Care Home: Carlton Hall Residential Home

What the care home does well Carlton Hall provides a clean, comfortable, well-maintained and homely environment. The atmosphere is warm and friendly. This is commented on by visiting relatives and visiting professionals. "Lovely friendly home. The staff are cheerful and friendly." Visitors told us they were always welcome, and residents told us they were happy with the quality of care they received. The home employs three activities organisers covering the different parts of the home. This offers residents a wide choice of activities to take part in if they wish. What has improved since the last inspection? Care plans have been changed to a new improved format which covers the areas of need more fully, including the needs of those with dementia. This has ensured that residents` needs are identified and met, with staff clear on how they can best support them. Staff recruitment documentation has improved to protect residents. Training plans and records give a clear picture of where staff are on their training programmes. This ensures that staff have the right skills to meet people`s needs. The home took immediate action from the last report to put controls on the remaining hot water outlets which constituted a hazard to residents. What the care home could do better: The only requirement from this inspection is that the home must inform the Commission of all matters listed under Regulation 37, concerning the health, safety and protection of residents. We have recommended that all complaints, concerns and safeguarding referrals should be included in a complaints log, showing the action taken and the outcome. Now that the new style care plans are in place, the manager should consider improving them further by using the person-centred approach to needs identification, for the greater understanding of residents` needs and wishes. Key inspection report Care homes for older people Name: Address: Carlton Hall Residential Home Chapel Lane Carlton Colville Lowestoft Suffolk NR33 8AT     The quality rating for this care home is:   two star good 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: John Goodship     Date: 1 6 1 2 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: Carlton Hall Residential Home Chapel Lane Carlton Colville Lowestoft Suffolk NR33 8AT 01502513208 01502567643 carlton_hall@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Carlton Hall (Lowestoft) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 42 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 Code OP Dementia Code DE Date of last inspection Brief description of the care home Carlton Hall is a registered care home for older people, providing residential care for up to forty-two residents, including for people who may have dementia. Care Homes for Older People Page 4 of 27 Over 65 11 31 0 0 1 5 0 9 2 0 0 8 Brief description of the care home Carlton Hall is a large detached country house, situated in its own grounds. The home opened several years ago, as a small home. Over the years the property has been extended, and the numbers of registered care beds have increased. An extension was added during 2006, which increased the number of beds from thirty five to forty two. The home is situated in the village of Carlton Colville, on the outskirts of Lowestoft, north Suffolk. The accommodation for service users is situated over two floors, with the majority of residents accommodation located at ground floor level in the extensions that have been added to the house over the years. The home is set in attractive grounds which include a long driveway, visitors and staff car parking areas, mature gardens and grassed areas, patios and decking, a fenced off ornamental pond, and paddocks used for animal grazing during different periods of the year. The range of fees at the time of this inspection was £363.00 to £650.00 per week. 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: two star good 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 was a key unannounced inspection which took place on a weekday. The owners, Mr and Mrs Baxter were present. The registered manager, Ms Owers, had retired shortly before our visit. Mrs Baxter had assumed the role of manager whilst they sought a new manager. Throughout this report, reference to the manager means Mrs Baxter. Our visit focussed on the outcomes for residents assessed against the National Minimum Standards. We toured the premises, spoke to two visitors, and three residents in detail. We also chatted to other residents as we went round. We interviewed a carer and an activities organiser. We inspected two care plans, two staff personal files, training records, and maintenance records. We observed a medicines round and saw the drug records. Before our visit, we sent surveys to staff, residents and NHS professionals. Ten Care Homes for Older People Page 6 of 27 residents replied, with some surveys being completed with the help of relatives, plus eight staff and three NHS professionals. The manager was required to complete an Annual Quality Assurance Assessment form, which gave them the opportunity to tell us about changes and improvements that had taken place in the past year, and what plans there were for the future. Comments and information from all these sources have been used to compile this report. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect that their needs will be accurately assessed before the home accepts them, and that they will be given sufficient information to assess the homes suitability for them to live there. Evidence: We saw the information which prospective residents and their families were given before they decided that they wished to live at Carlton Hall. It included information on the range of care needs that the home could meet, as well as details of staffing and facilities. Guidance on how to make a complaint was also included. Much of this information had been put into the well-produced colour brochure also given to prospective residents. This described the homes accommodation, how care was supplied, the special unit for those with dementia, and the current fees. All the residents who replied to our survey told us that they had received enough information to help them decide if this home was the right place for them. The informative brochure encouraged people to visit and see for themselves what the home had to Care Homes for Older People Page 10 of 27 Evidence: offer. All new residents