Care Home: Butlin House

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• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well People using the service are assessed prior to admission and are given the opportunity to visit beforehand to ensure that all identified needs can be appropriately met. Individualised activities are available to people using the service to provide them with stimulation, contact with the community, family and friends. This ensures that social links are maintained and encouraged. Food is well prepared and presented attractively to make sure that nutritional needs are met. Procedures are in place to respond to complaints and safeguarding issues, to make sure that people using the service are listened to and protected from risk of harm. The premises are clean and adequately maintained promoting a positive environment for the people who live there. People who returned a survey were positive about the care offered at Butlin house. Comments included "the home allows visitors at all times." "The home has a relaxed atmosphere." "Some lovely, helpful regular staff. " "Kitchen staff are excellent." What has improved since the last inspection? Improvement to the home`s recruitment procedure has been made to ensure that gaps in prospective staff members` employment history can be identified and explored at the interview. A recent photograph is available on staff members` files to confirm proof of identity. The home has introduced a formalised supervision framework. This is to ensure that staff receive supervision regularly and to support them in understanding their roles and responsibilities to achieve positive outcomes for people using the service. Health and safety practices are being adhered to and any identified or potential risks to people using the service are supported by a plan of action detailing how risks are to be managed. What the care home could do better: Action is needed to ensure that there is a robust monitoring and auditing system in place to demonstrate that the home understands the need to comply fully with the administration, recording and safehandling of medication. Staff must adhere to best practice guidelines and ensure that handwritten entries are checked by a second person to minimise the risk of error when transcribing. Any alterations to the care plan documentation and daily reporting sheets must be written in a legible manner to ensure a high standard of record keeping is promoted. The home`s quality assurance system needs to be consistent, effective and robust to ensure that the service delivery is promoted and provided to a high standard. Key inspection report Care homes for older people Name: Address: Butlin House Beaverbrook Court Bletchley Milton Keynes Buckinghamshire MK3 7JS     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: Joan Browne     Date: 1 8 0 5 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 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) © 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 26 Information about the care home Name of care home: Address: Butlin House Beaverbrook Court Bletchley Milton Keynes Buckinghamshire MK3 7JS 01908376049 01908630534 carmelita@princescharitablecorporation.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Printers` Charitable Corporation Name of registered manager (if applicable) Susan Bradley Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home with nursing - (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 (OP). Date of last inspection Brief description of the care home Butlin House is a purpose built care home owned by the Printers Charitable Corporation. It is set in a residential area, close to local shops and other amenities, and is served by local bus services. Milton Keynes is located a short distance away, where national rail and bus links are available. Care Homes for Older People Page 4 of 26 Over 65 0 0 Brief description of the care home Butlin House can accommodate up to 40 service users that may require nursing or personal care. Accommodation is provided over two floors. All bedrooms are single occupancy with en-suite facilities. There are two communal bathrooms on the first floor and one on the ground floor - these contain disabled bathing facilities. A large lounge and dining room are situated on the ground floor, and a quiet area is on the first floor. The home has a passenger lift and a stair lift. A team of qualified nurses, carers, catering, and housekeeping staff support the homes manager. A qualified nurse is on duty 24 hours a day. Allied healthcare professionals are accessible through direct contact or by General Practitioner referral. Additional charges are made for hairdressing, chiropody, newspapers and toiletries. 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: 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: This unannounced key inspection was conducted over the course of a day on the 18 May 2010 and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on the 12 January 2010. Prior to the inspection, a detailed self assessment questionnaire was sent to the manager for completion and surveys were sent to a selection of people living at the home and staff. Any replies that were received have helped to form judgments about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussions with people using the service , the manager, the homes operations director, staff and two relatives. Some of the required records were looked at such as care plans, medication administration records, staff recruitment files and the training matrix. Care Homes for Older People Page 6 of 26 Feedback on the inspection findings and areas needing improvement was given to the manager and the operations director at the end of the inspection. There were two requirements made on this visit. Please see health and personal care and management and administration outcome areas for full disclosure. We (the Commission) would like to thank all the people who use the service, the manager and staff for their co-operation and hospitality during the unannounced visit. Care Homes for Older People Page 7 of 26 