Care Home: Dorset House

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What the care home does well Information about the home and the service offered is available to people who are thinking of moving into Dorset House. People`s care needs are assessed prior to admission to ensure that needs can be met by the staff group. A wide range of activities and clubs are available within the home and outings are arranged. The home celebrates events throughout the year. The home is well maintained which ensures that people have a comfortable place in which to live. National Vocational Qualification training NVQ is encouraged to ensure that staff have the knowledge and skills to care for people. Equipment within the home is serviced to ensure it is in good working order. What has improved since the last inspection? A new carpet is now in place in the hall way and up the main stairs. The home has made sufficient improvement in the management of medication to ensure that the requirements of our Statutory Requirement Notice were met. What the care home could do better: Care plans need to be accurate and up to date . Improvement is needed in the recording of medication once administered. Key inspection report Care homes for older people Name: Address: Dorset House Blackfriars Avenue Droitwich Spa Worcestershire WR9 8DR     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: Andrew Spearing-Brown     Date: 3 0 0 3 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: Dorset House Blackfriars Avenue Droitwich Spa Worcestershire WR9 8DR 01905772710 01905771476 dorset@agecare.org.uk www.agecare.org.uk Royal Surgical Aid Society Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Emma Miles 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: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 42 Old age, not falling within any other category (OP) 42 Date of last inspection Brief description of the care home Dorset House is a large attractive building, set within its own gardens near to Droitwich town centre. The older part of the building was built in 1928. There are currently 40 single rooms that measure at least 10 square metres, all of which have en-suite facilities. There is one double room currently occupied by a single occupant. Two shaft lifts are available to enable people with mobility concerns to move easily between Care Homes for Older People Page 4 of 28 Over 65 0 42 42 0 0 6 0 8 2 0 0 9 Brief description of the care home floors and a stair lift is also provided on a small flight of stairs on the first floor. The home is one of several care homes for older people run by Age Care, a charity formed in 1862 as the Royal Surgical Aid Society. Car parking is available in the grounds of the home. For up to date information regarding fees, the reader should contact the service directly. 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: 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: The last key inspection at Dorset House was carried out during April / May 2009. Following the key inspection we carried out a random inspection during August 2009, to check compliance with us issuing a Statutory Requirement Notice at the home during August 2009. This inspection was carried out over two days by one inspector. Nobody within the home knew that we were going to visit. The focus of our inspection is upon the outcomes for people who live there. This includes where possible the views of people using the service. The process we use considers the homes capacity to meet regulatory requirements, standards of practice and looks at aspects of the service that need further development. Prior to the visit we looked at the information we have received since our last inspection. This information included the Annual Quality Assurance Assessment (AQAA). The AQAA is a document completed by the home and provides us with Care Homes for Older People Page 6 of 28 information about the home and how they believe they are meeting the needs of people living there. We also sent questionnaires for some people living in the home and some members of staff to complete. We looked around the home. We viewed care plans and other documents regarding residents such as medication records. We also looked at records relating to staffing and health and safety. We spoke to the registered manager, some nursing staff and carers as well as to people living within the home. 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 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 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 9 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. Information is available to help people make a choice about whether they would like to live at Dorset House. The needs of people who may use the service are assessed so that individuals and their relatives can be assured that identified care needs can be met. Evidence: Dorset House has a Statement of Purpose which is available in the reception area of the home. Within this document is a welcome pack for residents. Details of how fees are worked out, taking into account what the home calls Hotel charge Care charge and Room charge, are included within the statement of purpose. In their survey residents told us that they had received enough information before they moved into the home. The manager told us that people interested in moving into the home or their family are encouraged to have a look around the home prior to an admission taking place. One resident confirmed that her family had visited the home Care Homes for Older People Page 10 of 28 Evidence: before she had moved in. A four week trial period takes place to ensure that the placement is the right decision. Dorset House does not offer intermediate care. It does, however, offer a respite (short stay) service if a vacancy is available at the time such a service is requested. We viewed the assessment completed by a representative from the home regarding somebody who had received a respite stay which concluded shortly before this inspection. The assessment was completed prior to the respite commencing. The registered manager had signed the assessment the day before the person arrived at the home. The assessment contained some