Care Home: Belton Lodge Nursing Home

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What the care home does well The people live in comfortable and homely accommodation. They are also offered choices about what they wish to do and to make decisions about how they spend their lives. People who live in this home told us they like the way the staff care and support them. They told us, "I am quite happy here" and "the staff are very nice to us. They are offered a varied menu that takes into consideration their likes and dislikes. People told us they liked the meals which suited their tastes. What has improved since the last inspection? The home is more organised and all requirements from the last key inspection have been addressed. One bedroom has been repainted. They have introduced throughout the home a new system for the recording of care in order to make it more individual. This will be developed further to make them more person focused. They have improved the level of training provided so that staff have more knowledge about how to care and support the people living in the home. What the care home could do better: We feel that although the management arrangements have improved the organisation needs to be more proactive rather than reactive and the provider should ensure that a total quality assured service is provided. He should also monitor that care practises carried out by staff including nurses are safe and up to current practise. Key inspection report Care homes for older people Name: Address: Belton Lodge Nursing Home 213 Belton Lane Grantham Lincs NG31 9PW     The quality rating for this care home is:   one star adequate 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: Tobias Payne     Date: 2 3 0 6 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: Belton Lodge Nursing Home 213 Belton Lane Grantham Lincs NG31 9PW 01476579798 01476579798FP dimplemotors@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): R S Medicare Limited Name of registered manager (if applicable) Mrs Indra Nathan Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Condition of Registration The maximum number of service users in the home with nursing does not exceed 10 and the maximum number of service users with personal care only does not exceed 3. Date of last inspection Brief description of the care home Belton Lodge is a care home providing personal and nursing care for 13 older persons. On the day of our inspection vist there were 7 people living in the home. The home is a converted bungalow situated in Belton, a village located on the outskirts of Grantham. There is a lawned garden at the rear of the home and there are car parking spaces at the front of the property. All accommodation is situated on the ground floor. There are 7 single bedrooms one with en-suite and 3 shared bedrooms each with en-suite. Care Homes for Older People Page 4 of 27 2 8 0 9 2 0 0 9 0 Over 65 13 Brief description of the care home The home has one lounge/dining room and an adjacent conservatory which overlooks a lawned rear garden and covered gazebo with patio chairs. The fees at the inspection visit on the 23/6/2010 ranged from £398 to 420 a week. Extras are for hairdressing which ranged from £5 to £25 , chiropody £10, toiletries and personal newspapers and magazines. Information about the home including the statement of purpose and service users guide are available in a folder in each persons bedroom and copy of the last inspection report is available at request from the manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection took place on the 22/7/2009 and random inspection visits took place on the 28/9/2009 and 5/1/2010 to follow up and monitor issues arising from the last key inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit which formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of the people who use the service. The visit lasted approximately 5 hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection The manager was present and assisted us throughout our inspection and was given feedback at the end of the inspection. The main method of inspection used Care Homes for Older People Page 6 of 27 was called case tracking which involved selecting 2 people and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between the staff and the people living in the home and related care practises. . We looked at a sample of care records, policies and procedures, equipment records and walked around the home to see the quality of accommodation and visited some of the bedrooms with the permission of the people living in the home. We spoke with 5 people living in the home, as well as 2 members of staff. An (AQAA) Annual quality assurance assessment was completed by the manager and sent to us before we made this inspection visit. This is a self- assessment document completed by the manager of the care home. It sets out evidence from the provider to demonstrate that they are meeting the Care Home Regulations. We also sent out before this inspection surveys and received responses from 2 people living in the home and 1 from the staff. All were positive and their comments are reflected throughout this report. Where the use of we or us is used it refers to the Care Quality Commission. 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: 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 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming in to the home receive information and support to help them make an informed choice of where to live. There are assessment processes in place, which ensure that individual needs can be met within the home. Evidence: There was a detailed statement of purpose and service users guide in each bedroom. A copy of our last inspection report could be made available at request to the manager. During our inspection we noticed that our name, address and telephone number needed to be added to these documents. However following the inspection visit on the 25/6/2010 we received an email from the owner with copies of both documents which had this information and had been updated in June 2010. We were told that copies of these updated documents would be put in each persons bedroom. The manager told us that since the last inspection no new