for people living in Alexandra Nursing Home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering Alexandra Nursing Home as a home for themselves or someone they are responsible for can be confident that they will only be admitted once a thorough assessment process has indicated that their needs can be met appropriately in a way that recognises and takes full account of their individual life history and preferences. Evidence: In their AQAA the home told us that the information collected as part of the preadmission assessment process is used as a base line for the draft care plan, which is then developed following admission, involving all parties to ensure that day to day care is genuinely person-centred. When we looked at care plans we saw that initial assessments were in place and when we spoke to care staff, including activities staff, we found that they had a good knowledge of the background, interests and preferences of the people for whom they Care Homes for Older People Page 11 of 27 Evidence: provide care. When people living in the home were asked if they had enough information about the home before they moved in to enable them to decide if it was the right home for them, they all said that they did. During the inspection we were able to speak to people who had recently moved into Alexandra Nursing Home, and they told us that their expectations about the home had been met since their admission. When we looked at care plans we found that the sections giving information about personal interests and detailing significant life history events were better completed and should enable care staff to get a good understanding of the individual persons background, preferences and requirements when addressing their care needs. People have previously told us that they were able to visit the home before admission in order to see if it was suitable for them and that the manager and her staff had been helpful and welcoming throughout the admission process. Care Homes for Older People Page 12 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. People living in Alexandra Nursing Home can be assured that they will receive a high standard of care and support delivered in a way that respects their dignity and individuality. Evidence: They look after me very well was only one of several very positive comments received from people living in the home about the standard of care they receive. When we observed care staff interacting with people who live in the home we saw that it was unhurried, appropriately informal and considerate. The home has a dignity champion whose role is to ensure that people receiving care do so in a way that is positive, respectful and takes account of their preferences. One comment received from a relative notes; The carers washed and cared so thoughtfully, allowing my father to retain his dignity. There have been significant improvements in the end of life care in the home, which is reflected in positive comments recorded from other health professionals and which reduces the need for disruptive hospital admissions at such a sensitive and potentially distressing time for all concerned. Things are much more peaceful there now and nurses seem much more confident in end of life care was the Care Homes for Older People Page 13 of 27 Evidence: assessment of one end of life specialist health professional. The standard of nursing records seen was good, with appropriate monitoring charts in place as appropriate. We found that sometimes these are less fully completed over the night time period than during other times and the need to address this was raised with the manager. The standard of medication administration found was good, with regular monitoring in place by the home and through the homes pharmacy. This means that people living in the home can be confident that their medication is being administered safely and in a way that promotes their health, safety and well-being. Care plans have been improved in terms of the personal life history and preferences elements which means that peoples individual needs and how they prefer their care to be provided is much more obvious and explicit and can be used effectively to ensure that their care needs are met in a way that is appropriate for them. We were able to see very good evidence of the involvement of people living in the home and those who are responsible for them in the care plan review process which indicates that care plans are living, working documents that are kept under review and amended and developed as peoples needs change over time. When we spoke to care staff and nursing staff, we found that they had a good knowledge of individual people living in the home for whom they were responsible and this was reflected in very positive comments received about care and nursing staff from people living in the home. They are really very kind to me was one typical example. 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. People living in Alexandra Nursing Home can now be confident that they will have consistent access to a range of activities if they chose to participate in them and that a person centred activity profile will be used to provide stimulation according to their preferences and interests. They can also be confident that they will be provided with a choice of food served where and when they prefer it to be. Evidence: When we asked a number of people who live in the home about the food, they were all very positive; It is really very good was one comment made. We observed the breakfast routine on two units and the atmosphere was calm and unhurried, people appeared to be able to choose when they ate, and whether they had breakfast in their own rooms or in the dining room. Where we observed care staff assisting people with their meal it was done considerately and without compromising their dignity. We saw copies of the monthly catering audit, carried out on the 10th March 2010 which was a thorough and comprehensive process, covering all aspects of catering Care Homes for Older People Page 15 of 27 Evidence: from storage to table. The audit recorded a score of 93 which represents a good overall performance. We saw minutes of the relatives meeting held on the 26th February 2010 at which food was discussed and at which the chef was present to answer questions. This provided relatives with an opportunity to ask about menus and raise any concerns they might have on behalf of people living in the home. We saw the activities programme and were able to observe a musical session taking place which appeared very popular and in which several people were participating enthusiastically, although were told the piano was out of tune! We were able to speak to a recently appointed activities organiser, who explained how the activities programme is to be developed, retaining the most popular existing activities and introducing others, with the two organisers working closely together. Although when we spoke to several people they indicated they preferred what they called ; their own company they were not dismissive of the activities available. Where people do prefer not to participate in group activities, some individual one to one sessions are possible, for example one person living in the home was teaching one of the organisers a new card game, and we observed a person living in the home being taken outside in their wheelchair by activities staff to enjoy some fresh air. We found that there is a new mens group, which is proving quite popular, which includes wine and a wii- games console, plus discussion about football and other topics. One person living in the home has been enabled to attend a day centre during the week, which is of significant benefit to them and represents a positive development using community based services for the benefit of people living in the home, who are after all part of the wider community. