Care Home: East Dean Grange

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What the care home does well There is a detailed and informative Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. There are robust admission processes to the home. A full needs assessment by a competent person is undertaken and they are assured in writing that their needs will be met before they move in. Some residents were able to confirm that they were visited by the appointed manager prior to admission to the home and two relatives confirmed they they were involved in the admission process. The menus evidence a well thought out balanced diet with a varied choice of food in line with residents` preferences. A comment received was ` The food is varied and my father enjoys it`. Quality assurance systems are in place which enables the service to monitor and improve their service and ensure that the home is run in the best interests of residents. Comments received included: `The manager is approachable, understanding and readily discusses any issue I want to raise`. There is an open-house policy which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included, `Loving care of the individual, couldn`t be better`, `Lovely upgrade, superbly managed by all` `The staff are always kind and courteous, and the whole premises clean and bright`. What has improved since the last inspection? The requirements set at the last key inspection have been met. The staff have worked hard on the care plans and risk assessments to ensure that a person centred approach is used along with involvement with the residents. There was evidence of regular review and monitoring of residents health needs. The medication practices now seen in the home promote and safeguard the health needs of the residents. The AQAA stated that activities are an area that are constantly being reviewed and improved to meet the residents social needs in the home. The staff team is stable now and all staff are recieving the training they need to perform their job. What the care home could do better: As discussed there are areas that still need developing, but these are areas that the manager has identified and were fully discussed. Therefore there are no requirements made at this time. Some valuable comments were received from visitors in respect of areas that could be improved and these include: ` The staff could be more pro active with wheelchair users and enable them to get outside more often` `More activities, as many are room bound`. Key inspection report Care homes for older people Name: Address: East Dean Grange Lower Street East Dean East Sussex BN20 0DE     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: Deborah Calveley     Date: 1 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: East Dean Grange Lower Street East Dean East Sussex BN20 0DE 01323422411 01323422412 phillini@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 33 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 33 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category; Old age, not falling within any other category(OP) Date of last inspection Brief description of the care home East Dean Grange provides care for up to 33 older people requiring personal care. The home offers hotel style accommodation in a large detached country house situated in the village of East Dean approximately four miles from Eastbourne. The home is close to the church, village hall and public house. There is a four-person passenger lift and a chair lift that provide access to most areas except for three bedrooms in the older part of the building. All bedrooms are en-suite and decorated to a high standard. There is a communal shower. Other facilities include a variety of sitting rooms, a terrace, a drinks bar, a split-level dining room and an indoor swimming pool. The home is Care Homes for Older People Page 4 of 27 Over 65 33 0 Brief description of the care home surrounded by well-maintained gardens and there are ample car parking facilities. All bedrooms are connected to the call alarm system, have cable TV and fitted with telephone points. The homes Statement of Purpose and Service Users Guide is available in the reception area of the home alongside the latest inspection report. 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: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at East Dean Grange will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 5.5 hours on the 17 July 2009. There were 20 residents living in the home on the day of which five were case tracked and spoken with. During the site visit five other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. During the inspection visit, a range of documentation was viewed. These included the Service Users Guide, Statement of Purpose, care plans, medication records and Care Homes for Older People Page 6 of 27 recruitment files. Five members of the care team were spoken with in addition to discussion with the appointed manager. Telephone contact was made with visiting professionals following the visit and one health professional was spoken with during the inspection visit. The response to the care quality commissions surveys was good and the information received from those and received verbally have been incorporated into this report. An Annual Quality Assurance Assessment was received from the appointed manager completed in full prior to this key inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? The requirements set at the last key inspection have been met. The staff have worked hard on the care plans and risk assessments to ensure that a person centred approach is used along with involvement with the residents. There was evidence of regular review and monitoring of residents health needs. The medication practices now seen in the home promote and safeguard the health needs of the residents. The AQAA stated that activities are an area that are constantly being reviewed and improved to meet the residents social needs in the home. The staff team is stable now and all staff are recieving the training they need to perform their job. Care Homes for Older People Page 8 of 27 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission ensuring that the home can meet the needs identified. Evidence: East Dean Grange has a comprehensive Statement of Purpose and Service Users Guide in place, which contains clear information about the home and the services it provides. The Service Users Guide is now placed into every bedroom and in communal areas for residents and visitors to access at anytime. It was confirmed whilst talking to residents that the contract arrangements were clear and understood. There is a copy of the terms and conditions of residency included in the homes information documents. Care Homes for Older People Page 11 of 27 Evidence: A review of the care documentation confirmed that pre-admission assessments are completed by the appointed manager prior to moving into the home. The last two admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide an adequate assessment of prospective residents care needs. The appointed manager confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. A recommendation of good practice was made in ensuring that enough information is recorded to make that decision. Prospective residents are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach could be more clearly recorded on the assessment documentation to demonstrate the procedure followed. The home now confirms in writing that having regard to the assessment that the home can meet the assessed needs of the prospective resident. The manager was able to verbally demonstrate her knowledge and awareness of the different specialties required in the home. The organisation ensures that the carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The manager confirmed that residents are invited to a trial period to ensure suitability of the home and this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. East Dean grange does provide respite care and short stay visits. Intermediate care is not provided at East Dean Grange. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide a good framework for the delivery of care which give clear guidance to care staff on all the care needs of all the residents. The home was found to be meeting residents health and general needs with accessed additional specialist support when needed. Medication practices in the home promote and protect the health needs of residents and the privacy and dignity of residents are promoted. Evidence: The care documentation pertaining to five residents was reviewed in depth as part of the inspection process. The organisation have produced a care plan format that includes a pre admission assessment that guides the staff in to compiling a care plan when required. It is acknowledged that the staff have worked hard on the care plans to ensure they are person centred and specific to the individual. There are some areas that need to be developed. This relates to ensuring that once the care need is identified that the guidance to be followed is included to ensure that the needs are met in a consistent manner. Care Homes for Older People Page 13 of 27 Evidence: Risk assessments for health needs are included in the care planning format used by the home and all risk assessments were found to be completed and followed through with an appropriate plan of action when identified as required. The homes documentation ensures that the residents receive the care and support they need to protect and promote their health and well being. Residents are registered with a GP from local surgeries. The home support and enable residents to access services from other health care professionals in order to promote their well being. The district health care assistant was visiting on the day of site visit and was happy to give her opinion of the home, Communication with the home staff has improved, the home is clean and welcoming, the staff are friendly and courteous. Residents spoken with were satisfied with the care provided at the home, comments received included Very good, They are very supportive, I do need help to get about Good staff. There are policies and procedures in place for staff to refer to regarding the safe administration, storage disposal and recording of medication including insulin administration. The systems for recording and checking controlled drugs were found to be thorough. The home have changed the medication supplier since the last inspection and systems for ordering are now more efficient. The Medication Administration Charts (MAR) were viewed, gaps were identified and these need to be followed up by the senior staff. Practices for medication administration have improved considerably since the last key inspection and the health and safety of the residents protected by safe practices. There are residents who self medicate and these are appropriately risk assessed regularly and supported by the homes procedures. The home follow robust procedures for medication errors and the relationship with the local G.P surgeries is good. Feedback from a health professional was positive regarding the home and confirmed that advice was sought as and when required. Staff were seen to be respectful and considerate to all residents whilst attending to their needs. The residents spoken with confirmed that they were treated with dignity and respect and that their right to privacy was respected. Staff always knock before entering Care Homes for Older People Page 14 of 27 Evidence: Make sure I am decent!. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. The staff support their residents with hair, makeup and ensure their nails are clean. A male resident said Staff assist me with shaving and making sure I am managing. Care Homes for Older People Page 15 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. The lifestyle and meals experienced by residents at this time meets their expectations choices and preferences Evidence: The home employs a full time activity co ordinator, who has devised a weekly activity programme which is displayed on a notice board. The home is still running a cruise which includes visiting a different country every week and the meals for one day are then dedicated to that country.The home has a terrace and well kept gardens for residents to enjoy in the good weather. Care plans evidence some residents past histories and social preferences and these contribute to the activity programme. From talking with residents, it was found that some social care documentation gave incorrect information and this needs to be reviewed. The activity notes kept now illustrate who did not attend activities, the reason and what they preferred to do. There was also evidence of one to one sessions with those residents who prefer not to attend group activities. Comments from the surveys received indicated that more activities would be beneficial. More activities, More stimulation for those that are confined to their room. Care Homes for Older People Page 16 of 27 Evidence: The AQAA confirmed that areas identified for improvement include: Extend exercise classes, plans to develop the afternoon activities, more one to one sessions for residents who spend their time in their rooms. There are also plans to extend the scope of visiting shops. It was confirmed by staff that the residents are supported and enabled to join local events held in the village and attend the Church Services at the nearby church. Residents are supported and facilitated to maintain their independence for as long as they are able within a risk assessment framework. There are no restrictions on visiting times as long as consideration is shown to all the residents. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. Many of the residents have individualised their bedroom with items from home and residents and relatives spoken with confirmed that they are encouraged to make it homely. It was observed during the inspection that the routines at the home are flexible residents spoken with confirmed that they were consulted about all aspects of their lives. The home has an advocacy policy in place and the information regarding this is available to all residents. The mid day meal was observed and was seen to be organised and well managed. It was confirmed that residents had a choice at lunchtime which included a vegetarian choice. Residents said that if they did not want the menu choices they could choose something else. Menus are changed seasonally and rotate on a 4 week cycle. The menus are circulated the day prior to the meals being provided and many residents had forgotten what they ordered but menus are also kept on individual tables. The chef confirmed that the communication with staff was good. He notes the amounts returned so as to know when a residents food may need fortifying. It was confirmed that records are kept of the food cooked including variations to the menu and special diets. All feedback about the food was complimentary and comments included Very good food, A varied menu Always nicely presented. Care Homes for Older People Page 17 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. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. Evidence: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. The complaint folder was viewed and demonstrated that all complaints are taken seriously, investigated and respoded to in the timescales set. Residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the safeguarding of vulnerable adults and staff have all received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. 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. East Dean Grange provides a comfortable clean and safe environment for those living in the home and visiting. Evidence: East Dean Grange is well maintained and safe and meets its stated purpose and the aims and objectives of the home. There are attractive gardens with seating areas which are safe and accessible to residents who have a physical disability. A swimming pool is attached to the property and is appropriately monitored and checks are in place in to ensure its safe and hygienic. All residents that use it are appropriately supervised. The home has had a major refurbishment in the past year and this is now completed. The improvements have in the main been well received by the people who use the service, The furniture in my bedroom is much better, gives me more space, Its been done nicely. The whole place is very nice Peaceful surroundings, good staff, Very comfortable place to live. The home have a choice of various communal areas which are attractive and allow for different uses ensuring residents have choice where they spend their time. There are adequate communal bathrooms and shower rooms in the home with Care Homes for Older People Page 19 of 27 Evidence: specialist equipment to ensure all residents can have a bath or shower. The home has specialised equipment available throughout the home to promote health and encourage independence. In relation to fire safety all records are current and in place to protect the safety of those living and visiting the home. All of the staff team attend regular fire safety training. It was confirmed that all staff receive training in infection control and that the policies and procedures are updated regularly. They are easily accessible to staff thus protecting those living and visiting the home from risk of cross infection. Good practice in respect of infection control measures by staff was observed during the inspection visit and there were gloves and aprons freely available in the home. Sluice areas were found to be clean and safe with appropriate systems in place for soiled linen and waste. 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. There is sufficient trained and competent staff on duty at all times to meet the assessed needs of the residents. Robust recruitment procedures and appropriate staff training ensure the safety and protection of residents. Evidence: From direct observation and from viewing the staffing rota, it evidenced that there were appropriate numbers of trained and competent staff on duty over a 24 hour period to care for the residents. The fire safety risk assessments and resident dependency levels are taken into consideration when reviewing staffing levels at night. It was confirmed by the manager that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents. Residents confirmed that the home had enough staff to give the level of care they expect and need. In addition to care staff, separate staff are employed for ancillary roles. A selection of staff recruitment files were viewed and demonstrated that there is a thorough and robust recruitment process in place to protect their residents. The documentation in the files supported the information supplied in the AQAA, that all staff receive a thorough induction to the home. All new staff complete a trial period Care Homes for Older People Page 21 of 27 Evidence: to ensure that the job is suitable for them. Staff spoken with said that training opportunities are good and interesting. The appointed manager has introduced a training matrix which enables the management team to track the training needs. This ensures that all staff receive the training required to perform their job competently and therefore promoting the health and well being of the residents living in the home. There is an induction programme in place and has been introduced for all staff. Files seen confirmed this. The induction and foundation training is in line with the Skills for Care guidance. As previously stated all new staff are required to complete an initial induction programme and undertake mandatory training including fire and health and safety. This leads into foundation training in preparation of National Vocational Qualification (NVQ) training. At present 8 of the 17 staff have a NVQ qualification. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of this home is good with effective systems in place to protect residents. Evidence: East Dean Grange is owned by BUPA Co Ltd. The appointed manager has been in post since November 2007 and is still to submit her application for registered manager. It was confirmed that it would be submitted shortly. She was previously employed as a manager of a domiciliary care agency for five years and has the necessary experience and knowledge to manage the home. She enrolled on the Registered Managers Award course in June 2008. The manager and staff have worked hard over the past year to meet the requirements made at the last key inspection. They have improved the outcomes for the people who use the service. There are systems in place to monitor the quality in the home and include the use of questionnaires. It was confirmed that these are audited, reported on and responded to. There are resident/relative meetings and staff meetings which are minuted and Care Homes for Older People Page 23 of 27 Evidence: form part of the quality assurance system. The complaints received are also audited and responded to. T he home manage the personal monies for a number of their residents. Residents monies are held in a separate interest bearing account as per the BUPA policies and procedures. It was confirmed that the system used provides an audit trail of how transactions are managed on behalf of residents. Thus safeguarding their financial intersts. Evidence was seen of regular supervision sessions and all staff spoken with confirmed that they receive regular supervision. The appointed manager confirmed and the staff training records show that all staff are kept updated on the Health and Safety policies. The manual is available to all and clearly defined with regularly updated policies and procedures and best practice guidelines. This ensures that the health, safety and welfare of the people using the service are both protected and promoted. The accident book was completed in full and the organisation conduct an audit monthly and strategies are put in to place for prevention of a recurrence. First aid boxes are located in the home and easily assessable when required. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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