brief details regarding the individual. It was evident from the assessment that the person concerned had minimal care needs. The information was,however, sufficient to provide staff with initial guidance regarding the support the individual would need from the home. Care Homes for Older People Page 11 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. People have an individual care plan which is reviewed although at times some areas are not fully up to date in order to give staff full and clear guidance about how to meet needs. The management of medication needs some improvement to ensure that records are fully maintained to ensure people receive medicines correctly and safely. Evidence: We looked at the care records of some people who live in the home and,where possible, talked to them. We also spoke to other residents about the care they receive. Within the questionnaire everybody told us that they are well cared for and receive the care and medical support they need. A visiting professional told us that staff are lovely and confirmed that staff carry out any instructions given to maintain peoples health and welfare. Care plans were in place for each resident as well as differing risk assessments. Generally care plans gave instructions for care staff in order that identified needs could be met. We saw that care plans are reviewed on a monthly basis to reflect changing care needs such as the need to use hoisting equipment. The lead nurse was, Care Homes for Older People Page 12 of 28 Evidence: at the time of our visit, devising new care plans for people as many of the original plans were drawn up some time ago. Care plans were generally not person centred. The lead nurse was aware of this and informed us that as part of the current re writing of care plans, she was intending to make them more person specific. We saw some examples whereby improvements in the care records were needed. The daily notes of one resident showed that the person had developed a small skin break and the need to obtain a pressure relieving mattress from the community nurses. Although reference was made earlier to applying cream, no breaks were noted. No care plan was in place regarding the soreness. The records did not show that the community nurse was contacted. However, during our time within the home, information was received regarding when the equipment would arrive. Care staff sign a sheet in residents bedrooms once they have applied cream. We looked at one of these and found that staff were not always signing to show that they had done this. The instruction on the sheet in the persons bedroom did not match the sheet held in the clinic. The nurse on duty was unable to account for the reason for these gaps in the records or the different instruction. One record stated that one person should have her blood sugar tested on a weekly basis. The records showed that this had happened more recently. However, the records were not so clear prior to that. The risk assessment of one person was not added up correctly as it did not show a difficulty in swallowing,which was identified elsewhere. We saw that the home call upon medical assistance as necessary such as asking for a referral to speech and language therapy to assess somebodys ability to swallow.We also saw reference to the tissue viability nurse visiting the home. As part of this inspection, we looked at some medication records. During our previous inspection we found a number of concerns regarding the management of medication. As a result of our concerns we issued a Statutory Requirement Notice. We returned to the home in August 2009 and found that the home had made improvements in documenting and recording the administration and disposal of peoples medication. Records were in place regarding the temperature of the fridge used to store some medication and the room itself. These records showed that medication is not exposed to too high a temperature. The vast majority of MAR sheets were completed correctly showing that residents had Care Homes for Older People Page 13 of 28 Evidence: received their medication as prescribed. When we found a gap and we checked the blister pack we found that the medication was not there. This would therefore indicate that staff had administered the medication. We audited some medication. Some of the audits balanced correctly but some others did not. The nurse on duty was unable to account for the discrepancies that we found. We saw a supply of homely remedies. The nurse told us that these drugs, such as painkillers, are used by residents and staff. Records were held, but we were unable to audit and balance the medication held. People living at the home appeared well cared for. Residents attire was good taking into account gender and weather conditions. Staff were seen and heard to be kind and respectful towards residents. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Dorset House are able to participate in a range of social and recreational activities within the home and away from the home reflecting their personal preferences. Meal times are relaxed. Evidence: The Statement of Purpose states that Residents are encouraged to continue with any social activities and hobbies they already have and, if necessary will be assisted in this. The document states that the home has a good relationship with Methodist church and Church of England and that a communion service is held each month. During our visit we were informed that people from local churches visit the home on a regular basis. We asked people within our survey whether the home arranges activities that they can take part in. Some people answered always while others said usually. During our visit people told us that the home provides a range of activities. One person let us know that the sports day last summer was great fun. Dorset House employs an activities co - organiser for 25 hours per week. We saw information around the home on notice boards and monthly planners about events Care Homes for Older People Page 15 of 28 Evidence: due to take place that day as well as forthcoming events. The former drawing room is now used as an area for certain activities to take place. The room contains a large flat screen