Care Home: Eglantine Villa Residential & Nursing Home

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What the care home does well The care plans include good documentation for health care needs, and very detailed risk assessments for the health and safety of individual residents. The home provides a good range of activities throughout the day, including one to one time for residents who stay in their own rooms. This is apparent in both houses. The home is well maintained both inside and out, and there is an ongoing programme of redecoration. The grounds are well maintained, and provide residents with a variety of places to sit or walk. Residents are enabled to air their views freely, through residents` forum meetings each month; through questionnaires; and through the help of independent advocates. This provides an excellent framework for residents to be confident that they can make their concerns and ideas known, and that they will be listened to. What has improved since the last inspection? Medication management and storage in Jasmine Lodge has been improved. The clinical room has been changed to a more suitable room, providing a better room temperature and storage. The home has increased the range of activities even further during the last year, and the activities organisers work hard to try and meet the different preferences of the residents. The manager has been carrying out ongoing recruitment, and has successfully filled some available posts. What the care home could do better: Documentation in care plans could be further improved with clearer assessments for residents who have a reduced mental capacity. This would show how decisions are made on behalf of residents, and in their best interests. Medication auditing could be improved in regards to "as necessary" medicines; so that there is a clear pathway for the numbers of these medicines received into the home and given to residents. Medication Administration Records should have two signatures from appropriately trained staff for any hand written entries. Staffing levels need to be kept under review; especially for care staffing during the day in Jasmine Lodge; and at night in Lavender Cottage. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eglantine Villa Residential & Nursing Home Eglantine Lane Horton Kirby Dartford Kent DA4 9JL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Eglantine Villa Residential & Nursing Home Eglantine Lane Horton Kirby Dartford Kent DA4 9JL 01322863019 01322860552 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) : BUPA Care Homes (CFC Homes) Ltd care home 51 Number of places (if applicable): Under 65 Over 65 0 51 dementia old age, not falling within any other category Additional conditions: 51 0 The maximum number of service users who can be accommodated is: 51 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Eglantine Villa comprises two buildings, Jasmine Lodge and Lavender Cottage, which are set in well established gardens., and extensive grounds. Jasmine Lodge is for the care of up to 26 older people with nursing needs, and Lavender Cottage is for the residential care of up to 25 older people with dementia. The service is owned by BUPA Care Homes Limited, who are a recognised provider of care homes. Care Homes for Older People Page 4 of 29 Brief description of the care home Jasmine Lodge has three floors, with accommodation for residents provided on the ground and first floors. A passenger lift provides easy access between floors. It is linked by a short walkway to Lavender Cottage, which is a single storey building, and has keypad locks to all external doors for the safety of the residents. These open on to secure garden areas, which include lawns, patios, and a herb garden. The home provides extensive activities for residents in both buildings, tailoring these to the differing needs of the residents. There is a commitment to offering individualised care in all aspects of the running of the home. The service can easily be reached by road via the M20 and M25 motorways, and although it is within a short distance of these, it is set in a country lane, with pleasant views across a valley. Car parking places are provided on site. The fees range from 470.76 pounds to 983 pounds per week, depending on the assessed needs of the individual resident; and whether they are receiving nursing, residential or dementia care. Care Homes for Older People Page 5 of 29 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 home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes assessing information gathered about the home during the past year, as well as a visit to the service. Information provided by the home includes formal notifications, which care homes are required to send to the Commission; and an Annual Quality Assurance Assessment (AQAA) completed by the manager. The AQAA was satisfactorily completed, and provided helpful information. We sent out survey forms to residents, staff, and health professionals, and received three of these back. The visit was carried out by one inspector over two days (an afternoon and the next morning), and lasted for seven hours. During the visit, we (i.e. Care Homes for Older People Page 6 of 29 the Commission) viewed all areas of the home; inspected documentation such as care plans, staff files, and maintenance files; and chatted with a total of twelve residents, four visitors and twelve staff. The staff were all very helpful and co-operative throughout the visit. The manager was not in the home on the first day, but we met her on the second day, and gave feedback about the inspection findings. Residents in Lavender Cottage were unable to provide much verbal information, due to their dementia, and we carried out a time of observation known as a Short Observational Framework Inspection (or SOFI). This is a process of watching the care provided for a specified number of residents (four in this case), over a set period of time. The SOFI was helpful in backing up other findings, and showed that staff interact well with residents with dementia, and are aware of their individual needs. Remarks from residents in Jasmine Lodge included I have settled in much more quickly than I thought I would; and the staff are very kind and helpful, and work hard. 