were offered a months trial to see if they had made the right decision. The manager told us that no-one had changed their mind yet. The home had a contract with Suffolk County Council who block purchased 17 places. The remaining places were filled by a mixture of residents paying entirely for themselves or through support from the County Council. The home retained two beds for respite care. The AQAA told us that full pre-admission assessments were carried out on each applicant whether for respite or permanent accommodation. Other professional assessments were also obtained for those referred by a local authority. We looked at three care records and all included a pre-admission assessment. Topics covered included personal details, a dependency profile, personal care needs, medical history and current medication. This information was then used to decide if the home could meet the persons needs, and then used to compile a comprehensive care plan. The previous report had recommended that the home needed to collect more information about the health care needs, including mental health needs, of new residents. We looked at the records for a recent admission who suffered from diabetes. There was sufficient information and advice from specialists about their needs for the staff to know how to meet those needs. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their needs identified and met. They are protected by the homes medication practice. Evidence: The AQAA told us that the home had completely changed its format of care plans to meet concerns made in the previous inspection report that there was insufficient detail about some aspects of residents needs, and not always clear guidance to staff on how to meet their needs. We examined the plans of two residents, speaking to the manager and staff about their care. We were not able to speak to the residents but were able to observe them. We noted that the files were well organised to enable staff to find relevant information quickly. All plans identified needs under the same headings. These included personal care, eating and drinking, breathing, continence, skin care, sleep routines, moving and handling, oral hygiene and psychological assessment. The needs were clearly identified with guidance for staff on providing the correct support. More guidance was now given on the needs of those with dementia. A carer on the dementia unit showed Care Homes for Older People Page 12 of 27 Evidence: us how needs were expressed and how information was handed over from each shift. She described the range of activities which the activities person put on in the mornings. This staff member also confirmed that the home received good support from GPs who would always attend if asked and regularly reviewed peoples medication. A relative had commented that there was sometimes food left in their family members cheeks. This person needed a high level of support to take nutrition. The plan instructed staff to observe the residents mouth to ensure it was empty of food after eating. Comments on this aspect of care had been entered by staff in the daily record to confirm what they had done. The AQAA told us that all care plans were reviewed once a month by a senior. This was recorded in the plans we saw. Risk assessments for nutrition, moving and handling and pressure area care were reviewed monthly. These reviews were recorded and dated. Any changes were written in the handover book for the information of staff. The plans for those with dementia would benefit from being written in a personcentred way which put the perspective of the resident first. This was discussed with the manager who agreed to follow this up. She told us that she hoped to try again to interest relatives in helping prepare life stories for the residents, to help staff support them better and provide more personal references in their care. One of the residents whose plans we examined had high levels of health care needs. They were cared for in bed. The plans recorded risk assessments for nutrition, moving and handling, and skin care. The manager told us that this resident had never had any pressure area problems. This was evidenced from the records. Another resident was an insulin-dependent diabetic who was visited regularly by the district nurse. The specialist diabetic nurse had visited this resident on the day of our inspection to advise staff on their care. Records also showed that residents had access to a variety of other healthcare professionals including doctors, chiropodists and opticians. Comments from NHS staff who completed our survey included: My needs and queries are always met in a competent and professional manner, always willing and helpful to assist district nurses, a lovely friendly home. All the residents who replied to our survey told us that the home always made sure they got the medical care they needed. They also told us that they always received the care and support they needed. We spoke to two visitors in the dementia unit who said how pleased they were with the care of their family member. Other relatives told us in the survey that I think it is a very caring home. The staff are cheerful and friendly. We observed part of the lunchtime medication round. Good practice was observed. Care Homes for Older People Page 13 of 27 Evidence: Medicines were checked and audited and found secured in the medicines trolley. The records were fully completed with no gaps in signatures. We noted that the medication for one of the residents whose plan we examined had been changed in November. This was clear on the records and in the care plan. We checked the contents of the controlled drugs(CD) safe. The stock of one drug was checked against the records in the CD book and was correct. The AQAA told us, and staff confirmed, that only staff who had completed the training were able to administer medications. We saw the staff treating the residents with dignity and respect, addressing them in a friendly way and knocking on their room doors before entering. The call system in the home was monitored by a print out in the office which the manager checked each morning. This gave the time taken to cancel the call. We looked at the previous day and night, and there were no significant delays in response. 