Care Home: Appleton Manor

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What the care home does well Southern Cross Health Care have set a high priority on ensuring that staff understand the importance of promoting people`s dignity and have introduced a "Dignity in Care" agenda to encourage staff discussion and involvement. The manager is very enthusiastic about promoting this agenda and has appointed a carer to the role of Dignity in Care Champion to attend training at the company head office and pass on to other staff what they have learned. People we spoke to during the inspection and people that returned surveys to us all said that staff treated them well and they received good care. Comments included "Brinnington unit is a very caring home looking after all types of dementia. The carers look after the needs of the residents making them feel happy and content as a part of a big family", "It is staffed by completely caring staff. This attitude emanates from a secure leadership. The home treats the client as an individual and ensures that their surroundings are as they would wish if they were in their own home", "Staff are good to me and look after me well" and "The staff are so kind patient and efficient". We watched how staff spoke to and dealt with people living at the home and they seemed to have fun with them, chatting, listening and singing along to music and making people laugh by dancing like John Travolta! Medicines are managed well at the home and regular checks (audits) are made to make sure staff follow the proper procedures. People said they liked the food provided and we saw that a choice of meals was served at each mealtime. The manager has been in post for over 10 years and has a real commitment to making the home as good as it can be. Everyone we spoke to both staff and people living at the home said the manager was approachable and supportive and was ready to listen to them at any time. The manager told us that she viewed complaints as a "gift" given in good will to help her improve things that went wrong and do better the next time. As such the home has an open culture where people are not afraid to say what they think and are able to put forward suggestions for improvements. The home was clean, warm and welcoming and individual rooms were personalised to the occupant`s liking with their own photographs, mementos and small items of furniture. In the AQAA the manager reported that 54% of the staff had successfully completed National Vocational Qualifications (NVQ). This qualification is obtained following training in providing personal care. This meant that staff had a good basic knowledge of the care they needed to provide and the reasons such care was needed. All new staff are recruited following thorough checks to make sure they are suitable to work in a care home and receive initial training and ongoing training to make sure they develop their skills. There is a very good system of checks in place to make sure that staff provide care to a good standard and the health and safety of people living at the home and staff are protected. What has improved since the last inspection? At our last inspection we made 4 recommendations which the manager has acted on to improve shortfalls identified in the service. Since the last inspection staff have worked at including more details in peoples` care plans to make them more individual, with specific information about peoples` preferences and abilities. This means staff have the information to understand people more fully as individuals and can treat them accordingly. Everyone living at the home is involved where possible in a review of their care plan every 3-6 months and where appropriate family members may be involved. This gives people a chance to say what they are happy with and if there are any problems with the care they are getting. An activities organiser is now employed specifically for Appleton Manor - previously someone was employed to work between the Manor and Appleton Lodge and therefore the amount of time they had was limited. Records showed that a range of activities and opportunities for social stimulation were provided with the activities organiser always looking for new ideas to try. The first floor unit has been redecorated and the environment has been considered in light of what is suitable for people with dementia. Along the hallways sensory pictures are displayed that provide visual and tactile stimulation for people. What the care home could do better: We did not make any requirements or recommendations at this inspection and are confident that the manager will continue through her own quality assurance checks to look at how she can continue to improve the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Appleton Manor Lingard Lane Bredbury Stockport Cheshire SK6 2QT     The quality rating for this care home is:   three star excellent 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: Fiona Bryan     Date: 1 7 0 8 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 28 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 28 Information about the care home Name of care home: Address: Appleton Manor Lingard Lane Bredbury Stockport Cheshire SK6 2QT 01614067261 01614068962 appletonmanor@schealthcare.co.uk 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) : Southern Cross Healthcare Services Ltd care home 59 Number of places (if applicable): Under 65 Over 65 0 59 0 dementia old age, not falling within any other category physical disability Additional conditions: 59 0 59 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE, Physical disability Code PD. The maximum number of service users who can be accommodated is: 59. Date of last inspection Brief description of the care home Appleton Manor Nursing Home is owned by Southern Cross Health Care Limited. The home shares its grounds with Appleton Lodge, which is owned by the same company. Appleton Manor is located on the borders of Brinnington and Bredbury and is close to local amenities, with convenient access to public transport and motorway networks. Care Homes for Older People Page 4 of 28 Brief description of the care home The home offers nursing care for up to 26 people. In addition, the home is registered to care for up to 33 people who have a physical disability and dementia. Accommodation is spread over two floors offering single en-suite bedrooms. One double room is provided for service users wishing to share. The first floor, called the Brinnington unit, accommodates service users who have dementia. The ground floor accommodates service users who require nursing and residential care and is called the Bredbury Unit. The current weekly fees range from £ 442.00 to £857.60 dependent on the package of care required. Further details regarding fees are available from the manager. Additional charges may also be made for hairdressing and other personal requirements. 