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 set out 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 Care Homes for Older People Page 8 of 29 7535. Care Homes for Older People Page 9 of 29 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 29 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 good information for prospective residents; and enables them to visit the home to assist them in making their choice. Evidence: A copy of the statement of purpose and service users guide is kept available in the reception area, and in each residents room. This ensures that information about the home is available to new enquirers and to existing residents. Other informative booklets about BUPA are also kept in the reception area, and a copy of the most recent inspection report. Residents and their representatives are encouraged to visit the home; and all prospective residents have a full pre-admission assessment by the manager or a trained nurse. This is to ensure that the home will be able to meet the individual needs of each person. Care Homes for Older People Page 11 of 29 Evidence: Residents are admitted for a trial period of four weeks, after which a review is carried out to check that the placement is suitable before it becomes permanent. All residents are provided with terms and conditions of residency and a contract; and are informed about items which are not included in the fees. Care Homes for Older People Page 12 of 29 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 demonstrate that staff are committed to meeting residents health and personal care needs. Evidence: A personal plan of care is drawn up for each resident, with their involvement where possible, or with the involvement of their relatives or advocates. We examined five care plans; three for Jasmine Lodge, and two for Lavender Cottage. BUPAs Quest documentation is a system which combines initial pre-admission assessments with ongoing assessments and care planning. We found that care plans are generally well written, and include comprehensive information enabling staff to carry out effective care. Detailed assessments are in place for all activities of daily living, such as personal hygiene and skin care, nutrition, continence, safety, communication and social preferences. The health and safety risk assessments are particularly well managed, with individual Care Homes for Older People Page 13 of 29 Evidence: risks assessed for items such as: window restrictors properly fitted in bedrooms; thermostats in place for hot water outlets; furniture safe and not likely to topple over. Other risk assessments are in place for use of bed rails, walking outside unsupervised, storage of cleaning materials, storage of beauty products, and ability to use a call bell. These show good attention to detail, ensuring residents safety. Health care is well documented with other assessments such as moving and handling assessments, pressure relief, and falls assessments. These show the action to be taken in order to prevent a deterioration in health. Records are maintained for doctors visits, and visits by other health professionals such as dietician, or speech and language therapist. Referrals are made as appropriate for these specialisms. Private physiotherapy can also be arranged if required. We noted that care planning could be improved further with a clearer assessment for residents mental capacity. This is more straightforward for residents in Lavender Cottage, which is the house for residents needing dementia care. However, some care plans for Jasmine Lodge could be more specific in this respect, showing if residents still have full mental capacity, or if this is limited. This has implications for making decisions in their best interests, if they no longer have the capacity to make an informed decision themselves e.g. for going to hospital, or for end of life care. Medication management was inspected in Jasmine Lodge. Storage has been moved to a different clinical room, and this is more suitable, and has a better room temperature for safe storage of medicines. Controlled drugs are properly stored, and the register is well kept. One item was found dated as dispensed in 2007, and this should be disposed of if it is no longer in use. There is insufficient cupboard space at present, but the manager has already put processes in place to deal with this. Homely remedies are well managed, with clear records maintained. Internal medication is correctly kept separate from external. However, some liquid medication has not been dated on opening, so it it unclear when these go out of date. Medicine Administration Records are generally satisfactory, but some hand written entries had not been countersigned, and it is important to have two suitably trained staff to check these entries. Some of the records lack clarity in regards to completing the times for giving as necessary medication. The manager said she would be discussing this with the nurses, to see if they can implement a clearer system. BUPA auditing processes include a detailed monthly medication audit. However, this does not show how as necessary medicines are audited; and a clear system is needed to ensure that these medicines are clearly audited and numbers accounted for. The home is also experiencing some difficulty with obtaining medicines which are prescribed at short notice, when it is out of normal prescribing hours e.g. evenings and weekends, and the manager is also addressing this situation. Care Homes for Older People Page 14 of 29 Evidence: Residents feel that they are well looked after, and are confident that the staff will meet their needs. Staff were observed interacting with residents, and showing concern and interest in their welfare. They try as much as possible to preserve residents privacy and dignity, although this is not so easy in Lavender Cottage. Staff are committed to helping residents in every way when they are dying; keeping them comfortable and pain free, and sitting with them if they wish. Discussions are held with each resident or their representative to establish any individual wishes, as soon after admission as possible, so that everyone is advised of these. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled to pursue their choice of lifestyle. Food is suitably nutritious and is well managed. Evidence: The home has two activities organisers, who work closely together to provide a range of activities in both houses. They are aware of each others specific skills and strengths, and this enables them to assist residents in different ways. Residents can mix from both houses for some shared activities, but this does not work for everything, as some residents in Jasmine Lodge can find it a frustration to share activities with residents who have dementia, although others find it a joy. This is therefore assessed on an ongoing basis, to try and provide the best possible mix for everyone. The activities plan may be altered on a day to day basis to take account of different residents preferences on the day. A tea tasting morning was just finishing as the inspection commenced, and it was evident that residents and visitors had really enjoyed this. Group activities include items such as reminiscence (which is carried out by a different Care Homes for Older People Page 16 of 29 Evidence: person who is self employed and comes into the home); a classical music club on Thursdays (which is carried out by a relative); cinema shows, arts and crafts, and a gentlemens morning. Special events such as Burns night, Valentines Day, Mothers Day and Easter are celebrated; and activities staff spend one to one time with residents as well. Residents are able to go out in the grounds, and there is a separate garden for residents from Lavender Cottage which is secure, and maintains their safety. Outings are sometimes arranged to visit local places, or for shopping. The activities staff take part in a Residents Forum, for which there is a meeting in each house, each month. The manager chairs these meetings, and they enable residents to have group discussions about how the home is running, and to air any views to promote change. Each house also has a residents advocate, who are active in ensuring that residents can make their feelings known. The home also has the Friends of Eglantine, who support the home in many ways, including fund raising for the residents fund, and taking part in events such as the Summer fete. Other links with the community include visits from a local church minister, who provides a church service in each house each month, and will visit residents in their own rooms if they wish, to chat and pray with them. Food is well managed in the home, providing residents with sufficient choice throughout the day. All the meals are prepared in the main kitchen in Jasmine Lodge; and there is a satellite kitchen in Lavender Cottage which is used for serving up meals, and for preparing snacks and drinks. Residents can have additional snacks at any time. An extra tray of sandwiches is provided for Lavender Cottage in the late evenings, in recognition that many residents with dementia become hungry from wandering, and need extra calories. Menus are prepared in a picture format for Lavender Cottage to help residents to make a choice. The menus are prepared on a four weekly cycle, and are reviewed twice per year, and then assessed by a BUPA nutritionist. The kitchen was seen to be compact but well organised. There are separate areas for food preparation and for washing up. Daily and weekly cleaning programmes are in place. Kitchen staff have relevant catering qualifications and food hygiene training. Care Homes for Older People Page 17 of 29 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 are able to raise concerns and know that they will be taken seriously, and will be acted on appropriately. Residents are protected from abuse. Evidence: The BUPA complaints procedure is available in the reception area, and shows a clear pathway of how to make a complaint and who to go to. We have been informed that BUPA care homes are currently reviewing the complaints policy. The home maintains a record of any concerns and complaints, and these are checked by the regional manager every month. This ensures that any complaints are properly dealt with, and that appropriate action is taken to deal with specific concerns. There are forms available for anyone to use, either to make a complaint, or to compliment the home. We viewed the complaints log, and it confirmed that complaints are well managed. Residents are enabled to make complaints through one of the homes advocates if they do not wish to complain personally. The staff training matrix confirms that all staff receive initial training in the prevention of adult abuse during the induction period; and this is followed up with further training. Staff recruitment procedures are well managed, and this also provides protection for residents. Care Homes for Older People Page 18 of 29 Care Homes for Older People Page 19 of 29 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. The home provides a safe and pleasant environment for residents. There are good systems in place for day to day cleaning and maintenance. Evidence: The home is generally well maintained, and is light and airy. There are comfortable sitting areas in each of the two houses, so that residents can choose where they prefer to sit. Some areas have been redecorated, and the manager is in the process of implementing an ongoing programme for redecoration and refurbishment. Furniture and fittings were seen to be of good quality, and the houses were both clean in all areas viewed. There is a full time maintenance man who carries out ongoing repairs, as well as carrying out daily and weekly checks for systems such as the fire system, call bells and hot water temperatures. The home employs separate gardeners to keep the large grounds maintained to a good standard; and there are a variety of places to sit outside, or to walk. There are sufficient numbers of baths and showers, although Jasmine Lodge only has one bath, which is not easily accessible for the equipment needed. There are three shower rooms which are easier to use. Bedrooms are fitted with en-suite toilets and wash hand basins. There are bedrooms on the ground and first floors, and a passenger lift provides access to all areas. Residents are encouraged to bring in items to Care Homes for Older People Page 20 of 29 Evidence: personalise their own bedrooms. The bedroom doors are fitted with self closures which activate in the event of fire. The housekeeper oversees the team of domestic staff, and there are usually two domestic staff for each house, each day. There is a programme in place to ensure that each bed room is deep cleaned every two months, and good records are maintained to show when these have been done. There are cleaning staff on duty every day of the week, and separate laundry staff. The laundry is situated on the ground floor of Jasmine Lodge. There are two washing machines and two tumble dryers. New tumble dryers were recently fitted by the contracted company, and are proving to cause problems at present. The laundry staff think that