Care Home: Croft Lodge Residential Care Home

What the care home does well Croft Lodge provides an excellent level of care and support for people. The home is well maintained and is described as a real home from home: people said they enjoy living there. Many people said it had been a difficult decision to move into a care home but the registered manager and her staff team have made them feel at home and comfortable. The home is to be commended for its service with regard to its staffing and staff training, the quality and spaciousness of the accommodation, its commitment to listening to people`s view and the management of the service overall. People`s personal, health care and social needs are well met by a staff team that are well trained, supported and experienced to provide quality care in a way that people prefer and choose. Staff said they receive all the support and training they need and training events are organised every two weeks. All the staff attend training regardless of their role in the home as the registered manager feels it is important that everyone who comes into contact with the people living in the home has a thorough understanding of their needs. People described the meals as "excellent" and the home provides a good range and choice of meals that takes into consideration people`s likes and dislikes. The owners have demonstrated their commitment to the home and the registered manager, Mrs Southey, who continues to run the home for the benefit of the people living there. What has improved since the last inspection? Redecoration and refurbishment of the home has improved with the owners investing to improve the environment. Staff receive more frequent and varied training relating to the needs of the people in the home. A full time administrator has been employed to support the registered manager with managerial tasks and to give her more time to spend with people and staff. What the care home could do better: The owners, registered manager and staff have worked hard to ensure the quality of the service provided continues to improve and no requirements for improvement have been made as a result of this inspection. A good practice recommendation was made where health care needs are being monitored by staff to ensure they have clear instructions as to what is expected from the condition, such as safe blood sugar levels, and what actions to take if there are any changes, as well as to expand the daily care records to give a more clear indication of how staff have assisted each person. Key inspection report Care homes for older people Name: Address: Croft Lodge Residential Care Home 26 Haldon Avenue Teignmouth Devon TQ14 8LA     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: Jane Gurnell     Date: 0 7 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 28 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 28 Information about the care home Name of care home: Address: Croft Lodge Residential Care Home 26 Haldon Avenue Teignmouth Devon TQ14 8LA Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Langton Care Limited Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Croft Lodge is a detached house in a quiet residential area, about a mile from Teignmouth town centre and is on a bus route. The home provides accommodation and personal care for up to 24 older people. All the bedrooms are single and, with the excpetion of one room that has an adjacent toilet, all have en suite facilities. Many of the rooms have pleasant views and several ground floor rooms have patio doors onto the garden. There is a large lounge room and a separate dining room/conservatory on the ground floor. A stair lift provides access to the first floor and where the upper hallway has three steps a chair lift has been fitted. There is a garden and car park in front of the house, a patio to the rear and pathways Care Homes for Older People Page 4 of 28 0 Over 65 24 Brief description of the care home all around. The weekly fee is the same for all those living in the home and is currently £575. This does not include hairdressing, chiropody, newspapers and personal toiletries. Information about the services provided at Croft Lodge can be obtained directly from the home. Care Homes for Older People Page 5 of 28 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: This inspection took place on Wednesday 7th April 2010. During this time the majority of the people who live at Croft lodge were asked for their views about what it was like living there. The staff on duty were spoken with and time was spent observing staff interacting with people and going about their daily duties. The registered manager was present and time was spent discussing the recent changes to the home with the new owners and their future plans as well as the documents looked at. These included, plans of care, staff files, training records, records of administration of medications, the fire log book, menu plans and records of incidents and accidents. A tour was made of all communal areas and some of the individual bedrooms and lunch was observed as was care practices during the day. Prior to the inspection the home were asked to provided some information about how they maintain a safe environment, train and support staff and how they ensure that Care Homes for Older People Page 6 of 28 the views of the people who live at the home are used to improve the quality of care provided. The registered manager gave very detailed responses and this has helped us to better understand how the home runs and how they ensure that the people who live at Croft Lodge are valued and their views are acted upon. Some surveys were sent to the people who live at Croft Lodge and to staff and their comments and views are included throughout this report. Care Homes for Older People Page 7 of 28 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 Care Homes for Older People Page 8 of 28 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 9 of 28 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 28 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 considering moving to Croft Lodge benefit from a good admission and assessment process, which ensures that the home can meet their needs. Evidence: One person who had recently moved into the home said he had been made very welcome and had settled in well. He said he had met the manager prior to moving in. The registered manager explained that either she or her deputy visit people considering moving to the home to provide them with information