television. Films are shown on occasions in this room. A desk top computer is available for residents, however it does not have internet access. Photographs were seen taken during outings to Elgars Birthplace and Worcester Porcelain. Some residents told us about forthcoming trips to the Sea Life centre in Birmingham. Dorset House celebrates a wide range of days such as Burns Night, Chinese New Year and St Georges Day. When it is a residents birthday, this is celebrated. An announcement is made at lunch time and people join in a verse of Happy Birthday while a cake with candles is presented. Residents are able to partake in a number of clubs within the home such as gardening club, knitting club and talking book club as well as other activities such as exercise, board games and sing a longs. Dorset House welcomes visitors at any reasonable time. People are able to have a meal with their relative if they wish. The days menu is displayed at the entrance to the dining room. We asked people whether they enjoy the food provided. We received a range of responses. Some residents believe the food to be very good while others commented that it is over cooked. Upon our survey, one person commented that not all hot meals are hot when served. We were able to join residents for a meal. As Dorset House has dedicated staff to serve meals, care staff are able to sit and join residents. The meal time was a pleasant event which was unrushed. Care Homes for Older People Page 16 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 good 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 the home have access to a complaints procedure. Evidence: The homes complaints procedure was on display in the hallway. The procedure is also available within the Statement of Purpose and within a leaflet entitled Comments, suggestions and complaints. The information within the leaflet needs to be amended to inform people that they can contact the commission at any time. The leaflet also needs a minor change regarding our contact address as it reflects the South East region where Age Care has other services. We viewed the records regarding complaints received within the care home. It was evident that the manager had carried out an investigation and responded to the complaint. People told us that they are aware of how to complain and were confident that their concerns would be listened to. We raised with the manager the content of a couple of complaints whereby it was evident that we should have been informed under Regulation 37. The manager had, however, taken action to resolve these incidents but had not involved the local authority who may have also had an interest in the events. Recently the registered manager has informed us of some other incidents and has also informed the local authority under their safeguarding procedures. Information was Care Homes for Older People Page 17 of 28 Evidence: available regarding safeguarding and the homes procedures reflected Worcestershire procedures. The manager has attended training regarding the Deprivation of Liberty Standards (DOLs)and has in the past made a referral to the DOLs team. Care Homes for Older People Page 18 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. People living at Dorset House do so in a well maintained, clean and comfortable environment. Evidence: Dorset House provides a clean and well maintained place for people to reside. Prior to the inspection we received a survey written by a relative which stated The home is always friendly and open to comments and ideas. Those in charge aim to provide an environment where residents can feel at home(eg making the drawing room available as a day room to entertain family on special occasions.) Maintenance staff try to ensure residents are comfortable (eg adjusting heating / picture hanging etc). As part of our visit we viewed communal areas of the home and saw a small number of bedrooms. The dining room has a restaurant feel to it. The tables were well laid out for the mid day meal. One resident commented upon how nice tables look. Since our last inspection the chairs in the dining room have been refurbished and some new pictures are displayed. A loop system is fitted within the dining room to aid people who wear a hearing aid. On our survey one person wrote The home is always friendly and open to comments and ideas. Those in charge aim to provide an environment where residents can feel at home eg making the drawing room available as a day room to entertain family on Care Homes for Older People Page 19 of 28 Evidence: special occasions. Numerous pictures and other items such as plates are on the wall, some of which show either Dorset House or Droitwich Spa. A digital photo frame was on during most of our visit showing residents undertaking a range of social activities. The reception area has a new desk in place for a receptionist to sit. A display cabinet housed Easter Eggs which were prizes for a fund raising raffle. We previously reported that the drawing room had undergone some changes. This area was, in the past, rarely used apart from formal occasions. After receiving some funding a wide screen television was purchased and the area is now used for activities including a weekly film. The room is comfortable and welcoming. Dorset House provides single accommodation and all bedrooms have en-suite facilities. The bedrooms we saw contained personal belongings such as pieces of furniture as well as ornaments and pictures to make them feel more homely and individual. During our last inspection we noticed a free standing wardrobe which was not secured to the wall to prevent accidental toppling. The home only has a small number of such wardrobes as the vast majority of rooms have built in wardrobes. We were unable to check any of the free standings ones on this occasion. However, we were told that they are now secure. We noted one radiator at the top of a back stair case which was very hot and had no cover fitted to prevent accidental scalding. We were previously informed that this radiator is not used. It was felt that it could have been turned on following some plumbing work within the home. We were assured that a cover would be fitted. All parts of the home are