person had been admitted to the home. However where a referral was made to stay in the home a visit was made to meet each person to make a thorough assessment of their needs. This would Care Homes for Older People Page 10 of 27 Evidence: involve each person wherever possible and other people involved in their care and support. As a result written confirmation would then be sent to them that based on the assessment they could meet their needs. We saw in the records that assessments take place before admission to the home. The service does not provide intermediate care Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person had a care plan. Records included written confirmation that the person or their relative had agreed to the care plan, a photograph of each person, an admission assessment of their needs, nutritional assessment using a nationally recognised assessment tool, dependency assessment, risk assessment with the signature of the member of staff, specific care plan outlining the care and support, daily record and evidence of monthly review. We looked in detail at the care plans for all 7 people. We saw that they gave details about how staff can support and meet the needs of the people. The staff completed daily records so that the changing needs could be recorded and responded to. Care records included a record of daily activities which each person was involved in and a monthly audit. We noticed that in 4 care plans not all had been completed to include the capacity of people to make decisions about their lives. The manager however whilst we were in the home completed this information for each person. We saw that all staff had recently received training about respecting each persons capacity to make decisions about their lives. The manager told us that they were to further develop the care plans to make them more person focused and involve wherever possible each person in identifying their needs or at reviews of their care. We saw that they now contained a life story to give staff more information of significant aspects of each persons past life. Care Homes for Older People Page 12 of 27 Judgement: We saw staff encouraging the people to remain independent and in control of their lives by being asked about what they wanted to do. Staff we spoke with told us that we like to take our time and not to hurry people. During our inspection visit we saw staff attend to people promptly and with little fuss. The inspection took place on a hot day and we could see a jug of fruit juice in the dining room and staff offering drinks to the people. There were a variety of slings and pressure relieving mattresses and nursing beds whose height could be adjusted to suit the needs of people confined to bed. The home had an electric hoist and a standaid hoist. We saw a person who was nursed in bed. Staff attended to her every 4 hours and we could see their position was changed to relieve pressure every 4 hours and their fluid intake and output was monitored. We saw staff taking their time, talking to the person and explaining what they were going to do in a calm manner. There were plastic aprons, gloves and antibacterial hand wash in each bedroom and at the entrance to the home. Where required, people living in the home were referred to their local doctor, community nurse, community psychiatric nurse, tissue viability nurse, continence nurse, physiotherapist, opticians, dentist and chiropodist. Since the last inspection they have a Link Nurse for tissue viability who meets up with other nurses and NHS Lincolnshire to share knowledge and ensure their practise is up to date. We noticed that they had a recent thorough infection prevention and control audit by NHS Lincolnshire in June 2010 which gave a rating of 58 and showed areas of concern about infection control management and as a result an action plan had been sent to the home which will be followed up in 6 months. We had been made aware of a safeguarding investigation by Lincolnshire County Council which showed concerns as a result of poor practise in medication administration and moving and handling. As a result each nurse had been retrained in up to date medication practise and all staff had received up to date training about how to move each person safely. During our inspection we saw staff using a mobile hoist to safely transfer a person from wheelchair to their chair showing respect to them. The manager told us that action from the recent investigation had been carried out. She showed us a book which records any medication errors which are then discussed with nurses to ensure that they do not occur again. Registered nurses continued to give the medication. Each nurse was assessed by the manager and considered competent to administer medication. The manager told us that although the people are encouraged by the staff team to self medicate each person needed some form of assistance in order to ensure that they took their medication safely. We saw a medication round taking place. Medicines were given Care Homes for Older People Page 13 of 27 Judgement: from a trolley, checked against the chart, given to the person and signed for after this. The home received a pharmacy inspection visit on the 15/4/2010. There were concerns that there was some overstocking and this needed to be monitored. People we spoke with were satisfied with the way staff cared for them and had confidence in the staff. We saw throughout our inspection staff attended to the people in a warm, friendly and kind manner. The people told us the staff are so friendly and kind. Staff comments included we respect elderly people and provide individual care but I feel we could respect their choices better. Evidence: The health and care needs of the people are in the main met. Medication is given safely by staff who knew what they were doing. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to maintain and develop social interests and relationships of their choice. People receive a nutritious, varied diet, which meets their individual preferences and health requirements. Visitors are made to feel welcome and supported. Evidence: In the entrance hall to home there was a very large poster with details of the menu over a 4 week period, programme of activities for the morning and afternoon, photographs of each person and of group activities with an example of the range of activities available. We saw details about each persons interests included in the care records. The manager told us that efforts have continued to provide more stimulation in order prevent boredom for the people living in the home. We could see there was an activities programme. We were also told that they had a person who provided activities twice a week and a cooking club had been introduced. Other activities we saw in care records had included drawing, dominoes, pass the ball, singing, reading magazines, crosswords, hand and foot massage, gentle movements to music and hairdressing every week and an occasional church service. During our inspection visit Care Homes for Older People Page 15 of 27 Evidence: we saw very little activity taking place. People were sat in chairs with the television on. Occasionally staff would come and speak to them. We saw staff assisting those people with their breakfast and later on in our visit with their lunch. They sat by the side of them and assisted them in a dignified manner. We were told that staff had been told to be more involved with the people. One person told us that she felt bored and wished there was more to do. The manager told us that after lunch they would be encouraged by staff to sit outside under the covered gazebo in the garden to enjoy the sunny weather.. The people living in the home were offered 3 main meals a day plus snacks and drinks. The menu for the day was displayed on a large notice board outside the kitchen in the dining room. There was a set menu but an alternative could be arranged to suit the needs of the person. South Kesteven District Council awarded the home 5 stars (excellent) following an inspection in May 2009, in recognition of the catering service provided. We examined the records for food served, temperatures, menus and cleaning rotas and found them again well maintained and up to date. Meals were served in the dining room which was part of the lounge or on tables in front of the people in the adjoining lounge. Tables were set with tablecloths and place mats. Information provided in the AQAA and what people told us showed that the menus were varied and choice was offered. People we spoke with told us they enjoyed the food. We saw breakfast and lunch being served. We were told that breakfast included a cooked option if requested. People told us the food suits my needs, and I like the food we are given. We saw staff were assisting those people who needed assistance in a dignified and sensitive manner. They sat by the side of them and helped them. 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 know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. People are recruited in a safe and robust manner. Evidence: Each person received a copy of the complaints procedure in the service users guide and statement of purpose. The homes complaints procedure was displayed on the wall by the visitors book at the entrance to the home. It was up to date with our name, address and phone number. However at the time of our inspection visit this information was not in the service users guide and statement of purpose. However this was addressed following our inspection visit and we were informed that this information would be included in the future. We and the home have received no complaints. However we had been made aware of 2 safeguarding adults issues since the last inspection both of which were investigated by Lincolnshire County Council. The issues concerned care practise issues and action plans as a result had been developed. The home had a copy an up to date copy of Lincolnshire County Councils adult protection procedures and staff were to receive an update to ensure their knowledge was up to date. Two staff we spoke with knew what abuse was and what they would do if abuse was suspected. We looked at all staff files and saw that all staff were now correctly recruited including a check by the criminal records bureau (CRB). We could see that during their induction each member of staff Care Homes for Older People Page 17 of 27 Evidence: received information about abuse. None of the people we spoke or the staff had any complaints about the home and felt they could discuss any concerns with staff or the manager. Staff also knew what to do if they received a complaint from a person living in the home. We received the following comments, whenever I visit we feel welcomed at any time.. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, comfortable, safe and well maintained accommodation. Evidence: Since the last inspection the environment in the home has continued to improve. A new covered gazebo with patio and seating had been provided which overlooked the garden and provided shade on a very hot sunny day. The lawn had been recently cut. The manager told us that a decoration programme was to start in the future. People we spoke with told us they felt the home was clean, tidy and odour free throughout. There was an antibacterial hand wash at the entrance to the home and there was an infection policy which staff used to reduce the risk of cross infection. There were also gloves and aprons which we saw being used by staff. There were 2 commercial washing machines and one commercial tumble dryer being used to make sure peoples personal clothing was cleaned regularly. The laundry room was clean and tidy. Facilities were available to ensure clinical waste was well managed. In shared rooms there were privacy screens. They had also installed signs with words and pictures indicating bedrooms with the photograph of each person and the use of each room to assist people to find their way around the home. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is enough staff on duty to meet the needs of the people living at the home. Procedures for the recruitment of staff are robust and offer protection for people living at the home. Staff have access to training to help them meet the needs of the people they care for. Evidence: People we spoke with felt the home was adequately staffed with people who were competent to care for older people. People we spoke with did not express any worries about the level or availability of staff. During our inspection visit we saw staff attended to the needs of the people promptly and in a calm and friendly manner. There were separate registered nurses, care, domestic and catering staff. We looked at all the staff files. Records had improved since our last key inspection and each person had their own file. Records were clear and detailed and now showed that all staff had been safely recruited in accordance with the regulations including receiving 2 references one from the persons current employer and a recent check by the Criminal Records Bureau (CRB). We were told each person received a supported induction programme. We were told that the manager encourages and supports care staff to study for a care qualification to National Vocational Qualification standards. The manager told us that this has increased from 20 to 30 of staff with an NVQ. In addition, 3 staff now had NVQ level 3 and 2 staff were to start NVQ level training in Care Homes for Older People Page 20 of 27 Evidence: the future. Training records we saw showed that the training provided since our last inspection had included mental capacity and deprivation of liberty, fire safety, first aid, safe handling of medication, moving and handling and health and safety. During our inspection we saw staff applying their training outcomes to their daily work. Observation of care practises at the home showed us that the staff were caring for people in an appropriate manner. They were visible in communal areas and responded well to peoples needs. The day seemed unrushed with staff had time to chat and spend time with the people. The people we spoke with commented The staff are nice. Other comments we received included, the staff are very caring, polite and helpful. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not being managed consistently well enough to ensure that the people receive at all times a quality service. This has the potential to result in their needs and wishes and not being entirely met. There are opportunities for people to make their views known about the quality of the service. Evidence: The manager is a registered nurse and has extensive care and management experience. She also has a management qualification. She is assisted by a registered nurse who is also experienced and knows about the needs of the people living in the home. At the last key inspection we had been told that the owner had recruited a new manager but we have learnt since then that the person did not take up the post. We have been made aware that the owner has continued with the aid of an outside consultant to continue to search for a new manager but at the time of our visit this had still not been successful. We had been made aware by Lincolnshire County Council Care Homes for Older People Page 22 of 27 Evidence: that as a result of concerns about the care practises in the home the council had suspended contracts since April 2010. The service was being monitored closely by the councils quality assurance department. We saw that improvements had taken place about monitoring quality assurance. There was a folder with detailed monthly reports made to the home by the owner as required as a result of his monthly unannounced monitoring visits. In addition there were 2 weekly quality monitoring reports by the manager which covered care, environment and staffing issues. We also found that improvements had been made in the way records were managed and organised and some records were now being stored in an office on the first floor. In addition the owner had commissioned an independent review of the home by an outside consultant. As a result an action plan had been produced with time scales when action was required. We could see that visits had been made by the consultant to the home on the 17/5/2010 and 16/6/2010. However we had been informed by Lincolnshire County Council that following their most recent monitoring visit made on the 11/6/2010 that they had not yet received a report from the consultancy to follow up their audit of the home which took place on the 27 and 28/10/2009. The manager told us some of the actions from the report had been acted upon. We saw new procedures had been introduced in April 2010. We also saw that a self assessment by the manager for NHS Lincolnshire on the 15/4/2010 had given an overall score of 81.5 excellent. The report had advised that they introduce a record keeping audit and that activities are improved and we noted this would also be followed up at a future meeting. However despite these improvements the information we hold shows evidence that the management of the home react to issues which are brought to their attention and there is a lack of overall consistency. Staff told us they received regular formal supervision and notes were being kept. Staff told us that they felt the management were supportive. Staff told us we have regular meetings and are kept informed about what is going on, we work very hard and are keen to help the residents. There was a comprehensive and detailed health and safety policy together with risk assessments covering all aspects of daily living activities. Records also showed there were regular tests of the fire system. We saw that Lincolnshire Fire and Rescue Service made their last inspection to the home on the 8/1/2010 and their report mentioned, the fire and rescue authority regards that suitable progress is being made towards addressing the previous report. The fire risk assessment was last reviewed 8/4/2010. Records were available, up to date and well maintained and better organised. Information provided in the AQAA, demonstrated that regular checks on equipment such as hoists and fire fighting equipment had taken place. Records also Care Homes for Older People Page 23 of 27 Evidence: showed that essential equipment was regularly serviced. 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 1 33 The manager should introduce regular audits of care records and arrange for activities to be improved so that the people do not feel bored by living in the home. 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. © 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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