and to undertake an assessment of their car needs to make sure the home is suitable for them and to prepare for their admission. The assessment information was available for all three people whose care plans were looked at and this gave information about the persons personal and health care needs. People are given the opportunity to visit the home to decide if they liked it and to meet the other people living in the home as well as the staff. One person said they Care Homes for Older People Page 11 of 28 Evidence: had visited the home prior to moving in and two others said their families had visited the home and decided it was the best one for them. The registered manager said that where family are able they ask them to complete an initial assessment information form and the home then build on this. The information gathered enables the manager to decide if the home can meet needs, and this is then used to develop a plan of care. Care Homes for Older People Page 12 of 28 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. Peoples health, personal and social care needs are met in a manner of their choosing. Care plans provide clear information to ensure consistency in care giving. Evidence: Many of the people living in the home were spoken with and all confirmed they felt well cared for and staff listen and act upon what they say. This was further supported by the 10 people who returned a survey to us prior to the inspection. Comments included, Its lovely here, the staff are wonderful, a real home from home, perfect in every way and excellent. The care plans for three people were looked at: one for someone new to the home, one for someone with more complex care needs and one for someone who had lived at the home for a longer period of time. The plans were divided into sections that help staff identify peoples needs, such as their past medical and social history, how they wish to be assisted with their personal care, how well they sleep, pressure area care, nutritional needs and mobility and the risk of falling. The care plans generally gave clear guidance for staff to follow to ensure that personal and health care needs are Care Homes for Older People Page 13 of 28 Evidence: met consistently, however one care plan did not give sufficient detail regarding the management of a persons diabetes. For example, the staff were measuring the persons blood sugar levels every other day but there was no instruction to staff as to what was the acceptable range for blood sugar readings and what they should do if the persons blood sugar level fell outside of this safe range. The registered manager and deputy manager said that staff were aware of what action to take if the reading was high and there was evidence that advice had been sought from the District Nurse: they said the care plan would be updated immediately. Staff spoken to said that plans of care were clear and well structured to help them understand peoples needs and to assist them to record all actions taken. Plans also included peoples preferred daily routines as well as their hobbies and interests. Where possible the home involves people in the development and review of their plans of care and some plans had been signed by the person. The home uses a recording system that uses codes to record the care and attention each person has received, however the registered manager was advised to expand this as this method gave little detail regarding how personal care had been delivered and the persons state of well-being. For example, staff were seen assisting people who were confused or who were in discomfort with great patience and kindness but this good practice was not recorded. Visits from the GP or District Nurse were recorded separately for clarity and the registered manager said the home has an excellent relationship with both. All 10 people returned a survey said they receive the medical care they need. The medication system was looked at and discussed with the registered manager and staff. The records for receiving and administering medications were up to date and in good order. Only staff who have received training are able to take on this task. Medicines were stored safely in looked cupboards in the kitchen. The home did not have any controlled drugs at the time of the inspection but safe storage was available along with the correct administration records. In the AQAA the registered manager said that GPs are routinely asked to review peoples medicines to ensure all are necessary and preventing people from becoming over medicated. People who wish to self medicate are assessed to ensure they can do so safely and this is reviewed on a monthly basis. They are given lockable storage to ensure that medications are kept safe. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to exercise choice and control over their lives. Meals and nutritional support is excellent. Activities provide interest and stimulation for people but the home should review the variety offered to ensure peoples preferences are met. Evidence: In response to the question in the AQAA what does the home do well? regarding daily life, the registered manager said, Clients choose when to rise and retire, what time they wish to eat, what to eat and where. All daily activities are client led regardless of ability. They are encouraged to continue or take up hobbies, some clients continue the same pattern as when they were at home. Visitors are always made welcome, refreshment and meals are offered on behalf of the client or by them. Visitors are welcome at any time as long clients wish this. Providing they are able to do so, clients do their own thing, some polish and dust their own rooms, make their bed and decide when the spring cleaning is done for them. This flexible routine was confirmed by the people spoken with and those who returned a survey. On arrival at the home people were seen still to be getting up and breakfast was available throughout the morning. One person said he always has two breakfasts, Care Homes for Older People Page 15 of 28 Evidence: one early in the morning in bed and another later in the morning when he gets up. People spoken with said that they could have visitors at any time, and one person explained that her husband joins her for lunch and the evening meal everyday at no extra charge. Two people confirmed that a phone is available to receive private call and that they receive their mail unopened. People were observed to be spending time in their rooms or communal areas and several confirmed