the settings are incorrect, as clothing items are shrinking, and clothing is more difficult to iron. The manager and Estates Management are fully aware of this situation, and are addressing it with the company concerned. Care Homes for Older People Page 21 of 29 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. Staffing levels have been low at times, and additional recruitment is in place to address this. Staff training is well managed. Evidence: The staffing numbers for nursing and care staff have been a bit low at times due to staff sickness, and staff who have left who have not yet been replaced. The numbers for Jasmine Lodge are usually one nurse on duty at all times; four carers in the mornings, three carers in the afternoons and evenings, and two carers at night. However, the staffing rotas confirmed that there have been occasions when there have only been three carers on duty in the mornings, two in the afternoons, and one at night. The manager has been recruiting staff, and said that three staff were due to commence employment within the next week. It would also be advantageous to have two nurses on duty for some morning shifts, so that there are some supernumerary hours for completing other nurse duties such as medication management and updating care plans. Care staff on Jasmine Lodge stated that they did not have sufficient time to spend with residents, and they would like to be able to assist more with activities as well as with personal care. Care Homes for Older People Page 22 of 29 Evidence: Staffing for Lavender Cottage comprises one team leader, and three other care staff in the day time; and one team leader and one other carer at night. We questioned the suitability of only two care staff at night, as sometimes residents need two carers to assist them. This does not leave any one else available to watch over other residents, and this should be reviewed. BUPA actively encourage and assist staff to study for NVQ training, and there are currently sixty-two per cent with NVQ levels 2 or 3, which is very good. Recruitment processes are well managed. We inspected three staff files, and found that they contain the required checks such as POVA first and Criminal Record Bureau (CRB) checks; photograph; proof of ID; training records; and NMC PIN number checks for nurses. One file did not contain a full employment history. This was pointed out to the manager, who said that she would follow this through, and ensure that a full employment history is obtained in the future. Staff files were not in good order, and the manager and new administrator were fully aware of this, and said that they were looking forward to sorting these out. BUPA provide staff with a comprehensive induction programme, and records showed that these are well completed. The staff training matrix confirmed that all mandatory training is carried out, such as fire training, basic food hygiene, infection control and moving and handling. Not all staff working at Lavender Cottage have completed dementia care training, and the manager is addressing this. She is also arranging training in managing challenging behaviour. Care Homes for Older People Page 23 of 29 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. Good management, and good procedures, provide a framework for ensuring the health and safety of residents and staff. Evidence: The manager has been in post for several months, but is not yet registered with the Commission. She is in the process of completing the Registered Managers Award, and NVQ level 4; and she has experience in the care of older people. BUPA use auditing systems which show how homes are progressing, and the regional managers audits have shown consistent improvement in this home. The audits include items such as health and safety management, care plan auditing, wound care, food management, and the handling of complaints. Staff meetings are held every week for heads of departments, and at regular intervals for other staff. Residents and relatives meetings are held every month in each house, and customer Care Homes for Older People Page 24 of 29 Evidence: satisfaction surveys are carried out to enable further input. The results of these are analysed and published. It is also very helpful for residents to have advocates available. These processes ensure that residents are supported in voicing their opinions and their concerns, and have input into the way in which the home is running. Residents are encouraged to manage their own finances if they are able to do so. The home can store small amounts of pocket monies on their behalf, and records are maintained for all debits and credits. Receipts are retained, and these records are audited on a monthly basis. All staff have one to one formal supervision, and this provides a forum to discuss personal goals and training needs. Policies and procedures are reviewed annually. All documentation seen was well maintained, and up to date. The home has health and safety meetings with representatives from different departments. Maintenance records show that there are ongoing processes to identify concerns quickly; and identified issues are dealt with, promoting the health and safety of staff and residents. Care Homes for Older People Page 25 of 29 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 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 To review the numbers of 09/06/2009 care staff on duty in Jasmine Lodge, and ensure there are sufficient numbers to provide effective care. And to review the numbers of care staff for Lavender Cottage on duty at night, ensuring that the safety of residents is maintained. The registered person must ensure that there are sufficient numbers of suitably qualified and competent and experienced persons working at the home as are appropriate for the health and welfare of service users. 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 27 of 29 1 8 To ensure that care plans include evidence for residents mental ability; and clearly showing how any decisions are made on residents behalf. To ensure that any handwritten entries on Medicine Administration Records (MAR charts) are signed by two appropriately trained staff. And to ensure that procedures are in place for the auditing of as necessary medicines. The company should encourage the manager to apply for registration with the Commission as soon as possible. 2 9 3 31 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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