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that they are able to raise any concern or complaint they may have and that it will be dealt with appropriately. They can be confident that staff have the necessary training to ensure they can identify actual or potential abuse and take appropriate action if it is seen or suspected. Evidence: We have asked people in the home in surveys if they know how to make a complaint and they have told us that they do. The complaints policy and procedure is wellpublicised and visible throughout the home and this should mean that any concerns or complaints can be raised appropriately. In the AQAA the home inform us that all complaints are recorded and acted upon and we were able to see the complaints records in the home during the inspection. Training records seen indicate that all staff receive appropriate training to enable them to identify actual or potential abuse and the action to take if it is seen or suspected. We were able to confirm this in conversations that we had with members of the staff team during this inspection. We saw minutes of both staff and residents/relatives meetings as well as letters of appreciation from people associated with the home as relatives which praised the openness of the manager and her team. This means that people wishing to do so can Care Homes for Older People Page 17 of 27 Evidence: make a comment or complaint either formally or informally. 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. Alexandra Nursing Home provides a safe and comfortable environment for the people who live and work there. Evidence: When we arrived for the inspection early in the morning, there was little evidence of unpleasant smells anywhere and what little there was had been dealt with within thirty minutes as the cleaning staff worked their way round the home. One relative, writing a letter of appreciation paid tribute to; The wonderful lady who did the cleaning with a beaming smile on her face The home has an appropriate amount of specialist equipment, for example profiling beds and pressure relieving mattresses and the manager has previously indicated that if a specific need is identified for additional specialist equipment it will be provided. There were new chairs and tables being delivered during the inspection and the AQAA indicates that there is a rolling programme of redecoration and refurbishment that is ongoing. When, with their permission, we saw the rooms of people who live in the home, we found ample evidence of personalisation with pictures, ornaments and pieces of furniture. This meant that individual rooms reflected the interests, taste and life style Care Homes for Older People Page 19 of 27 Evidence: of the people living there. We saw a report from the local environmental health service following an inspection of the kitchen and found it was very largely positive, with any issues raised already having been fully addressed by the time of our inspection. The gardens have been cleaned up and planted more effectively since our last inspection and this has enhanced the visual appearance of the home and provided a more pleasant view for people living in the home. The AQAA told us that access to the grounds of the home is being encouraged for people who may not otherwise leave the home and as noted elsewhere we observed one person being taken out for a breath of fresh air. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Alexandra Nursing Home can be confident that they will receive care from a well trained and supported staff team with the necessary skills to enable them to meet their care needs appropriately and who have been recruited following a robust and thorough recruitment process. Evidence: When we spoke to care and nursing staff they were able to confirm that the standard and frequency of training had been maintained since the last report noted a significant improvement and they also confirmed that regular supervision is taking place. We were able to see minutes of various staff group meetings that take place and offer a forum for the promotion of good practice within the home. When we looked at some recent recruitment files for staff, they contained evidence that the appropriate checks were being undertaken in order to protect people living in the home from the recruitment of unsuitable people to provide care or services to them. The staff spoken to were again positive about the way the home is now being managed and there was, when we arrived a pleasant and positive atmosphere as the night staff handed over to the day staff team. Care Homes for Older People Page 21 of 27 Evidence: We saw training records and the manager showed us the monitoring tools she uses in order to ensure all staff receive the training they require in order for them to safely and effectively provide care to the people living in the home. Training includes the implication for staff and people living in the home of the Mental Capacity Act and the associated deprivation of liberty safeguards. We saw supervision records that confirmed what care staff had told us about the frequency of supervision and the whole training and supervision administration system now in place appears to be robust and reliable. People living in the home were very positive about the care staff and we observed some very good interaction between people living in the home and staff during the inspection including some karaoke sessions which were led by some members of the care staff team. On this occasion when we observed breakfast there appeared to be adequate staff on duty to ensure that the meal time routine was pleasant, unhurried and positive for people living in the home. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live and work in Alexandra Nursing Home can be confident that it is wellmanaged and that the well-being of the people who live there is supported and enhanced by the management systems and practices of the home. Evidence: The AQAA, completed by the manager was received within the agreed timescale and was well-completed setting out not only what had been achieved but also a realistic appraisal of where further improvements could be made and how that will be achieved. When we looked at the system of self-audit for the home we found that there are a range of routine audits and quality assurance measures in place, for example on medication, catering and care plans and the home is subject to external scrutiny from Southern Cross. This should ensure that areas for improvement are identified and a structured action plan put in place to address them which will in turn benefit people who live in the home. Care Homes for Older People Page 23 of 27 Evidence: When we talked to staff, particularly those who have worked in the home for some time, they confirmed the view expressed at the last inspection that the home was now a much happier place to work. The manager has an open door policy for staff and people living in the home or visiting and people living in the home told us that they felt able to raise any concerns they may have with the manager. We saw minutes of meetings with people living in the home and relatives and staff at all levels which confirms comments made about the improvements experienced in communication throughout the home. Care and nursing staff confirmed that regular supervision takes place and this was supported by documentation seen. This provides staff at all levels with the support they require to enable them to achieve good care outcomes for the people living in the home. In general the standard of record keeping, including that for nursing care, was found to be good which should support good care outcomes for the people who live in the home. The system for the handling of money held on behalf of people who live in the home has previously been judged to be robust and subject to appropriate audit. The effectiveness of this remains the responsibility of the manager and Southern Cross. The manager has recently completed an application to the CQC for registration as manager, although this has yet to be determined. This process has, for one reason or another taken almost two years to complete which is not best practice, as registration with the CQC is the way that formal confirmation of a persons fitness to manage a registered care is determined. We were informed that there are currently no people living in the home who are subject to a deprivation of liberty authorisation under the Mental Capacity Act. Care Homes for Older People Page 24 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 25 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 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 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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