Care Home: Caradoc House

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What the care home does well People told us that they like living at the home and that they feel safe and looked after. A visitor to the home was the relative of a recent admission. The admission had taken place on an emergency basis and they could not thank the home enough for the care they were providing for their relative. They said as a visitor they were always made welcome and involved in their relatives care. People are provided with a homely place to live, in very picturesque surroundings. Bedrooms are personalised and the environment is domestic in appearance. The recent changes in management have been received positively by staff. Staff consider they are well supported and receive training to help them keep people safe and well looked after. What has improved since the last inspection? Recruitment procedures were review in depth at the last key inspection. The inspection findings this time evidenced that the service is working to expected standards to make sure that only people suitable to work with vulnerable people are employed. The atmosphere within the home is homely. Staff provide a good standard of care to people living in the home, communicating with and managing residents in a thoughtful, respectful manner. One resident said that staff at the home were, "lovely, caring, people, I love it here." Care plans have received a lot of attention since our last inspection. The care plan for the most recent admission was well structured, detailed and patient centred. This standard was in the process of being replicated across all care plans. What the care home could do better: Medication procedures were satisfactory in practice but we have recommended that the service improves its formal recording and monitoring systems in line with good practice. We have not made any statutory requirements on the service following this inspection but there a number of recommendations that have been made to support further development and improvement of standards at the home. At the time of inspection the manager had applied for registration but the outcome of that application was not known. Since this application took place Ms Thotapali has been registered as the manager. Key inspection report Care homes for older people Name: Address: Caradoc House Ludlow Road Little Stretton Church Stretton Shropshire SY6 6RB     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: Deb Holland     Date: 1 4 0 4 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: Caradoc House Ludlow Road Little Stretton Church Stretton Shropshire SY6 6RB 01694723626 01694722200 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Supercare (UK) Ltd Name of registered manager (if applicable) Ms Udaya Lakshmi Thotapalli Type of registration: Number of places registered: care home 14 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 who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home Only (Code PC) 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) 14 Date of last inspection Brief description of the care home Caradoc House is a residential home situated in the picturesque village of Little Stretton, offering a quiet, countryside care setting. The home is registered to provide accommodation and personal care for up to 14 people over the age of 65. The home was looking after only 6 residents during the inspection dates. We are aware that the home has recently admitted a further two residents. Care Homes for Older People Page 4 of 27 Over 65 14 0 Brief description of the care home Accommodation at the home is set across 2 floors and provides 10 single and 2 double bedrooms. There are no ensuite facilities at the home. The upper floor can be accessed via two passenger lifts. There is a communal lounge and dining room on the ground floor. The residents dining room has recently been redecorated and furniture replaced. Caradoc House delivers care in accordance with individual care plans, supported by an ongoing assessment of needs. Prospective service users are offered the opportunity to spend supported time in the home as part of the admission assessment process. The current weekly fees are published in the service user guide and statement of purpose published for the home. These are currently £385 per week. There are Additional charges are made for newspapers, toiletries, dry cleaning, chiropody and hairdressing. 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 quality rating for this service is 1*. This means that people who used this service receive adequate quality outcomes. The key inspection of Caradoc House took place over two days. We visited on 14th April 2010 and 5th May 2010. The inspection was unannounced on both occasions so the care home did not know that we were coming. The acting manager was not available on both days due to prior commitments but the senior care worker and staff on duty were very helpful during the visits. We looked at some key records which are important to the running of a care home and essential for keeping people safe. We reviewed care records, reflecting how to keep people safe and well, and recruitment records to make sure that only people suitable to work with vulnerable people are employed. We spoke to residents, visitors and staff on duty during our time on site. We also completed a tour of the home and observed the care experienced by residents. Care Homes for Older People Page 6 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 Care Homes for Older People Page 7 of 27 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 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. Information about Caradoc House is made available to help prospective residents and their representatives make an informed choice about whether the home is suitable to meet their individual needs. An assessment of their needs is undertaken prior to admission to ensure Caradoc House is the appropriate service for them. Evidence: Prospective residents and their representatives are provided with information about Caradoc House through the Statement of Purpose and Service User Guide. These had been updated to reflect the management arrangements at the time of inspection. Each resident is provided with a copy of these documents which contain information about the service provided. Care Homes for Older People Page 10 of 27 Evidence: Prospective residents and their representatives are encouraged to visit the home and meet with staff and residents. The first month of the placement is considered trial period and enables the individual to make an informed choice as to whether Caradoc House is suitable to meet their individual needs. Records seen for the person most recently admitted to the home evidenced that a needs assessment had been undertaken by the manager prior to admission. This detailed information about the persons health and personal care needs, medical history, and personal preferences on daily living and activities. Discussions held with the individual concerned and a visiting relative indicated that they have settled into the home well and that personal preferences and needs are being met. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are person centred and provide staff with most of the information required to ensure peoples health and personal care needs and preferences are met. The actions of staff and their approach to care ensures that residents are treated with dignity and respect. Staff support people with the management of their medication to ensure the right person receives the right medication, at the right time. The service does need to improve its formal medication recording and monitoring systems in line with good practice. Evidence: Peoples personal, health and social care needs are set out in an individual plan of care, which is reviewed regularly. People we spoke to confirmed they were satisfied with the care they receive. The relative of a person most recently admitted told us that the resident and the family had actively been involved in developing the care plan and continued to be very satisfied with the care being received. Care Homes for Older People Page 12 of 27 Evidence: We looked at the care records for all people living at Caradoc House. The care plans all included information about peoples personal and health care needs, preferred routines, and current medication. The care records evidenced that peoples needs are regularly reviewed and any identified risks are assessed to include falls and pressure areas. A review of risk and care needs did not consistently take place following a fall or other event where a review would be expected. The care records reflected that peoples health needs are kept under review and that the home arranges for health professionals to visit as required, including the GP. Care plans are in the process of being transferred into a revised format of care and risk assessment to provide a systematic and consistent approach to the assessments. Some of the care plans were not easy to follow and there was duplication in paperwork. We have asked the home to ensure that the care plan transition is completed as soon as possible to ensure that plans are clear and to ensure that assessments are revisited in response to events, such as a fall. A senior care worker has been designated as a medicines management lead. Their medicines management training was evidenced as up to date. We spent some time observing and talking through the medication system and process. As part of this, a stock check of two residents medication was completed. The stock levels were correct but there were some errors in recording, which a formal management reconciliation check would have easily identified. On reviewing the incoming and outgoing medication records, the home makes a clear record of what is transferred but there is no formal receipt process between the home and the pharmacy. Staff confirmed that they receive training so that they are able to administer medication safely. No one currently self administers their own medication. Several people are prescribed medication as required and since the last inspection, individual medication protocols have been put in place. We are satisfied that the right people receive the right medication, at the right time. The acting manager has been asked to review management systems and processes in the home to ensure that the reconciliation of stock in and out of the home and the monitoring of medicines and medicines recording is formalised, recorded and consistent. This will provide the home with a robust audit trail if there was any future query. Observations and discussions evidence that staff are generally sensitive to the needs of the individuals in their care. Staff interacted with residents in a professional, engaging and gentle manner. It was evident that there was a good day to day Care Homes for Older People Page 13 of 27 Evidence: relationship between staff and people staying at Caradoc. Residents confirmed that staff usually knock before entering their room and that privacy is respected. A resident was observed whilst waiting to be assisted with a bath being sat only partly dressed with the bedroom door wide open. The resident was not concerned with this. The home should observe privacy and dignity in practice as part of the supervision and appraisal of staff. 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 living at Caradoc House are provided some opportunities to get involved in activities based on their personal preferences. Activities provided have recently been extended through a weekly visit by an activities coordinator. The home welcomes visitors and visiting times are flexible. The food prepared at the home follow an eight weekly programme. The menus reflected access to fresh fruit and vegetables on a daily basis. Evidence: People living at Caradoc House are given opportunities to take part in activities if they choose. Routines are flexible and residents are able to rise and retire as they wish. People able to mobilise independently were able to access areas across the home as they chose. Some people prefer to spend their time in their own rooms, watching TV or reading. A limited formal schedule of communal activities is in place. There is a weekly visit from an external activities coordinator and all residents spoke highly of the time they spent at the home. People told us that music sessions are available but that other activities are limited and would welcome a wider range of communal activities both Care Homes for Older People Page 15 of 27 Evidence: within the home and the local community for example card games, local walks and trips out. A hairdresser visits regularly and care staff give manicures regularly. The home is planning to vary activities during the summer through trips and days out. Residents meetings discuss activities and the home does try to take requests on board. Staff invest time in individual 1 to 1 activities. The home uses memory tools and other games to engage and activate thinking and discussion. One relative