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: three star excellent 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 key unannounced inspection, which included a visit to the home, took place on Monday 17th August 2009. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people living at the home, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to three people were looked at in detail, looking at their Care Homes for Older People Page 6 of 28 experience of the home from their admission to the present day. A selection of staff and care records was examined, including medication records, training records and staff duty rotas. Before the inspection, we asked for surveys to be sent out to people living at the home and staff asking what they thought about care at the home. Seven residents and five staff returned their surveys. Comments from these surveys are included in the report. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form very well and gave us a good picture of how the service has developed since we last inspected. The manager was able to show that she was realistic about the service provided and could identify where there were areas for development. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 28 At our last inspection we made 4 recommendations which the manager has acted on to improve shortfalls identified in the service. Since the last inspection staff have worked at including more details in peoples care plans to make them more individual, with specific information about peoples preferences and abilities. This means staff have the information to understand people more fully as individuals and can treat them accordingly. Everyone living at the home is involved where possible in a review of their care plan every 3-6 months and where appropriate family members may be involved. This gives people a chance to say what they are happy with and if there are any problems with the care they are getting. An activities organiser is now employed specifically for Appleton Manor - previously someone was employed to work between the Manor and Appleton Lodge and therefore the amount of time they had was limited. Records showed that a range of activities and opportunities for social stimulation were provided with the activities organiser always looking for new ideas to try. The first floor unit has been redecorated and the environment has been considered in light of what is suitable for people with dementia. Along the hallways sensory pictures are displayed that provide visual and tactile stimulation for people. 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 9 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 10 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. People have their needs assessed before they move into Appleton Manor so they know their needs can be met. Evidence: Information about the home in the form of a statement of purpose and a service user guide was displayed in the reception area. A copy of the last inspection report was also available and comments about the home from past and present residents and relatives were provided to give prospective residents an idea of peoples views about the home. We looked in detail at the care provided to three people. Each person had been assessed before they came into the home to make sure that their needs could be met. Assessments from other health care professionals were also available and all the information gathered had been used to develop draft care plans before admission that staff could then use to build on with additional information as they got to know the Care Homes for Older People Page 11 of 28 Evidence: person. Care Homes for Older People Page 12 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. People who live at Appleton Manor have their needs met and their care is provided in a manner that protects their privacy and dignity. Evidence: We looked in detail at the care provided for 3 people. Each person had detailed care plans which described their abilities and preferences as well as the care that staff needed to provide. Risk assessments for falls, moving and handling, nutrition and pressure areas were undertaken and where people were identified as being at high risk associated care plans had been developed to address their care needs. Regular reviews took place that included the person being cared for and their relatives. This meant they were able to give their views about the care being provided and in one case someones care plan had been amended to take into account further information about their likes and dislikes. Care Homes for Older People Page 13 of 28 Evidence: The system for assessing the risk of pressure sores was different in the pre admission assessment to the system being used when the person was actually living at the home and the 2 different systems appeared to give contradictory scores in one case, indicating that the same person was at both high and low risk, which was confusing. This was discussed with the manager who said she would look again at how staff were using the systems to ensure the level of risk to a person was calculated correctly. Records showed that people had seen their GPs, district nurses and opticians. One persons records showed that they had not seen the chiropodist since March, despite being diabetic and therefore needing regular foot care. The manager said that she had encountered some difficulty in accessing chiropody/podiatry services for people but would pursue this. We spoke with a district nurse who visited the home regularly. She said that staff always listened to their instructions and followed their advice and were quick to refer people to the district nursing team for assessment if they had any concerns about their health. She commented that the care she observed being delivered