Care Home: Carl Court

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What the care home does well Carl Court provides excellent personal care and support for all the people who live at the home. We saw that staff were most attentive, respectful and caring throughout their work with residents. Staff told us the management were `very supportive`. There was good provision of training. The home owners have substantial experience in managing a care service, having owned and run Carl Court for the past twenty years. They work with attention to detail and dedication to providing a quality service. One of them is a qualified nurse (RMN) and she has completed NVQ in Care level 4 and the Registered Managers Award. Both owners are present in the home most days and form additional support to care staff as well as being fully aware of the care needs of the people at the home. Carl Court is well maintained, exceptionally clean and offers accommodation in a comfortable and homely way. What has improved since the last inspection? The house had been painted externally and was looking smart. Raised beds had been built around the garden, so that residents could tend and enjoy the plants with ease. The garden`s security had been improved, so that residents could come and go in safety, and the door to the garden from the sun lounge could be left open through fine days. A staff member told us they they worked more efficiently now, which made time available to work in a person centred way, able to give more individual attention and organise the daily routines to suit the residents. One resident told us the home was `almost perfect`, and they could not think of improvements. What the care home could do better: To enhance the person centred approach to their work, the home should, with the help of family and friends and with residents` agreement, gather information about the residents` former lives, to improve staff`s knowledge and social engagement. The home owners should obtain a professional assessment of the premises by an Occupational Therapist, in particular when planning to provide or alter bathing facilities, in order to maximise utility and independence for the residents. Alarms should be fitted to resdents` bedroom doors and switched on at night when needed to alert staff when residents leave their room, to protect them from potential harm. Key inspection report Care homes for older people Name: Address: Carl Court Carl Court Guestland Road Cary Park Torquay Devon TQ1 3NN     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: Stella Lindsay     Date: 1 5 0 7 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 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) 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 27 Information about the care home Name of care home: Address: Carl Court Carl Court Guestland Road Cary Park Torquay Devon TQ1 3NN 01803329203 01803329203 carlcourt@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Kim Hioh Mungar,Mr Farzand Mungar care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service Users with Dementia may be admitted from 50 years age Service Users with Mental disorder may be admitted from 50 years age Date of last inspection Brief description of the care home The last key inspection took place on 25th July 2007. Carl Court provides accommodation with personal care to older people (65 ), older people with a mental disorder and older people with dementia (from the age of 50). The home is registered for up to fifteen people both male and female. Bedroom Care Homes for Older People Page 4 of 27 Over 65 15 15 15 0 0 0 Brief description of the care home accommodation is provided over two levels with a stair lift. There remain four steps that still need to be negotiated, where the chair lift finishes, to allow people access to the homes first floor. There are fifteen single rooms, ten of which have en suite facilities. At night, two staff are on-call within the home, and they make periodic checks. There are no waking night care staff. In terms of communal space, Carl Court offers two lounges and a dining room. There is also an easily accessible, secure and attractive garden. The building itself is a large detached property that is almost adjacent to a public park and located in the St. Marychurch area of Torquay. Local shops and amenities are within walking distance of the home, with Torquay town centre a bus ride away. Fees currently range from 340 to 450 pounds per week. The homes inspection report is contained within the homes service user guide or can be found on the large sideboard within the entrance hall. It is also available within the Managers office. 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: 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: The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. Prior to the unannounced inspection we sent questionnaires to people who use the service and received three back. We sent questionnaires to staff and received four back. We received one survey from a health professional and another from an entertainer who regularly visits the home. The visit to Carl Court was unannounced and took place on 15th July 2009, between 9:30am and 6:45pm. One inspector carried out this inspection, but this report refers to we as it is written on behalf of the Care Quality Commission. During our visit we spoke to eight people who use the service, and observed four others. We met with the home owners, the trainee Deputy Manager, and three other Care Homes for Older People Page 6 of 27 staff on duty. We toured the premises, and shared lunch with residents in the dining room. We case tracked two people who use the service. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at staff recruitment records, training records, and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Carl Court. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 27 order line 0870 240 7535. Care Homes for Older People Page 9 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information about the service is provided. Assessment of a persons needs is carried out before a service is offered, including mental capacity assessment to judge whether they are competent to make this decision. Admissions are arranged flexibly to suit individuals. Evidence: We were given an up-dated Statement of Purpose, which was clear and provided comprehensive information about the service. The home does not give individuals a statement of terms, but the terms of the service, including what the fees cover, is in the Service Users Guide. The home owners told us that what enquirers want to know is about the accommodation - is it single and en suite - what activities are on offer, and what the current residents are like. They ask to see the menu, and enquire about laundry arrangements. Care Homes for Older People Page 11 of 27 Evidence: The home owner visits people in their own homes to make her assessment of their care needs. If the person is planning to move to Carl Court from another care home, the Manager prefers them to visit Carl Court for this assessment. because this home offers a service to people with dementia, the home owner requires a Mental Capacity assessment to be carried out by a suitable professional before offering admission. This is because they may not have capacity to make the decision to move into residential care, and needa person identified as making this decision on their behalf. The home owners told us that they are flexible about visiting arrangements, which can be arranged to suit individuals. The same goes for trial periods. A person who recently came to stay at Carl Court originally came for three weeks, then four, and now had agreed to stay for three months. This was to help them settle in without feeling confined, giving time to become familiar with staff and other residents. The assessment of night care needs needs to demonstrate that these can be accommodated by the regular checks made by the two staff who are on-call every night, as there are no waking night care staff. There is no set notice period for leaving. If a move becomes necessary, arrangements for moving and payment are agreed with the family or representative. Care Homes for Older People Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are well ordered, and care is given with great attentiveness and diligence. Evidence: Care plans were written concisely but clearly so that staff knew what they were to do. They had been reviewed recently and discussed with staff from the Community Mental Health Team. They were task based, and made staff accountable for accomplishing tasks. The care plans had little information about the persons background and social interests. However, staff and Managers were able to tell us about peoples family connections and past achievements. One carer said that they had become more person-centred over the past year. She said they kept time better, which meant they could be available when people wanted them, and had more time to give individual attention. There were records of a dietitian being consulted where there was concern about a resident not eating. We saw that staff gave them food in small amounts for an hour over lunch time. A Community Psychiatric Nurse had been involved in care planning for a resident who had developed an obsession with eating. The staff who were on-call Care Homes for Older People Page 13 of 27 Evidence: every night told us that they were always prepared with chopped apple or carrot to give this person when they awoke during the night, as they would then settle again. We received a survey completed by a health care professional who worked regularly with residents at Carl Court. They said that staff had been good at communicating with others involved in the care of their residents, and appreciative of relative/carer issues, also that the staff were receptive to feedback and willing to consider new ideas for how they work. An Occupational Therapist had been involved with helping staff communicate with a new resident who had little English language. The family had provided a Sky dish so that they could receive television programmes in their native tongue. The home provides transport to medical appointments and an escort if family are not able to do this. Staff are not required to administer medication until they have become an established part of the team. They are then given training by the pharmacy. We saw that the system for administering medication was dealt with carefully by staff in the home. The Deputy Manager had recorded all medication coming into the home. Records showed when residents had taken or refused their dose, so there was a clear audit trail of the medication. There were no non-prescription medicines. Controlled drugs were properly stored and recorded, and there was a lockable fridge for any medicines that needed to be kept chilled. We visited one of the residents who were being cared for in their room, towards the end of their life. District Nurses had visited and were satisfied that staff in the home were competent to provide this care. A Speech and Language therapist had visited to advise on swallowing difficulties. We found that this person was comfortable in their chair, beside a full length window, and with classical music playing. Staff told us how they would explain to this person what they were doing when providing personal care, and that they would understand and not be anxious. The home owner told us that families have stayed at the home when their relative was very ill or dying. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy the social life in the home. A good variety of quality meals are served. Evidence: Residents are asked for their preference when they like to bathe or shower, and this is then incorporated in to the bath list which shows staff their preferred days and times. Individual attention has been arranged to provide morning care in a safe way for a resident who needs this. Two residents told us they were sometimes disturbed by other residents behaviour, but they were satisfied they could stay in their room and be quiet if they felt like it. All but four residents came down for lunch during this inspection. Group activities were arranged each afternoon. A visiting craft teacher led a lively group on the afternoon of this inspection. There had been a performance by a musician the previous day, and hymn singing on the Monday. One of the staff told us they take a group for a drive out regularly on Thursdays, and other days too when the weather is good. There had been weekly musical therapy sessions, and fortnightly sessions of relaxation therapy. Staff had engaged residents in activities such as quizzes, various board games, bingo and manicure sessions. One resident told us they Care Homes for Older People Page 15 of 27 Evidence: had been to the local shopping precinct with a carer. Some residents had been assessed as able to go out independently. We met one such person who carried a card to show where they live, and who was able to remember the number to access the keypad on the front door. One resident attended a local Church. They said that staff bring them breakfast in good time, then a taxi comes to take them. The home owner said they were seeking a particular Church for a new resident, of their own community. At Christmas, the home owners hold a party, inviting relatives past and present, and offering home cooked Asian food. The cook told us they spend time with new residents to find out what they like to eat, and watch every day to see whether people want more food or drink. One resident was reluctant to eat, so the staff were seen to offer different sorts of food, especially food this person could pick up and eat without cutlery. The main meal is served at lunchtime, and is generally a set meal, plus any special diets. There was grapefruit for a starter on the day of this inspection, with alternative fruit for those whose medication would be affected by the grapefruit. Residents told us they liked the roasts. stews, fish and chips - we only have to say and something will be done. On the day of this inspection roast pork was served with roast potatoes, fresh carrots, baby sweetcorn and sugar snaps. This gave residents choice of vegetables on their plate. The meal was nicely presented, on hot plates. Apple sauce was brought round. Staff watched to see when people needed another drink. We were told that there is always a vegetarian option, whether using meat substitutes or a jacket potato or quiche. Four residents currently needed a soft diet. Three of these were fed by staff in their private accommodation before the main lunchtime, and one in the dining room with the others. They were given unbreaded fish with parsley sauce, with vegetables blended separately. At tea time there was a choice of pie or salad, and we saw staff taking round a choice of cake, fruit or yoghurt to follow, and a staff member also went for ice cream at the request of a resident. One resident liked to make his own tea, with help from staff. Two residents regularly accompanied the home owner when she went shopping for food. This enabled them to choose different foods that they saw, including recently red cabbage, and butternut squash. 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 are protected by close attention of well motivated and trained staff. Evidence: No complaints had been received either by the home or the CQC. The complaints procedure is included in the Service Users Guide. No documents were displayed publicly in the home, because at this time a resident was inclined to remove papers. The three residents who returned surveys to us all said they knew how to make a complaint, and knew who to speak to if they were not happy. One said, The staff are always ready to help with any complaint I may have, and listen to what I say. Staff had received training as Alerters in the Protection of Vulnerable Adults, and those who spoke to us knew what they must do if they became aware of any sort of abuse. There had been a safeguarding alert when a resident was found to have bruising on admission to hospital but this was not upheld, as the bruising was consistent with a fall that had been recorded in the home. The home owner had attended a training session on the Deprivation of Liberty safeguards. Residents at this home had free access to the garden, and most were accompanied if necessary when they wanted to go out. Arrangements for going out were included in their care plans. Two were not well enough to go out. One had disturbed behaviour at this time, and it was not considered safe to take them out. They were having three monthly reviews with their Community Psychiatric Nurse, to consider best practice in managing this behaviour, which could include consideration of whether DoLS procedures need to be invoked. Some residents had been assessed Care Homes for Older People Page 17 of 27 Evidence: as able to go out independently. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This house provides an attractive, safe and comfortable home for the residents, with choice of sociable places. Evidence: Carl Court is a very pleasant and well maintained house. The home owner was on site and carried out running repairs as necessary. The house had been repainted externally since the last inspection, and was looking smart. The garden is accessible from the sun lounge, with levels and surfaces safe so that the door may be left open, and residents come and go as they please. Raised beds have been provided, so that residents may join in with gardening. There is an aviary and a fish pond for residents interest. The garden is enclosed with attractive wooden fencing, is safe and has a sunny aspect. As well as the sun lounge, there is a television lounge. The dining room was also used for crafts and other activities. There were two bathrooms. The home owner told us they were planning to install a shower. We recommend that the premises and facilities are assessed by a qualified Occupational Therapist particularly when alterations to bathrooms are being planned, to ensure that accessibility for disabled people is maximised, to encourage independence. Suitable locks had been fitted to bedroom doors, so that people could be assured of privacy, with no danger of being locked in. Call