told us that they were extremely impressed with the homes efforts to ensure weekly access to day care services was maintained for their relative. The home supports people to practise their faith and have visiting church officials to the home. The home also ensured that residents had the opportunity to vote in the 2010 parliamentary elections. Residents are encouraged to maintain relationships with people important to them and they told us that their relatives and friends are made welcome when they visit the home. The majority of residents told us that they enjoy the food provided. The care files contained individual preferences so that staff have an understanding of peoples likes and dislikes. A nutrition book is kept as a diary for all meals served. The food prepared at the home follows an eight weekly programme. There was evidence that people living at the home have been involved in the review of the menus. The menus reflected access to fresh fruit and vegetables on a daily basis. Stock management processes need to be reviewed. Not all food in the fridges and freezers had been end dated. Freezer stocks were noticeably a lot lower than had been the case at the previous inspection. On the second day on site, some of the fruit in the bowl in the dining room was past suitable for consumption. Most of the current residents eat their meals in the dining room which is bright, airy and comfortably furnished. The chairs and tables have recently been changed. Residents were very happy with the new furniture. The chairs are of a design that will require close attention to people at risk of losing their balance when sitting as there are no arms. We had the opportunity to observe mealtimes. Everyone was happy with the food. None of the residents required formal assistance at mealtimes but the staff generally ensure that they are close by to support as required. Residents were offered drinks on a frequent basis across the day. 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. Residents and their representatives have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Staff receive training so that they have an understanding in adult protection to ensure people they support are protected from abuse, ensuring their well being. Evidence: Residents confirmed that they were aware of how to raise concerns. There is a complaints procedure in place, which was available in the home and referenced in the statement of purpose and service user guide. We have not received any concerns or complaints about Caradoc House in the last twelve months. On reviewing the home complaints file, there have been 2 formal complaints in the last twelve months, both of which were responded to quickly and resolved. The home has safeguarding procedures in place and a copy of the multi agency policy is available. The mandatory training programme for staff includes safeguarding. Understanding of the policy arrangements and how to respond was discussed with individual staff. Their understanding reflected the training provided and procedures at the home. Care Homes for Older People Page 17 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. Residents live in a safe, homely environment. All areas of the home are well maintained and cleaned on a routine basis. Evidence: A full review of the premises was undertaken on the first day of inspection. The home was clean, tidy and welcoming. There was one particular area where noxious odours were detected on the second day at the home. Nothing was said to staff and the area was revisited later on in the day. The noxious smells were no longer present. The bedrooms seen were personalised and equipped to meet their individual needs. Residents spoken with confirmed that the home, including their bedrooms, were always clean and tidy and that bedding was regularly changed. The dining room had recently been redecorated and refurnished. The home employs a part time maintenance worker. The standard of upkeep generally on the fabric and fittings across the home was observed to be good. There are daily and weekly cleaning schedules across the home. The kitchen has a rolling programme of routine and deep clean cleaning tasks and it was evidenced that completion of the tasks is checked. Infection control is included within the mandatory training programme for the home and observations on site confirmed that good infection control practice was observed by care staff. Care Homes for Older People Page 18 of 27 Evidence: Fire fighting equipment and electrical equipment at random were reviewed and all were labelled as up to date on required checks/testing and appeared to be in safe working order. Substances such as cleaning products that could cause harm to people are safely stored and the necessary data sheets on their safe use available. 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. Residents are cared for by a committed, trained staff team who know them well and work hard to meet their individual needs. The previous shortfalls in recruitment practices have been addressed to ensure that the home only appoints people who are suitable to work with vulnerable people living at Caradoc House. Evidence: Residents are cared for by a team of staff who appear committed to their work and know them well. The care staff team currently consists of the manager, assistant manager and senior care worker, and a team of 4 care workers. There are 2 members of staff on duty at all times other than nights, when this reduced to 1 waking night staff supported by 1 sleeping carer. During our time on site, there was always a minimum of two care workers on duty. Staffing numbers were considered by staff to be reasonable given the current occupancy levels and low dependency of people in the home. Handovers are competed between shifts verbally and through a communication book. A review of this reflected a high standard of communication between staff. We met with staff who felt supported in their day to day role. The feedback of staff Care Homes for Older People Page 20 of 27 Evidence: was they enjoy their work and have developed positive working relationships with the residents. Staff have recently experienced 2 deaths in the home. A number of staff are from overseas and English is not their first language. This does not prevent them from communicating with people at the home. This was evidenced through observations we made during our visit. People at the home stated that although there had been some initial communication issues, staff and residents understood one another and previous