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. Care Homes for Older People Page 8 of 26 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 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that service users needs are assessed before moving to the home. This is to ensure peoples diverse needs can be appropriately met. Evidence: Information in the AQAA stated that the home ensures that all prospective service users have a pre-admission assessment to ensure that the home was able to meet their identified needs. We looked at two service users care plans recently admitted to the home and both individuals needs had been assessed prior to admission. We spoke to a relative of a service user and they confirmed that a pre-admission assessment had taken place which they were involved with. One individual had been placed through a placing authority. The home had obtained a copy of the care management assessment and care plan. The home does not provide intermediate care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs could be compromised by the homes inappropriate record keeping and inconsistent medication recording practice. Evidence: The care of three service users was followed through. All the care plans were of a standardised type detailing how identified needs should be met by the staff team. A discussion was held with the manager regarding the presentation of the the care plan documentation and the folders. The manager told us that work was in progress to review all the care plan folders. Evidence seen indicated that the care plans were being reviewed monthly. It was noted that entries in the care plans and daily record sheets were scribbled over. To ensure effective record keeping is adhered to any alterations to entries should be written in such a manner that the original entry can still be read clearly and should be signed for. Two service users returned a survey to us and said that they always or usually received the care and support they needed. We were told that all service users were registered with a local general practitioner (GP) and were seen by the GP and other members of the primary health care team Care Homes for Older People Page 12 of 26 Evidence: such as the dentist, optician, dietician and chiropodist as and when required. Those service users at risk of pressure damage had a care plan in place detailing how the identified risk would be managed and were provided with the appropriate equipment such as pressure relieving mattresses and cushions to prevent pressure damage. Those at risk of falls or malnutrition had the appropriate plans in place. The two service users who returned a survey said that the home make sure they receive the medical support they need either always or usually. The AQAA informed that the home had introduced a named nurse system to ensure accountability for the care provided to individuals. Wherever possible the home encourages service users to maintain their independence and those assessed as capable to manage their own medication were being encouraged to do so with the appropriate risk assessment in place. At the last key inspection a requirement was made for a system to be in place to ensure that medication is handled, recorded and administered appropriately. However, the requirement has not been fully met. The manager has introduced a monitoring system and staff had been provided with training in the safehandling of medicines. Protected medicine rounds had been introduced. It was noted in some instances when staff had identified gaps on the medication administration record ( MAR) sheets there was no record of what corrective measures had been put in place to prevent recurrence. Minutes of staff meetings presented at this inspection indicated that the safehandling of medicines was discussed with all staff to ensure that they were fully aware of their roles and responsibilities. It was found that staffs practice was not consistent. For example, two unexplained gaps were noted on two MAR sheets and a further two MAR sheets had scribbled over entries. On two MAR sheets handwritten entries were not signed by a second staff member to minimise the risk of error when transcribing. A particular liquid treatment that was in use did not have a label with the service users name or date of opening. It was noted that not all staff were adhering to the homes practice when administering variable dose medication and those prescribed to be given when necessary (PRN). A random selection of controlled medicines were checked and balance in stock corresponded with the record. Within twenty four hours of this inspection the home submitted an action plan to the Commission detailing how it intends to address the shortfalls. A copy of the recent pharmacy report was also submitted which included recommendations that the home needed to act on. During the inspection we observed service users being treated by staff in a kind and respectful manner maintaining their privacy and dignity. Service users attire was clean and tidy with attention to detail. 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. Personalised activities are provided to service users to meet their diverse needs. Visitors are welcome in the home, which enhances service users fulfillment and lifestyle. Wholesome meals are provided in pleasing surroundings and to make sure that nutritional needs are met. Evidence: The home employs two activity co-ordinators enabling service users to have the provision of social activities seven days a week. The monthly activity programme was displayed on the notice board in the corridor. Each service user is provided with one to one time at least weekly. This time can be used to assist with letter writing, relaxation treatment, reading the newspaper or having a chat. We were told that some service users prefer to participate in small groups and their preference is usually granted. Wherever possible the activity co-ordinators try to make all the service users feel special. For example, work was in progress to create life history books for all service users and staff. This is to ensure that service users and staff get to