that they were able to choose what time they got up and went to bed and that they were free to come and go as they pleased. Plans of care have an emphasis on ensuring that people are supported in a way that promotes and maintains their independence: a section is headed factors for full contentment which identifies what is important in a persons life and how to make living in the home more enjoyable and acceptable. The home offers a range of activities such as musical entertainment once a week from a visiting singer, quizzes, bingo, scrabble, dominoes and cards. People were seen engaged in their hobbies such as needle work and jigsaws. Those people spoken with at the time of the inspection said they were satisfied with the activities and interaction with the staff and a few people said they would like to go out now that the more pleasant weather was here. From the people returning a survey to us there was a mixed review to the question, does the home arrange activities that you can take part in if you want?: 2 people said always, 2 people said usually, 2 people said sometimes, 3 people said dont know and one person did not answer the question. Several people added a comment that they would like to see more entertainment. This was discussed with the registered manager who said she was in discussion with the two activity coordinators employed next door at their sister home to expand the activity programme and that she would consult with the people living in the home what activities they would like to be involved in. The home offers a good range and choice of meals: people described the food as excellent. The main lunchtime meal was observed to be served in comfortable surroundings and in a relaxed manner. People confirmed that the cook knows their personal preferences and that a choice of main meals are available: cooked meals are offered at lunchtime and the evening meal. People are asked what they would like for each meal and their choice is recorded: people were observed being offered a free choice for their evening meal if they didnt want either of the two choices on the menu. They are then asked after each meal whether it was to their satisfaction and again the results recorded to allow the registered manger and the cook to adjust the Care Homes for Older People Page 16 of 28 Evidence: menu to peoples tastes. The attention to such detail is commended. For those people with a poor appetite due to ill health staff record what they have to eat and drink and their nutritional needs are monitored and discussed with the District Nurse who can advise the staff on supplements. One person required assistance with eating and this was observed to be done with great patience with the member of staff explaining to the person what she was having to eat. People are provided with a bowl of fruit in their rooms and staff were observed offering people drinks and biscuits throughout the day not just at set times. Care Homes for Older People Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Croft Lodge can be confident that their view are actively sought and their concerns listened to, acted upon and resolved promptly. Evidence: People who completed surveys and those spoken to all said that they could talk to staff or the registered manager about any concerns they had. The home has a stated complaints procedure and document how they have worked to resolve any issues raised. In addition the registered manager has produced an easy read report on the results of surveys completed by the people living in the home: the results of the most recent surveys were very positive. Every small concern was addressed and reported on. The registered manager also has one-to-one discussions with all people who live there and with staff. These are recorded and any issues raised are dealt with. Staff spoken with said the registered manager is approachable and they feel confident that if they have any concerns they can go to her. They said that the staff team work well together and any suggestions or concerns they have are listened and acted upon. This was supported by the five staff who returned a survey with all saying they receive support from their manager and they know what to do should someone make a complaint about the home. The staff group have had training in helping them to understand what abuse is and what the warning signs are. They also undergo checks prior to being employed at the Care Homes for Older People Page 18 of 28 Evidence: home to ensure they are suitable to work with vulnerable people. This helps to keep people who live at Croft Lodge safe. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Croft Lodge provides a comfortable, clean and spacious home with sufficient facilities to meet peoples needs. Evidence: During this inspection a tour was made of all communal areas and some of the bedrooms. The decor and furnishings are homely and maintained to a high standard. The furniture in the lounge room is arranged in group seating to take advantage of the views from the picture window and to encourage conversation between people. This room has recently been refurbished and redecorated by the new owners. There is also a library area and the books are changed regularly. The dining room is spacious and attractively decorated, again with attractive views. The bedrooms are redecorated each time a new person moves in and where possible the person is given a choice of colours. The registered manager said that they usually replace carpets in bedrooms before new people move in as well as when needed: at the time of the visit to the home three people had chosen new carpets for their bedrooms which were due to be fitted over the weekend. All bedrooms have en suite facilities or a dedicated toilet near to the room and locks have been fitted to doors to enable people privacy and security. The locks are not entirely suitable as they are not individual, but the registered manager confirmed that these would be changed upon request to a type that older people will be able to operate. Care Homes for Older People Page 20 of 28 Evidence: The gardens are well maintained and there is a patio area to the rear of the house and a lawned area to the front. The home employs ancillary staff to ensure the home is kept clean and hygienic and they work hard to ensure that high standards are kept. All parts of the home were clean, well maintained and free from odour. The laundry area is separate from where food is prepared and stored and several people said they were very happy with the way their clothes were laundered and ironed. There was a good supply of protective clothing available, as well as soap dispensers, paper towels and gels that staff were observed to use at regular intervals. This ensures that infection control is not compromised. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff group are experienced, well trained and supported to ensure the needs of the people who live at the home are well met. Evidence: Those people spoken with said the staff are kind and caring and that they are assisted promptly when they need help, indicating that there are sufficient staff available. This was supported by the 10 people who returned the survey: all said staff are available when they need them. At the time of the inspection there were 23 people living in the home, with a new person expected to be admitted shortly. There were 4 care staff available during the morning and three care staff during the afternoon and evening with two waking staff at night: these numbers have increased since the previous inspection and do not include the registered manager when she is on duty. In addition there was also catering, domestic and administration staff on duty, again these staff members have increased since the previous inspection with the new owners recognising the need for and investing in support staff. Staff spoken to said they had good opportunities to train, complete NVQ training and do additional training that helps them better understand their role and do their job effectively. Training records showed that all core training such as fire safety, moving and handling, basic food hygiene, first aid and understanding issues around abuse have all been done or have been booked for staff to attend. In addition to using an Care Homes for Older People Page 22 of 28 Evidence: external training advisor who works alongside the registered manager in designing training events specific to the needs of the home, the registered providers have invested in The Aged Care Channel. This is a TV channel available over the internet which provides 2-weekly training in topics relating to the care of older people, such as bowel management, nutrition, skin care and ulcers, preventing falls, depression in older people, dementia care and physiological changes in aging. Staff are provided with workbooks and additional information is available through the use of a DVD which means the information is always available. Over half the staff have nationally recognised skills training in care (NVQ2 or above). This ensures staff have a good understanding of good practice and helps to provide quality care. In addition to the training received staff meet regularly with the registered manager for formal supervision to discuss their work performance and their own needs. Topics of discussion include safe medication practices, interaction with the people living in the home, personal care giving, safe moving and handling fire safety, control of infection and health and safety issues. The owners and registered manager are commended for their commitment to staff training and development. The staff files of the three newest members of staff were seen and relevant checks and references had been taken up to ensure that individuals were suitable to work with vulnerable adults. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed and run in the best interests of the people who live there. Evidence: The home owners have many years experience in providing care and support for older people and for those with dementia: they own another care home next door to Croft Lodge for people with dementia. The staff and registered manager spoke highly of them and said they were very supportive and committed to the development of the home. As their other home is so close, the staff are able to get to know one another and train together and people can use the facilities of both homes. The registered manager is well qualified and experienced to provide good leadership of Croft Lodge. She has completed her NVQ 5 in Care Management, a nationally recognised award that ensures good practice is understood and implemented, and is currently undertaking a Masters Degree in Health and Social Care Management. Care Homes for Older People Page 24 of 28 Evidence: Staff and people who live at the home said that the registered manager is open, approachable and would action any concerns or suggestions raised. She demonstrates a high level of commitment to ensuring views are listened to and recorded and has introduced regular one-to-one sessions with the people living in the home as well as staff. One person returning a survey said this well run home stems from the excellent leadership from the top. The registered manager undertakes regular formal consultation with the people living in the home as well as their relatives and others involved in their care such as the District Nurses. She makes sure the results of any surveys are reported upon in a way that people can easily understand. She makes sure people are aware of what actions have been taken to try to improve the quality of care provided. This was also the case with the Annual Quality Assurance assessment (AQAA) we had asked them to complete. Answers were given honestly and it was evident that the home had looked very clearly at ways it could improve the service on an ongoing basis. The home does not keep individuals monies. If a service is paid for by the home, the person or their representative is billed in retrospect for the service such as hairdressing or chiropody. Receipts are kept so there is a clear audit trail. The information from the AQAA gives details of how the home is maintained and health and safety is not compromised. Staff have training in all areas of health and safety and safe working practices and new staff have a recorded induction programme that follows national standards. The fire logbook and accident and incident reports were looked at during this inspection and found to be well maintained and up to date. Care Homes for Older People Page 25 of 28 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 26 of 28 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 Care plans should provide clear instructions to staff with regard maitaining peoples safety and well-being when managing medical conditions. Daily care notes should contain more detailed information about the care and support provided by staff. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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