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 can expect the home to meet their social and leisure needs, and provide nutritious and varied meals. Evidence: All ten residents who replied to our survey told us that the the home always or usually arranged activities that they could take part in if they wished. The AQAA told us that three activity persons were employed who offered a variety of activities, from walking out in the garden, to games and reading. We saw the Album of Activities which was a photo record kept available to all in the conservatory. There were photos of the Christmas party, visiting dancers, fireworks, cream teas, and a coach trip to Dunwich. We spoke to one of the activity persons, who was working with residents in one of the lounges. They told us about the various activities they put on, some of them chosen by the residents. At the time we visited this lounge, the residents were playing a card game with extra large cards. A member of staff was helping to run this. We were told that one resident usually stayed in their room using their computer. The activities organiser told us about the course they had completed through a local college, which had helped to widen their knowledge and ideas, especially for helping those with dementia with exercise, memory quizzes and reminiscence opportunities. All activities were recorded together with the names of those taking part. In the afternoon, a choir Care Homes for Older People Page 15 of 27 Evidence: from the local church gave a carol concert in one of the lounges, distributing songsheets to the residents who could join in. We observed 17 residents having lunch in the pink lounge. The tables were laid with cloths and cutlery. The residents told us that the food at the home was excellent. Always good. This view had been supported in our survey. We saw that one resident was being supported to eat their meal, in a quiet and considerate manner. The home worked on a four week menu using local ingredients and prepared on site. (Apart from the chips bought from the local fish and chip shop on a Friday which we were told most residents liked). The lunch was served in an unhurried way by staff, and with generous portions. Staff we spoke to were aware of the likes and dislikes of the residents and what portion size they preferred. 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 can expect that their concerns will be listened to and acted upon. They will be safeguarded from abuse. Evidence: The home had a complaints procedure in place. This was included within the service users guide.We looked at the complaints book. This held details of three complaints in 2008. It did not include a complaint received by the home in April 2009 which contained a number of allegations of poor care. Although the home had responded, the incidents were over four months old so were difficult for the home to investigate. The home had referred two incidents to the local authority under the safeguarding procedure. These had not been listed in the complaints log either. In our survey, most of the residents indicated that they knew how to make a complaint. Those who said they did not know, knew who to speak to if they were not happy. One of the safeguarding referrals concerned an allegation that a staff member had bullied a resident. A senior social worker investigated this but had not found any evidence to support it. The other referral concerned an allegation of assault by a staff member. This was investigated by the police who decided not to prosecute. However at the same time, money was reported stolen which the police investigated. The same member of staff, who had been dismissed, was successfully prosecuted for theft and Care Homes for Older People Page 17 of 27 Evidence: their name forwarded to the Independent Safeguarding Authority for inclusion on the POVA list. The home had not reported this to the Commission. Individual staff training records, as well as the wall mounted Training Matrix, showed that there was a continuous programme for training and updating staff in the prevention and recognition of abuse of elderly people. This training was included in staffs initial induction programme, their NVQ course and in-house updates. We looked at the recruitment records of recently appointed staff which showed that two references were obtained before each person started employment. 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. Residents can expect to live in a safe,well maintained and clean environment. Evidence: Carlton Hall had 40 single rooms and one shared room. All rooms have en-suite facilities, including a toilet and wash hand basin.The home employed two maintenance people. Staff entered all maintenance problems in a book which was checked each morning. We noted that all the items had been signed off as completed. In addition the AQAA told us that the maintenance staff had a monthly schedule of routine work and cleaning to ensure that all items were covered in a year. We saw the records of the checks on hot water temperatures to prevent any risk of harm to residents. We confirmed that the hot water outlets in the kitchenettes identified as unsafe in the last report had been fitted the next day with thermostatic valves to control the hot water temperatures. The home had a rolling programme of redecoration to ensure that all areas were redecorated every four years. Furnishings in the home were well maintained and comfortable. All the residents who replied to our survey told us that the home was always clean and tidy. One wrote: The home is always clean and sweet-smelling. A new shaft lift was being installed in the older part of the home to replace the current stair lift. Care Homes for Older People Page 19 of 27 Evidence: The home had completed an Infection Control Audit in July 2009, which was followed by a visit from the Infection Control specialist from the health authority. This person had contacted the Commission and reported positively about the home, specifying that they had good infection control policies and that they had undertaken building work in the laundry room so that the handling of dirty and clean laundry could be managed safely. 