Care Home: Browns Field House

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What the care home does well This is an excellent home, which provides a high standard of accommodation, support and care to older people. The staff are highly motivated and strive hard to create the opportunities for residents to enjoy a fulfilling life, which is socially rich. We spoke to residents over lunch and they told us they were content at the home. One person said " I have come here to live not die". This resident had an active social life and was still very involved with community life. We looked at the surveys received from staff and residents. We received 12 returned surveys from residents/relatives. They told us in answer to, `what the home does well`: "Everything, I am constantly impressed by the level of care my mother receives. Empowered staff, the whole positive feel of the home, the atmosphere, relaxed, friendly and everyone at ease." " The care and the commitment that all staff give to all residents is second to none. Nothing is too much trouble." "Always something going on, activities, theme days, pre- lunch drinks, staff chatting with residents." " This is a truly exceptional home for the elderly and I unreservedly recommend it highly." " They make me feel cared for and respected. They will always listen to me if I need them." We had 11 returned staff surveys. They told us " Emphasis is put on the importance of training and enhancing your personal development." " Care staff have a great passion for the work they do with older people. The leadership and management is second to none." The Manager stated that, " She is very proud and grateful towards her team who work so hard." A tribute to this is the nomination that has been made to the National Care awards for the staff`s willingness and dedication to go that extra mile to make the house a home and not to be afraid to try new initiatives to help residents maintain positive mental health and reduce the need for medical intervention. What has improved since the last inspection? The home are constantly striving to improve and staff are constantly coming up with fresh and innovative ways to bring this home forward. Residents are actively involved and their strengths recognised and rewarded. What the care home could do better: We made one requirement. Self administered medication must be stored safetly to protect other residents from potential harm. The water temperatures are tested by outside contractors. Some of them exceeded 43 degrees and we did not see any recorded actions to address this. The manager stated that she would deal with this. Key inspection report Care homes for older people Name: Address: Browns Field House Browns Field House 25 Sherbourne Close Cambridge Cambs CB4 1RT     The quality rating for this care home is:   three star excellent 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: Shirley Christopher     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Browns Field House Browns Field House 25 Sherbourne Close Cambridge Cambs CB4 1RT 01223426337 01223420588 m.tuffin@abbeyfield.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Abbeyfield Society Name of registered manager (if applicable) Marsha Maria Tuffin Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 27 The registered person may provide the following categories of service, Care Home only, Code PC to service users of the following gender, either, whose primary needs on admission to the home are within the following categories, Old Age, not falling within any other category, Code OP, Dementia, Code DE Date of last inspection Brief description of the care home Browns Field House is a purpose built home for up to 27 older people, including a limited number who have dementia. The home is situated in a quiet residential area of Cambridge and is within reach of shops and other amenities. Twenty-five of the rooms are for single occupancy; one is a shared room which has been used for single Care Homes for Older People Page 4 of 26 Over 65 0 27 27 0 Brief description of the care home occupancy for some considerable time. Service users have access to a range of communal areas, including a large lounge and dining room and small seating areas by the windows elsewhere in the building. The home has two enclosed garden areas with mature shrubs, a summerhouse, and seating areas which are provided with suitable furniture. There are sufficient toilets and bathrooms which are provided with appropriate equipment to allow staff to assist service users with their personal care. Staffing is provided 24 hours a day; 2 staff are on duty at night. The registered provider is Abbeyfield UK. In March 2009 the registered provider put in an application to change the name of the service from Abbeyfield Uk to Abbeyfield society. This was approved and they were issued a new certificate in April 2009. It received its first inspection as a new service within six months of registering. We asked the manager if there had been any changes in terms of ownership, management or staffing. There has not. The current fees for this service range from 428.00 for a small room to 614.00 for a room with ensuite. The cost for a dementia care bed is 694.00. Care Homes for Older People Page 5 of 26 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: We carried out an unannounced, key inspection on the 18 November 2009. In preparation for this inspection we looked at the service history and asked the home to complete an Annual Quality Assurance Assessment, (AQAA.) This gives us information about how the home is managed and how they are meeting National Minimum Standards. We sent out surveys to staff and residents, some of which were completed by relatives. We will give feedback under what the home does well. On the day of inspection we looked around the home, talked to staff, residents and a volunteer. We observed care practices in the home and joined residents for lunch. We looked at staff and resident records. We also looked at maintenance records and management records. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: We made one requirement. Self administered medication must be stored safetly to Care Homes for Older People Page 7 of 26 protect other residents from potential harm. The water temperatures are tested by outside contractors. Some of them exceeded 43 degrees and we did not see any recorded actions to address this. The manager stated that she would deal with this. 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 26 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 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to exercise choice and have their choices respected. Evidence: The home has an up to date statement of purpose and service user guide. There is extensive information around the home which informs relatives and residents about their rights. Staff are more than happy to help relatives in accessing the benefits and support they may be entitled to for their relative. There is information about the Abbeyfield Society. The home has got a comprehensive assessment process and residents are given every opportunity to visit the home on an informal basis. This may involve visiting many times until the person feels they are able to decide if the home is right for them. There is a getting to know you form which is very detailed and enables staff to have a good insight into the persons preferred routines and lifestyle before they move in. Care Homes for Older People Page 10 of 26 Evidence: The home benefits from a stable staff team with considerable experience. All staff have completed training in dementia care and staff access training as necessary. One example is end of life care, completed as a pilot study through the open university and is a years course. The manager is also completing further courses in health care and dementia care pathways. Staff are completing training on mental health issues. A leading psychiatrist in Cambridge is completing a book, mental health issues in older people in which he has asked the manager and a resident to contribute. Care Homes for Older People Page 11 of 26 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. Residents can expect their health and personal care needs to be met by the staff. Evidence: We looked at two care plans in depth. They are written in a simplistic format and were therefore easy to follow. They were written in a person centered way and gave staff enough information. They had been signed by the manager and the resident. There was clear evidence that the plans are a working document and are actively reviewed monthly. Detailed life stories were on file and residents and their families are asked for as much information as possible. The life history gives information about family and about the persons interests and preferred pursuits. Reviews include the resident, relatives and staff members. In one instance the daughter of a relative wrote their plan of care with the involvement of their relative and staff. This was a very good example of how a person centered plan should be written. A high percentage of residents have some degree of memory loss. Residents have note pads in their rooms and staff will jot down what they have been doing so relatives can see. Care Homes for Older People Page 12 of 26 Evidence: Health care needs are clearly met and the staff will accompany residents to the doctors surgery if requested. The home use four different doctor surgeries, so clearly residents are given a choice. There is a fortnightly doctors surgery at the home. There was clear evidence of other health and social care involvement. Risk assessments are in place and there is good documentation regarding the incident of slips, trips and falls and the prevention of them. There is a falls register which is regularly reviewed. We saw evidence of assessments regarding nutrition, skin integrity, mobility, psychological risks, mental health assessments, an assessment of mental capacity and finances. Some residents had written a living will and there was information about peoples last wishes. We looked at accidents records and these are clearly reviewed. The home use body maps to plot any injuries or bruises. We looked at a small sample of medication records and the homes stock of medication. This was not a full audit. Senior staff hold the medication keys and complete a detailed internal audit twice a month. This is done by two Senior staff to reduce the risk of error. Staff receive regular training in the safe administration of medication. Medication was secure and records checked were in order. Medication is stored at the correct temperature. We did question the practice for one resident who takes their own medication. Staff check to see that they have taken it safely. When we visited this resident the medication was on the table in front of them. We were concerned that medication must be stored safely because of the risk it presents to other residents. Care Homes for Older People Page 13 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provide a structured environment for residents. The staff place great emphasis on maintaining residents health and emotional well being, through the provision of activities and maintaining their social and community contact. Evidence: The home provides a whole range of activities for people and these are clearly displayed all around the home. There are also photographs around the home. Social activities are carefully thought out and reflect the expressed wishes and interests of the people living at the home. Some recent examples included: a visit from the traveling theatre, a medieval banquet, trip to the local pantomime, French and computer lessons. The environment has been carefully thought out and provides ample opportunity for residents to sit in the company of others or to sit privately or entertain