know each other better. A newsletter is produced monthly. A phrase book was developed for a particular service user whose first language is not English and this has helped to enhance the communication link between this individual and the staff team. Outside entertainers are booked monthly to entertain service users. Once a week a facilitator Care Homes for Older People Page 14 of 26 Evidence: provides an exercise activity which is fun and exciting using music to help with individuals co-ordination. Special adult drawing books had been purchased for those service users with an interest in art. Those service users who wish to promote their spiritual needs are able to do so. Church services are held regularly and some individuals receive holy communion on a weekly basis from a Eucharistic minister. Those service users spoken to on the day of the visit said that they decide on how to spend their day. The AQAA stated that service users birthdays are usually celebrated and the chef will bake a cake. Two visitors spoken to said that they were able to visit at any time and were made to feel welcome. They confirmed that the home provides outings to the garden centre and the theatre. Service users are able to attend coffee mornings in the community at the sheltered housing complex next door. The lunch time meal was observed. The food was well presented to stimulate appetite.The main course consisted of two choices and a desert. Mealtimes appeared to be an enjoyable activity. Some individuals in the sheltered housing complex join service users for lunch daily and were complimentary about the high standard of food. Those service users who returned a survey said that they usually or always liked the meals. Service users confirmed that if they did not like what was on the menu an alternative would be provided. A visitor who joined a service user for lunch was complimentary about the meal. The AQAA informed that the home employs a catering consultant to give advice on best practice and menu ideas. The consultant is also responsible for facilitating food hygiene training for the staff team. Care Homes for Older People Page 15 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. The home has procedures to respond to complaints and safeguarding issues, to make sure that people using the service are listened to and protected from risk of harm. Evidence: The AQAA informed that the home had received nineteen complaints within the last twelve months. Fifteen complaints had been resolved within twenty-eight days and two remained outstanding. The manager explained that she was liaising with other agencies to resolve the outstanding complaints.Those service users who returned a survey said that they knew how to make a formal complaint. The complaints policy was displayed in the home and visitors spoken to said that they had confidence in the homes complaints procedure. One visitor said that they had made a complaint and it was addressed appropriately. Five staff who returned a survey said they knew what to do if anyone raised any concerns about the service. The AQAA informed that the home had made eleven safeguarding referrals and three of the referrals had been investigated by Social Services who takes the lead in safeguarding investigations.The Commission has been made aware of the investigations. The manager informed that there were no outstanding safeguarding investigations. The training matrix indicated that staff had been provided with safeguarding training. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean and appropriately maintained to promote a positive environment for the people who live there. Evidence: The home is situated on two floors. All bedrooms have en-suite facilities comprising of toilet, wash hand basins and showers. Television and telephone points have been fitted in all bedrooms. Those bedrooms seen on the day of the visit were personalised to reflect the characters of individuals. There is a spacious dining room and adjoining lounge on the ground floor and a small lounge on the first floor. The garden has been landscaped and is wheelchair accessible. Service users spoken to during the visit said that they enjoy sitting in the garden weather permitting. The layout of the home seemed suitable for its stated purpose and is maintained to a satisfactory standard. The service users who returned a survey said that the home was always or usually fresh and clean. Communal toilets and bathrooms were clean with adaptations to meet the needs of people with physical disabilities. The AQAA informed that the home employs a maintenance person to ensure that the premises and grounds are well maintained. Housekeepers are employed to maintain standards of hygiene and the training matrix reflected that staff had undertaken training in infection control. The premises were clean, hygienic and free from offensive odours on the day of the visit. The laundry area was fitted with washing machines with Care Homes for Older People Page 17 of 26 Evidence: the specified programming ability to meet disinfection standards. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of staff on duty ensures that service users are appropriately supported to promote their well-being. Recruitment and vetting procedures have improved and are effectively applied to minimise the risk to service users of inappropriate staff being employed. Evidence: On the day of the visit there were seven carers on duty and two registered nurses. The home depends on the use of agency staff and the manager said that where they are required the same agency and workers are used, who know the service and can provide continuity of care. Staff were observed to be busy throughout the day. The following additional comments were noted from a service user respondent on what the home could do better: if possible could a member of staff be in the day room to be on hand for residents. Service users spoken to described staff as lovely and helpful. Staff who completed surveys said they are usually (3) or sometimes (1) given up to date information about the needs of people they support. They said their employer