issues had not affected the standard of care received. We reviewed the recruitment records for two staff employed since our last visit. Both files were well presented and evidenced completion of the checks required by the regulations before commencing in post. The application for a work permit for one of the two members of staff did not get submitted until after commencement in post at the home. There is a training matrix in place to identify individual staff training needs and the training undertaken. The matrix includes expected areas of training but does not reflect the frequency of which staff should attend each area of training. The service does need to set training frequency standards. For example, the assistant manager undertakes care and kitchen duties, but completed the food hygiene training a number of years previously. Staff spoken with were positive about the approach of the home to staff training and the opportunities to access training provided. Staff confirmed that they receive training that is relevant to their role, helps them understand and meet the individual needs of people and keeps them up to date with new ways of working. First aid and defibrillation training are recent courses staff advised attending. New staff receive induction to ensure they are competent and confident to carry out their duties, which includes induction within the home through shadowing and observation. It was noted that a new member of staff had commenced on nights very soon after starting in post. The acting manager assured that active supervision and support was provided by the sleeping care by way of induction on nights. There is a more consistent approach to supervision, which is taking place with all staff more regularly. 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 home is maintained in a manner, which ensures the safety of people living at Caradoc House and the staff team. The service needs to develop management systems around audit and monitoring generally to ensure quality and outcomes are reviewed on a regular basis. Evidence: The home has had a recent change in manager who has applied for registration. The acting manager has completed the registered manager qualification and attended a range of relevant training. Staff and residents are positive about the recent changes in management. Feedback reflected improved visibility and leadership at the home The home is generally being managed appropriately and has effective processes in place to ensure the delivery of safe, quality care. People we spoke with told us that they feel safe living at the home. We looked at a variety of health and safety records and the checks that staff do to prevent people from being placed at risk of harm. The home receives advice and support through retained health and safety consultants to Care Homes for Older People Page 22 of 27 Evidence: ensure that sound practice is embedded. Records seen evidence equipment is serviced as required, ensuring it is safe to use. Staff confirmed they receive training in safe working practices for example manual and handling, food hygiene, fire safety and infection control to ensure peoples safety. There was evidence to demonstrate that the manager reviews the content and standard of record keeping and care planning but there is no formal audit programme documented. There was evidence of learning from accidents, incidents and complaints. Incidents are reported and recorded within the home but the linkage to care planning and individual risk assessments was not always explicit. The routine monitoring of quality and outcomes of care was not demonstrated. The recording of information regarding financial management in peoples care plans is not taking place. Lockable storage facilities are available and an inventory of belongings was seen in care plans. Following the inspection, we met with the acting manager to discuss our concerns on the viability of the business, given the current occupancy levels. It was acknowledged that occupancy levels needed to be increased. The current levels allow for the business to breakeven. Staffing levels have been held. The manager is aware of the emerging demands on social care locally and is looking to redesign admission processes so that respite care, planned and emergency, can be supported as part of the development of the home and its business. The manager is also considering if the home could accept people with increased care needs and higher levels of dependency, supported by development of staff training to ensure that staff have the necessary skills to meet increased needs. Care Homes for Older People Page 23 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 24 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 7 The registered manager is recommended to ensure that care plans are reviewed in response to specific issues and incidents The registered manager is recommended to review the guidance issued to staff on the development and content of care plans. This is to ensure that care plans are consistent and meet with expected standards, to include the involvement of the individual and families. 2 7 3 7 The registered manager is recommended to ensure that care plans are reviewed in response to specific issues and incidents The registered manager should review management systems and processes in the home to ensure that the monitoring of medicines and medicines recording is formalised, recorded and consistent. This is to ensure the home has a formal monitoring process and robust audit trail. 4 9 Care Homes for Older People Page 25 of 27 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 5 12 The registered manager should continue to review opportunities for wider communal activities. This is to ensure that there is a wider range of choice and variation in activities. 6 15 The registered manager should review food stock management processes need to be reviewed. This is to ensure that food served and available is safe for consumption 7 30 The registered manager should observe staff practice as part of the supervision and appraisal. This will ensure that any issues with practice can be identified and discussed to protect the ongoing quality of care. 8 33 It is recommended that the registered manager develops the frequency, content and recording of the audits completed at the home. This is to ensure that audits are meaningful and timely and focus on the quality of the outcomes of care. 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. 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