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 can expect to be supported by trained care staff in sufficient numbers and safely recruited. Evidence: The nine staff who replied to our survey told us there were always or usually enough staff to meet the individual needs of all the residents. One said that occurred only sometimes. The roster showed all staff working in the home. Shifts were normally 7am to 3pm, 2:45pm to 10pm, and 10pm to 8am, so allowing some overlap on the busy times and to ensure there was sufficient time to pass on information about residents. All the staff told us in the survey that the ways they shared information about residents with other carers worked well always or usually. During the day there were five carers on duty with one senior carer. Two of these were on duty in the dementia unit. In addition, there was an extra person on in the morning to cover breakfasts and lunch, and another person on duty to cover tea times. Four staff were on duty at night, one of them a senior carer. A carer told us that the number of residents who needed two staff to support them had increased so the number of staff sometimes needed to be more to avoid residents waiting to receive care. The manager was aware of the increasing levels of support needed by residents and was keeping the number of staff under review. Care Homes for Older People Page 21 of 27 Evidence: In addition to the care staff, there were three activities staff, two cooks, a cleaner every day, and a laundry person as well as two maintenance personnel. These posts ensured that care staff were only responsible for attending to the care needs of residents. Staff records showed us that when staff were recruited a criminal records bureau (CRB) check was made including a POVA First check, as well as recordsof proof of their identities. The two files we inspected contained all relevant documents including references confirming previous employments. We were shown a comprehensive record of the training programmes for staff, both those courses completed and those planned. Individual records of training including certificates were held in each persons file. Twenty one staff had completed a three month dementia course with a local college. This number included three non-care staff as the manager believed it was important for all staff to understand they had an important role to play in the care of those with dementia. Other training on the programme included medication, safeguarding, moving and handling, and fire training. Twenty staff had received training in control of infection procedures. We saw the induction records for a new member of staff, which followed the Skills for Care curriculum. The AQAA told us that 17 staff out of 45 had achieved an NVQ at Level 2 or above. The manager told us that there were staff waiting to start their NVQ courses when places and grant funding became available. We spoke to a head carer who confirmed what training they had received, including completing an NVQ level 3. The manager and a senior carer had attended a local authority training session on the implications for care homes of the Mental Capacity Act and the Deprivation of Liberty safeguards. There were no residents currently identified as needing referral under the local procedure. 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. Residents can expect the home to be run in their best interests, with their health and safety protected. Evidence: Maureen Owers, the registered manager, had retired shortly before our visit. The owners had informed the Commission. One of the owners, Mrs Shirley Baxter, was acting as manager until a replacement had been appointed. Interviews were being held. Mrs Baxter had previously been the registered manager for the home. Mrs Baxter had an NVQ Level 4 in Care and Management. A carer told us that: while Mrs Baxter will correct her staff, she also has an understanding of the problems her staff can encounter. The management team included a Home Administrator who had updated and reorganised much of the documentation and records of the home. These were displayed in an orderly and easily accessible way, with personal records in locked cabinets. We have described under Complaints and Protection that the homa had not sent us Care Homes for Older People Page 23 of 27 Evidence: notifications of all matters required by the Regulations. We have made a requirement under that section. The home used an annual survey of staff, residents and relatives to check peoples views of the care provided. The most recent one had led to menus being displayed in the hall, better lighting in one of the lounges, and the building of a sun lounge on to the dementia unit to give an alternative sitting area. This also gave access to a secure garden. We examined some maintenance and service records, and noted the service labels on assisted baths and hoists. The AQAA told us that electrical, fire and lifting equipment had been serviced in the past year. The owners confirmed that they had written assessments on hazardous substances. In the last year, the home had been inspected by the Infection Control Specialist (see under Environment), the health and safety officer of the local authority, and the environmental health officer. We were shown the reports of these visits.There were minor points for action, including cleaning flaking paintwork in the kitchen, and putting hinge covers on doors to prevent anyone trapping their fingers. Action had been taken on all issues. We saw the schedule of staff supervision sessions, and saw some examples of the records of those sessions, which showed that staff were able to talk about training and practice issues, to ensure residents got the right care. The home did not manage the finances of any resident. Some petty cash was held for some of them. The procedure for checking money in and out was examined. This showed that two signatures were required for both in and out transactions. These related mainly to payments for the hairdresser and the private chiropodist. We checked the records and cash for one resident. All items were accounted for and the cash amount was correct. 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 1 18 37 The Commission must be notified of all matters specified under this regulation. This is to evidence that the home hasan open and responsible manner towards these matters which help to protect residents from harm or abuse. 29/01/2010 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 Person-centred plans would focus attention on how the resident wished to be cared for, expressing their needs from their perspective. All complaints and concerns should be recorded in a complaint register showing the outcome and action taken, to evidence that residents and relatives concerns are listened to, and acted upon. 2 16 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. 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