visitors. There is memorabilia round the house, a library and an old fashioned sweet shop, where residents can purchase things. The manager stated that in the summer residents were in the garden and the home provided a big paddling pool and residents sat enjoying the sunshine eating ice-cream. The home had a designated activities co-ordinator but they have just retired after twenty years of service and will remain in contact with the home. The home have Care Homes for Older People Page 14 of 26 Evidence: recruited to the post which is 15 hours a week. Care staff were given extra time on shift to fulfill this role until all of the persons recruitment checks are in. There are regular residents meetings and it was clearly evident that residents are involved in the day- to- day running of the home and help with setting the tables, laundry and caring for a range of animals including chickens, rabbits, guinea pigs and fish. One resident collects the eggs every day. The day before the inspection the residents had a reptile encounter which was a great success. Residents are involved in the garden. There are raised flower beds and residents grow vegetables. In the garden there is a summer house, which was brought in by one of the residents. She has since died and there is a plaque in her memory. Her relatives are still involved with the home. Another resident was a keen artist and was able to bring in their art work and bureau where they still work from. We were able to enjoy a delightful meal with a group of residents. Two were old friends and had moved into the home because they needed some support and had heard of the homes good reputation. One person told me she was content at the home, another person told me they had come to live, not die. This was just before going off independently in a taxis to their art classes. We asked residents their views of the home and they said it was excellent. The food was served hot. It was tasty and nutritious and the feedback about meals was good. It is all home cooked and menus clearly displayed. The tables are beautifully arranged with napkins, condiments and sweets/mints. There is a fresh supply of fruit. Staff eat with residents. At weekends residents can enjoy wine/sherry and the home celebrate different traditions and local culture. For example one person was from Newcastle and they had local dishes from that area and Newcastle Brown Ale. Birthdays and special occasions are celebrated. Residents ARE served breakfast in their rooms. At lunch time there is a smaller dining room which may be used by residents who require some assistance with their meal. The manager has purchased heated plates for some residents who do not eat very quickly and there food therefore goes cold. We did not meet any visitors but there was a volunteer who regularly visits the home and felt that the home provides excellent standards of care. The managers enthusiasm for the home is incredible and staff freely give up their own time to fund raise. The home had an impressive raffle with lots of donated gifts. One staff member had just completed a marathon, raising over a thousand pounds and was looking forwards to her next challenge. Relatives clearly play a central role in the home and there are Care Homes for Older People Page 15 of 26 Evidence: informal occasions such as cheese and wine which they are invited to. They are also invited to the monthly care reviews and are kept informed on any decisions or changes made. The hairdresser was on site on the day of inspection and she has her own designated room to work from. The manager told us that visitors are always welcome and the home makes every effort to keep relatives informed. Relatives have the managers mobile number and staff text and email if they cannot get hold of a relative straight away. Arrangements for contact are clearly recorded. Staff were being nominated for the best Care Home Awards being held in London. Last year they had got into the finals. On the day of inspection there were sufficient staff on duty and different activities going on. Some residents went out in the afternoon. The only draw back for this service is they do not have a mini bus so have to rely on taxis which are expensive, public transport or relatives. There is a budget for activities. The budget is supplemented by fund raising activities. Care Homes for Older People Page 16 of 26 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. Residents and their relatives can feel confident in raising concerns and complaints in the knowledge that the staff will take them seriously and deal with them appropriately. Evidence: We asked to review the homes complaints procedure which was satisfactory. The home have not received any formal complaints in the last year. Any concerns or suggestions for improvement are acted upon immediately so they do not turn into complaints. The home has robust procedures for the recruitment of new staff and staff are regularly supported and supervised. Staff receive training in the protection of vulnerable adults. The home have policies and procedures in place. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lay out of the communal space creates a family-style home and provides a stimulating environment which is appropriate to older people and gives them the opportunity to reminisce. Staff enable residents to maintain the garden and take responsibility for the pets. Evidence: The environment is constantly being reviewed to make sure that it is safe for residents. It provides spacious communal accommodation, but also areas where residents can sit in private. The garden is easily accessible and there is a summer house, a green house and raised areas. It is a beautiful spot and residents take an active role in maintaining it. Residents grow vegetables and herbs. The accommodation is mainly laid out on ground floor level but there is an upstairs which accommodates four residents and they all have en suite facilities. This area is always staffed. Downstairs, residents have access to a small kitchen where they can make a drink. It has well equipped kitchen cupboards. The manager stated that residents often go in and re arrange the cupboards. Care Homes for Older People Page 18 of 26 Evidence: The home have purchased a new intercom system which is quieter. It also records what time the alarm was first activated and how long it took for staff to answer. There are policies and procedures in place for promoting good infection control. The home was cleaned to a very high standard and basic hygiene practices were observed. Care Homes for Older People Page 19 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels reflect the needs of residents. Staff are appropriately skilled and supported by a highly effective management team. Evidence: The home was well staffed. On the day of inspection there was the manager and deputy manager. There were five care staff, one who was a senior. In the afternoon, there are four care staff. There are two night staff. The manager stated that she had just had a meeting with the night staff who were finding early mornings difficult and wanted help with medication. The rota had been reorganized to accommodate their request. The home has an activities post, (15 hours) currently vacant but recruited to. There are also domestic staff, kitchen staff, a laundry person and an administrator. We looked at staff training. 95 of staff hold a national vocational qualification at level 2 or above, which far exceeds minimum standards. We were not able to see induction records as there have been no new staff but the home have an induction pack and supported training videos. The manager was already looking at ways of how to develop this to fit their service and make it better. The staff training matrix was being rolled out for 2010 and we saw evidence that staffs training needs are met through a rigorous training programme, both mandatory and Care Homes for Older People Page 20 of 26 Evidence: more specialist training provision . Examples included training in dementia, mental health, end of life, nutrition, challenging behaviors, Parkinsons, strokes, team building, deprivation of liberty and the mental capacity act. The home use a range of training providers and methods. Staffs mandatory training was up to date. We looked at supervision records. These were up to date and taking place every six to eight weeks. We looked at staff files. These were up to date. CRBs dated back to when staff were first employed and had not been renewed. This would be good practice. On one file we looked at there were no staff references, but this related to a staff member employed over twelve years ago. Before the beginning of each shift and at the end of each shift there is a thorough handover and a debriefing session. This was very informative. Care Homes for Older People Page 21 of 26 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 home is run by a competent manager who promotes an atmosphere of openness and respect. Staff actively consult residents about their health, personal care, interests and preferences. Evidence: The home benefit from a low turnover of staff and a very experienced manager who has a passion for the job and her enthusiasm motivates and drives staff. The deputy manager has been at the home since it opened and shares the passion for providing an excellent, innovative service delivering the best possible outcomes for the residents. This is done in consultation and involvement with residents, relatives and other professionals. There is an inclusive atmosphere in the home and there are a number of visitors. The home have regular staff, relative and residents meetings. We looked at the home internal audit systems, which are robust. We looked at the internal monthly audits required by regulation. These were completed in considerable detail. The home has a Care Homes for Older People Page 22 of 26 Evidence: thorough annual quality assurance system and seek views from those using the service, relatives, stakeholders and those contributing to the success of the service: staff and health and social care professionals. Surveys are completed and then results are analyzed and published. Action plans are put in place. We saw examples of comments made and they were positive. One Doctor said they would like a place in the home when they needed care. The home has been nominated for the National Care Awards. They have a fifteen minute slot in which they will be talking about dignity in care. We looked at some maintenance records and they were satisfactory. Records included Portable appliance testing, fire records and equipment servicing. The home have individual contracts with maintenance firms and records were satisfactory. We looked at the Environmental health report which was satisfactory and the gas safety records. The water temperatures are tested by outside contractors. Some of them exceeded 43 degrees and we did not see any recorded actions to address this. The manager stated she would deal with this. The home have very clear emergency plans and protocols. Most residents hold their own money and have a safe area to keep it. They pay for some items like hairdressers and chiropody. Small amounts of money are held for some residents and we audited a small sample and the balance was correct. Financial assessments are on file. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 Risks where possible must 30/12/2009 be eliminated. We refer specifically to self administered medication not being locked away. Action must be recorded where water temperatures exceed 43 degrees. This is to ensure people are kept safe. 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 25 of 26 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. 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. 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