to people was very good. We observed staff checking if people were OK and noticed they had a kind and pleasant manner with everyone. Of the 7 people that returned surveys 6 said they always or usually got the care and support they needed and staff listened and acted on what they said. Comments included Brinnington unit is a very caring home looking after all types of dementia. The carers look after the needs of the residents making them feel happy and content as a part of a big family, It is staffed by completely caring staff. This attitude emanates from a secure leadership. The home treats the client as an individual and ensures that their surroundings are as they would wish if they were in their own home, Staff are good to me and look after me well and The staff are so kind, patient and efficient. The manager told us that Southern Cross Health Care had initiated a Dignity in Care agenda and one of the carers had been appointed as the homes Dignity in Care Champion, to attend meetings and training at the company head office and cascade ideas and information to other staff. We looked at how medicines were managed for a small number of people. Records were up to date and accurate and there was a system of checks in place to make sure staff followed the correct procedures. Care Homes for Older People Page 14 of 28 Care Homes for Older People Page 15 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. Social activities and meals are both well managed and provide daily variation and interest for people living in the home. Evidence: Since the last inspection an activities organiser has been employed specifically to work at Appleton Manor rather than working between the Manor and the Lodge. This means that the activities organiser has more time and has been able to increase the range of social events provided for people. Records were kept of what activities had taken place and who had participated. Events such a Red Nose Day, St Patricks Day and St Georges Day were celebrated and people had enjoyed activities such as arts and crafts, manicures, reading and discussing items in the newspapers, tending pot plants and playing cards and board games. Some people had had High Tea in the garden and others had been out for pub lunches. The manager said trips outside the home had increased as they had easier access to a minibus from other homes within the group. Several trips to Southport had been or were about to take place and plans were being made to take a group of people for a short holiday to Pontins in April 2010. Care Homes for Older People Page 16 of 28 Evidence: Of the 7 people that returned surveys 4 said there was always or usually activities they could take part in. Most people said they liked the food provided at the home. The main meal of the day was served at 12.30pm and a choice of options was available at all mealtimes. The menu was displayed on the notice boards on each floor but staff told each person what the options were when they were serving them and asked them to choose what they wanted. Lunch on the day of our inspection was sausage or fish in parsley sauce, boiled new potatoes, grilled tomato and peas, followed by sago pudding or cheese and biscuits. People had a choice at teatime of soup and sandwiches or beans on toast. In the dining room on the ground floor there was a really good atmosphere. Staff had put on some music and people were singing and humming along, whilst staff danced and made them laugh! The atmosphere on the first floor was not as good as the television was left on and people were quieter. Tables on both floors had been laid with cloths and cutlery but no condiments or sauces were provided upstairs and one of the four tables downstairs also had no condiments and no one was offered sauce to go with their sausages. The food however, looked and smelled appetising and people said they were enjoying it. All the people that returned surveys said they always or usually liked the food they were given. Comments included Good with meals and Food looks to be of a good standard. Care Homes for Older People Page 17 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. People using the service were protected by the complaints and safeguarding procedures, which were understood by staff. Evidence: The complaints procedure was provided in the service user guide and a record was maintained of all complaints received, which showed how they had been investigated, what action had been taken and how the manager had responded to the complainant. The culture within the home was open with the manager being approachable and viewing complaints as a gift that enabled her to identify shortfalls and improve the service provided. Six of the 7 people that returned surveys said they knew who to speak to if they were unhappy about anything. All staff had undertaken training in safeguarding adults and were aware of the procedures to follow. A safeguarding policy was available in the staff office but this said staff needed to refer to the Local Authority all agency policy and staff were not sure where this was kept. It was recommended that the manager amend the homes policy to inform staff where to access the Stockport policy, which was kept in her office. Care Homes for Older People Page 18 of 28 Evidence: The manager had attended training in the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DOLS) and information was available for staff, to use as a guide when considering if people were being deprived of the liberty. At the time of our inspection no one was subject to an application being made under this under these requirements. Care Homes for Older People Page 19 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. A clean, pleasant and comfortable environment is provided. Evidence: Appleton Manor provides a good standard of single en-suite accommodation for people living there, with several lounges, dining rooms and bathing facilities. Since the last inspection a sun lounge had been created on the first floor, with large windows overlooking the gardens. It was reported that this room had become popular with people living at the home. Further decoration of communal areas, hallways and bedrooms had also taken place. People living at the home had been encouraged to make collages and sensory pictures to display on the walls using everyday objects such as wool and other