accessible via two passenger lifts. A stair lift on a small flight of stairs has been removed. The carpet on the main stair case and within reception is new. The home was clean and generally tidy with the exception of a lack of storage for items such as wheelchairs and hoists. Since our last inspection one bathroom in the original part of the home has been improved to make it more attractive. Other bathrooms within this part of the home remain the same, but we were told of plans to develop a wet room. Items such as gloves and aprons were available within bathrooms. The corridor areas throughout the home are showing signs of wear and tear and damage from equipment such as wheelchairs. Care Homes for Older People Page 20 of 28 Evidence: The grounds around Dorset House are well maintained. The manager told us of improvements made to the foot path around the garden and of plans to provide an improved ramp from the conservatory to a patio area. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home receive training in order for them to meet the needs of people using the service. People can have confidence in the homes recruitment processes. Evidence: We were told that staffing levels at Dorset House remain as previously reported. In the morning there are six care assistants and five in the afternoon. During the night 3 care assistants are on duty. A trained nurse is on duty at all times. On the questionnaire the majority of people told us that staff are available when they need them and that staff listen to them and act upon what they say. These findings were confirmed during our visit during which people told us that the majority of staff are very good. Within the AQAA the registered manager stated that the home has good staff retention. We looked over the file of a recently appointed employee and found that the required background checks had been carried out to ensure that people are suitable to work with older people. We saw the training plan for 2010. Agecare provides 2 days training per year for each member of staff. These training days include health and safety, fire awareness and manual handling on one day. The other day covers challenging behaviour, data Care Homes for Older People Page 22 of 28 Evidence: protection and infection control. We asked staff if they receive training that is relevant to their job, helps them understand and meet individual needs and keeps them up to date. Staff told us within the survey and during our visit that they receive this training. Over 70 of care staff have achieved a NVQ (National Vocational Qualification) with further staff currently undertaking this training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is open and operates in the best interest of people living in the home. Evidence: The registered manager has worked at Dorset House since September 2008. We previously reported that the manager holds a Diploma in nursing as well as the Registered Manager Award (RMA). The RMA is a level 4 NVQ (National Vocational Qualification). During this inspection the manager confirmed that this information was correct. The manager informed us that she has, since our last inspection, attended up to date training in medication administration, safeguarding training provided by the local authority and training in dementia care. The manager has an office, which is also used by the lead nurse, in the reception area of the home. The office door was, apart from when confidential discussions were taking place, open to demonstrate an open door approach. One member of staff wrote on a survey The new manager has made a big difference. She is encouraging Care Homes for Older People Page 24 of 28 Evidence: all depts to work together as a team. As indicated within this inspection report we found that some areas of management such as care planning and medication continue to need improvement so that people can be fully confident in the service. We did nevertheless note improvement in these areas particularly the overall management of medication. We were assured by both the registered manager and lead nurse that improvements would be made. Work had commenced on care planning. We were assured that discussions would take place with the trained nurse in relation to both of these areas to ensure that people realise the importance of having these systems in place and up to date. Since our last inspection the responsible individual for Dorset House has changed. Under Regulation 26 of the Care Homes Regulations, the provider or a representative working on their behalf has to visit the home on a monthly basis and prepare a written report. These visits are currently undertaken by a consultant who assesses the home using the current National Minimum Standards as a foundation. We previously reported upon a customer satisfaction survey on activities carried out during April 2009. The findings of these surveys are available in the reception area of the home. No further surveys have taken place since that date. We were told that AgeCare is currently exploring how they should carry out such surveys to seek peoples opinions in the future. Regular residents meetings are held and minutes were available. We were told that these meetings tend to concentrate upon food and seeking ideas for activities within the home and outings. Relatives meetings take place four times a year, the minutes of these meetings were also available within the home. Staff confirmed to us that they receive regular supervision with a manager. We were also informed that staff appraisals are taking place. We have previously found records regarding the servicing and maintenance of equipment to be well maintained. The AQAA completed by the registered manager gave us the dates when servicing had taken place. 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 plan need to be in place and kept up to date in relation to identified care needs in order to ensure that staff have suitable guidance in order to carry out their duties. A review of practice within the home regarding the administration of medicines needs to take place to ensure systems are safe. 2 9 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. 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