carried out checks before they started working and that their induction covered the areas they needed to know about either very well (4) or partly (1). All staff who returned a survey said that they receive training that was relevant to their role, helps them understand and meet the individual needs of people, keeps them up to date with new ways of working and gives them enough knowledge about health care and Care Homes for Older People Page 19 of 26 Evidence: medication. Staff said they receive support from their manager either sometimes (2) or never (3). They said the ways in which information is shared worked well either sometimes (3) or usually (2). Staff considered they had enough support, experience and knowledge to meet the different needs of people at Butlin House either sometimes (1) or usually (3). Additional comments included care for the residents is good. Our activities co-ordinator is extremely good, lively and organises visiting singers and shows. Some staff spoken to during the visit said that the communication system in the home needed to be more effective. Others said that the new handover system was not working and some information was not always conveyed. This information was passed on to the manager and operations director to be addressed. The AQAA stated that 60 of the care staff had achieved the national vocational qualification (NVQ) at level 2. There is an ongoing training programme. The home has its own training co-ordinator and the training matrix demonstrated that staff undertake all mandatory courses to make sure they are up to date with practices. A requirement was made at the last key inspection to ensure that a recent photograph is available on all staff members files and gaps in prospective staff members employment history can be identified and explored at the interview. It is pleasing to report that the requirement has been complied with. Personal files for two staff members recently recruited at the home were examined and found to be well organised and contained the required documentary evidence of employment history, references and criminal record bureau (CRB) disclosure. On the day of the visit staff interviews had taken place to fill vacant positions and to recruit bank (temporary) staff so that they can be used to cover annual leave and sickness absence. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Weaknesses identified in the homes monitoring and auditing systems relating to care plans and medication records need to be effectively addressed to ensure that the quality of the care to people living in the home is not compromised. Evidence: The manager has worked at the home as a registered nurse for the past fifteen years. She was appointed as manager in September 2009 and is registered with the Commission. She has completed the registered managers award certificate and updates her knowledge and skills by undertaking mandatory updated training and reading nursing journals. She is supported by a deputy manager, registered nurses, administrative support staff, carers, housekeeping and kitchen staff to ensure the smooth running of the home. Regular staff meetings and heads of department meetings take place. The AQAA stated that the home employs consultants on a regular basis to provide advice on organisational practices. A representative of the organisation visits the service on a regular basis to assess Care Homes for Older People Page 21 of 26 Evidence: quality of care and records of these visits were recorded and available to view. A quality assurance questionnaire exercise for staff had been carried out in February 2010 and a response rate of 35 had been returned reflecting some satisfaction with a couple of areas for improvement identified. We were told that a change management and vision work shop was held for staff to review the findings of the staff questionnare. This inspection has highlighted that more work was needed in improving and developing systems that monitor practice and compliance in the home. All sections of the AQAA were not completed. The information gave a resonable picture of the current situation within the service. There were areas where more supporting evidence would have been useful to illustrate what the service had done or how it was planning to improve. At the last inspection a requirement was made for the home to develop a system to ensure that all staff are supervised appropriately on a regular basis. It is pleasing to report that the requirement had been complied with and staff records examined indicated that they had been provided with at least two supervision sessions. A small amount of money is held in the home for service users to cover the cost of incidentals such as, hairdressing, newspapers and chiropody. The homes financial procedures ensure that service users money is protected. A requirement was made at the last key inspection to ensure that the hoists stored in corridors should be assessed for the risk they present to service users and action taken to minimise any identified risks. The requirement had been complied with and a risk assessment was now in place to promote safety. Statistical information in the AQAA data set indicated that equipment was being maintained in good order, such as gas appliances, electrical appliances and hoists. Care Homes for Older People Page 22 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 23 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 7 17 The manager must ensure 28/06/2010 that any alterations to entries in the care plan documentation and daily reporting sheets are written in a manner that the original entry can still be read clearly. This is to ensure a high standard of record keeping is promoted 2 33 24 The manager must make 26/06/2010 further improvements to the homes quality auditing system to ensure that is is consistent and robust. This is to ensure that the provision of care is provided to a high standard. Care Homes for Older People Page 24 of 26 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. © 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. 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