materials to stimulate visual and tactile senses. The environment for people living on the first floor had been considered with regard to therapeutic good practice in dementia care and the manager told us there were further plans to paint peoples bedroom doors different colours to aid orientation. A partial tour of the home was undertaken. Peoples rooms were homely and Care Homes for Older People Page 20 of 28 Evidence: comfortable and the home was generally clean and tidy. Six of the 7 people returning surveys said the home was always or usually fresh and clean. One person commented The home is spotless. Outdoors the home has enclosed garden areas with raised flowerbeds and patio furniture. The home is equipped with specialist aids and adaptations to promote peoples independence. A maintenance person was employed in the home and their duties included attending to the day-to-day repairs and general maintenance of the home. Care Homes for Older People Page 21 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. Staffing arrangements, recruitment and training ensure that people are cared for and supported safely. Evidence: On the day of our inspection there were 26 people living on the ground floor, being cared for by 1 nurse and 4 carers during the day and 1 nurse and 2 carers at night. On the first floor there were 33 people being cared for by 1 senior carer and 5 carers in the morning, 1 senior and 4 carers between 2pm and 8pm and 1 senior and 2 carers at night. Four of the 5 staff that returned surveys said there was always or usually enough staff to meet peoples needs and 6 of the 7 people living at the home that returned surveys said staff were always or usually available when they needed them. Staff on the day of our inspection told us that staffing levels were generally sufficient for them to care for people properly, although one person did comment that at teatime on the first floor it was often very busy as several of the people living on that floor tended to become agitated at that time of the day due to their condition. This was discussed with the manager and we recommended that staffing levels be kept under review to take into account the level of dependency of people. Care Homes for Older People Page 22 of 28 Evidence: We looked at the personnel files of 3 employees. Records showed they had been recruited via a robust recruitment procedure. All staff that returned surveys confirmed that they had been asked to provide references and obtain a criminal record disclosure before they were employed. In the AQAA the manager reported that staff interest and commitment to training had improved since the last inspection and that training within the company was more organised and given a high priority. The manager confirmed that all staff received an induction when they started to work at the home that covered health and safety, moving and handling, infection control, fire safety, safeguarding adults, how to recognise abuse, food hygiene and an introduction to dementia care. All the staff that returned surveys said their induction had covered everything they needed to know very well and they were given ongoing training that was relevant to their role. Training records were kept electronically and an alert was flagged up when refresher training was due. Proof of attendance and certificates of training were kept in individual staff files. The manager told us that 54 of care staff have successfully completed NVQ training. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of Appleton Manor is based on openness and respect. This ensures that the home is run in the best interests of the people who live there. Evidence: The manager has been in post for over 10 years and continues to be the driving force in the home, making sure high standards of care are provided whilst continuing to improve and develop the service. In the AQAA the manager was able to describe improvements that had been made to the service since the last inspection and also demonstrated that she could identify shortfalls and plan further developments. Over the past year she has attended training to ensure her knowledge and skills remain current and she continues to have great enthusiasm for ensuring people living at the home are happy and content and also ensuring that staff are well supported and trained. Care Homes for Older People Page 24 of 28 Evidence: The manager operates an open door policy and it was widely advertised around the home that she was always willing and available to speak with people living at the home or their representatives. Regular staff meetings gave staff an opportunity to make their own suggestions and staff morale appeared to be very positive. One staff member commented Our manager is always ready and willing to listen. Priority was given to listening to people that lived at the home and empowering them to have their say about how the home was running. The manager was about to initiate a scheme in which people were asked a specific question, for example, what dignity meant to them and was going to display the question asked, together with the various answers received and information about what staff had done in response to the feedback they got. Projects like this are good practice as they are inclusive and open to listening to what people think about the things that matter to them. A range of checks (audits) looking at staff practice in areas such as financial and administrative procedures, health and safety, care planning and medicines management were undertaken regularly in the home, and these were closely monitored by senior managers in the organisation. Copies of the audits were available in the home. The homes administrative support assistant maintains detailed records of all monies held on behalf of residents. Records were available and a clear audit trail was evident. The home employs a maintenance worker who undertakes routine repairs and monitors equipment to promote the health and safety of residents and staff. Records of maintenance including fire safety were available but not seen at this visit. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 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 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 27 of 28 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). 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