bells were fitted in bedrooms, though Care Homes for Older People Page 19 of 27 Evidence: not all residents were capable of using them. There were no alarms on bedroom doors to alert staff if a resident were to leave their room during the night, or under mattresses to alert staff if a person should get up in the night. The Deputy Manager who is on-call every night told us that she hears when a bedroom door is opened. The laundry was separate from the main house, and seen to be in good order. Bed linen was sent out to be professionally laundered. We found the house was clean and sweet-smelling throughout. Care Homes for Older People Page 20 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 well trained caring staff. Evidence: We found that a small group of reliable and well motivated staff were employed. The months rota was written up on a calendar in the office. This method had been used over the past 18 years and found to avoid misunderstandings in its simplicity. As well as the home owners and/or the Deputy Manager, there are two care staff on duty from 7 - 2pm and two others from 2 - 9pm. At night there were no waking care staff. Two staff who live in, one of whom was the Deputy Manager, are on-call every night. A cleaner was employed every day from 9 - 2pm, and at this time she also worked from 7 - 9am as a carer, to enable individual attention to be given to one resident. There was also a cook and a laundry assistant. We looked at the files of two staff who had been recruited recently. The checks needed to assure protection of residents from potential harm had been carried out. We saw that the staff had achieved their induction training, and were continuing with NVQ achievements. The Deputy Manager had completed NVQ 4 in Care and was working towards the Registered Managers Award. Training in Moving and Handling, including use of the hoist, emergency first aid, and control of infection had been updated. Other training provided included work on Dementia care, also malnutrition, and constipation, in order to meet particular needs Care Homes for Older People Page 21 of 27 Evidence: of residents. The management support us well with training - my NVQ is nearly finished one staff member told us, while the Manager said they put a lot of emphasis on training in order that staff can make informed decisions in the course of their caring work. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager leads and supports a strong team who work continuously to maintain and improve the quality of their service. The home has a consistent record of safe working practices and maintaining safety in the home. Evidence: Mrs Kim Mungar and Mr Farzand Mungar are the Registered Providers of Carl Court. Mrs Mungar qualified as a Registered Mental Nurse in 1977, and has run Carl Court with her husband since 1989. She has completed the Registered Managers Award, and attends training sessions periodically to keep up to date with changing legislation and good practice. We saw that the home owners are committed to spending time at the home, and have done over many years. They know the residents and their families well, and are available for discussion. They had distributed questionnaires to gather feed-back and give people another opportunity to express their views. The replies had been Care Homes for Older People Page 23 of 27 Evidence: favourable, but had not included ideas that could be acted upon. Residents and staff told us they could not think of anything the home should be doing that it is not. House meetings had been held, with minutes taken. The residents had a meeting on 10th June, when ideas for venues for outings were discussed. A staff meeting on the same day largely discussed details of good housekeeping and recording. Mrs Mungar meets with all staff individually for supervison and appraisal. We saw that she gave them feedback on their performance, and would act appropriately if there were any concerns. No money was held on behalf of any resident. Where necessary, the home pays, for example for the chiropodist or hairdresser, then bills the family or solicitor. Court of Protection had been applied for on behalf of two residents, to safeguard their finances. Mr Mungar takes responsibility for health and safety audit in the home. He had carried out a monthly check of the premises. A risk assessment had been carried out professionally the previous year, and actions taken in respect of all recommendations made. The Fire Safety Officer was due to visit two weeks after this inspection. Fire extinguishers and the fire precaution system had been professionally serviced in May 2009. We saw that window restrictors were in place. Bath hot water temperatures were checked and found to be safe. The bath hoist had been professionally serviced. We looked at the Accident records. The last accident recorded was in January 2009, and home owners confirmed that this was the last time anyone had suffered a fall. We looked to see whether people had been found on the floor after falling during the night, but this was not the case. Information was displayed on the office wall about the duty of the person in charge to inform the CQC of any occurrence of any serious injury to a resident or any event in the home which adversely affects the well-being or safety of any service user. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 We recommend that life histories are gathered, with help from families, especially where residents need help to remember, to enhance staffs understanding of the residents, and help them engage in conversation. We recommend that the premises and facilities are assessed by a qualified Occupational Therapist particularly when alterations to bathrooms are being planned. We recommend that door alarms are provided for bedroom doors which can be activated if there were a likelihood that the occupant may leave their room by night thus putting themselves at risk of falling, in case staff do not hear the door being opened. 2 22 3 22 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. 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