Care Home: Farmhouse Rest Home

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What the care home does well The home has a good admissions process which involves people in the process and includes detailed assessments and information before admission so that people`s needs are met when admitted. Care is provided by caring and friendly staff who know the needs of the people living in the home and create a pleasant atmosphere. Attention is given to health monitoring and professionals are contacted for guidance and advice routinely. People living in the home are offered an increased range and frequency of activities for mental stimulation based on assessed needs and interests. They are provided with a menu that they have influenced and like. Attention has been given the environment with some areas of the home having new furniture and items to make the home more `homely`. Servicing in the home is happening routinely and attention is given to health and safety. What has improved since the last inspection? Care plans and risk assessment in the home have improved and are more detailed. They include more individual information and guidance for staff and there is process in the home to monitor their effectiveness. Medication recording, storage and administration has improved and a system of reviewing staff competence has been established. Monitoring of food intake and dietary needs has improved and is completed more regularly and people`s weight is also routinely monitored. Monitoring systems in the home now include more effective infection control. The process of recruiting staff is now more rigorous to ensure that people living in the home are supported by care staff who have been fully vetted. Training has been taking place and has been reviewed and planned. The has been developing systems to monitor the quality of the service provided progress has been made. What the care home could do better: The management of the home need to continue to review and monitor the service and develop this further to ensure that the outcome for people using the service is regularly checked and altered to meet their needs. Key inspection report Care homes for older people Name: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ     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: Sue Kinch     Date: 2 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © 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 27 Information about the care home Name of care home: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ 02380667071 02380868865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Richard E Kitchen,Mrs Elizabeth Kitchen Name of registered manager (if applicable) Mr John Trevor Rickman Type of registration: Number of places registered: care home 20 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 to be accommodated is 20 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: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Farmhouse is a registered care home providing personal support and accommodation for up to twenty older people who may have dementia. The home comprises of ten single and five shared bedrooms, eleven of which have en-suite facilities. Communal Care Homes for Older People Page 4 of 27 Over 65 0 20 20 0 1 2 0 1 2 0 1 0 Brief description of the care home space includes two lounges and a dining room. Car parking and a small, enclosed patio can be found at the front of the property. Farmhouse is situated in a residential area on a main road close to the centre of Totton. The homes fees range from £504-£520 a week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: For this unannounced inspection visit we reviewed our records including those of random inspections completed since the last Key Inspection. We talked with some of the people living in the home, viewed care practices and looked at records. We viewed a sample care plans and risk assessments and other records required to be held in the home. We had conversations with visitors, some staff one duty and the manager. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 27 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has made changes to the admission processes in the home and ensures that needs have been fully assessed before someone comes to the home for respite care or to live. Evidence: Following our last inspection on 12 January 2010, in the improvement plan sent to us by the manager he said that pre-admission assessments now included consultation with the person moving and families and they were being asked to sign care plans. To assess the admissions process in the home we sampled records, spoke with staff the manager a care manager and two people who have recently moved into the home, one for a short -stay. The home has clear records to show that assessments were made including obtaining information from other professionals involved in care provided for those people, before Care Homes for Older People Page 10 of 27 Evidence: the people came to stay at the home. An assessment had also been obtained from the care manager. The manager had used the information to develop clear individualised care plans with action plans for staff to follow. These care plans, where checked, indicated the specific needs identified in the assessments. Staff told us that they had information about people before they moved in the home or came for short stay and therefore, were able to support them as they wished. They also commented about people being able to come and visit the home before deciding if they want to stay. From our conversations with the above people we established that joint work has taken place to liaise with relatives,to consider mental capacity and to involve appropriate people including the residents in decisions. We noted that daily records were being completed to monitor the experiences of those people. A care manager told us that reviews were planned to review these new admissions. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home have been consistently implementing a more detailed system of care plans and risk assessments identifying individual needs and support required. The manager has developed a system of monitoring to ensure that needs are met and the home is about to introduce a key worker system to improve this monitoring of meeting needs and increase staff effectiveness. The health needs of people living in the home are assessed and addressed however,although there is now a system in place for the ongoing assessment of staff competence in medication administration it must routinely include all staff carrying out this role to ensure that service users are not at risk of errors. Evidence: In June 2009 we found that care plans and risk assessments were not in enough detail to ensure that the needs of people living in the home were met. Monitoring took place in random inspections and a Statutory Requirement Notice was issued detailing when requirements about care plans were to be met. In January 2010 we noted they contained more consistent information and clearer guidelines for staff to follow to Care Homes for Older People Page 12 of 27 Evidence: meet needs. However, there were some matters that we brought to the managers attention. We required that by 12 /3/10 the registered person must ensure that a detailed system for monitoring care plans and risk assessments is regularly followed. This was to ensure that monitoring is ongoing and effective in ensuring that needs are met.The evidence below is our evidence that the requirement had been met. At this inspection we sampled records for two people newly admitted to the home and noted that detailed and individualised care plans were in place for staff to follow. We noted that daily records are routinely maintained and that systems are in place to highlight current issues to incoming shifts. We looked at the monitoring of the care plans and noted that systems of monitoring them were in place and developing. We also discussed the changing care plans with staff because not many have recorded that they have read and understood them. During the inspection when ever we asked staff about the specific needs of people they were able to identify key issues and how they would support people. Examples were of support with continence behaviours, bereavement, medication, dietary issues and stimulation. Some staff commented on how things had improved in the home with the change in management, that they felt they knew more about the people living there and that they were listened to. They said that they had access to care plans and one person said that they now enjoyed coming to work. We were also told that staff responsibilities will be increasing as a key worker system is developed in the home. Two staff spoken with about meeting health needs were clear that they had a duty to monitor health needs and report any concerns to the management. They said that they do this regularly and are confident that the matter will be addressed. A doctor called during our visit and a staff member subsequently gave was aware of how issues were to be followed up. We noted that the care plans viewed in detail included the health and emotional needs and how they would be met. There are sections in the care plans for monitoring health needs. We looked a the monitoring of these needs for two people who had been living in the home for a while and noted that there is recording of medical changes and interventions in the records. In the sample we looked at this included outcomes of interventions from doctors, such as prescriptions, opticians appointments and chiropody. In June 2009 we also made requirements in a report following a key inspection about medication.bThe home was subsequently assessed by a pharmacy inspector at random inspections and requirements were made of the home some of which were Care Homes for Older People Page 13 of 27 Evidence: included in a Statutory Requirement Notice. Following our key unannounced inspection in January 2010 we noted that improvements were being sustained but in the report we stated in a requirement that by 24/2/10. The registered person must ensure that a system of reviewing individual staff competence in medication practices is more detailed and carried out regularly. This was to ensure that staff medication practices are accurate and people living in the home receive their medication correctly. At this inspection we looked at records of training and of the assessment of staff competence.This had been carried out for most but not all staff who administer medication. Three staff had not been assessed and the manager said that supervisions had now been set up to ensure that this happened. We have not repeated the requirement as a system is now in place. It was also discussed that the current programme of training did not include medication in the rolling programme. However, the manager said that some staff were planned for medication training. A discussion was also held about the manager ensuring that he has refresher training in medication as he is assessing the competence of his staff and it is some time since he undertook training. He agreed to address this. We considered the current medication practices in the home and viewed aspects of storage, administration and recording and found that the system has improved and is being consistently monitored for errors. We checked the recording of two specific health needs being identified and how this was followed through. This included looking at the homes recording of health needs and medication records and found that the matters had been addressed and the people concerned had received medication. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are offered an increased range and frequency of activities for mental stimulation based on assessed needs and interests. They are provided with a menu that they have influenced and like. Evidence: In the morning of our inspection visit a regular entertainer was leading a singing session which many of the people living it the home were enjoying. Other people were in the smaller lounge or in their rooms. Staff said that activities are regularly organised in the home, more often in the week now and that this included, ball games, singing, quizzes and craft. A list is available to everyone. Staff said that on some days this happens twice. One said that a mens group was being planned to meet some of the differing needs and that the local evening paper is also available. We noted that people are encouraged to follow their own interests and one person was reading. Another was in their room for part of the time with their extensive model collection.We observed more activity about the home than on previous visits and more interaction between people living there and with the staff. Staff said that they had time for chatting and singing and many instances were observed during our visit. We noticed that people are being encouraged to make their own decisions about where Care Homes for Older People Page 15 of 27 Evidence: they want to be in the home. We noted more signs in the home to help people locate their rooms. Staff gave us an example of how they deal with the immediate emotional and social needs of people living in the home and talked about support through bereavement and family contact. A care manager told us about the admission process and family involvement. We had previously required that by 24/2/10 the registered person should ensure that records of the food provided are in sufficient detail to demonstrate that the diet is satisfactory in relation to nutrition and special diets. This is to ensure that individual needs are met. In the improvement plan the manager told us that the chef is recording full dietary intake. However to meet the requirement we asked the manager to show us how dietary intake is being monitored. We were shown that the home now has a system for recording food provided including variations and individual choices. On a few days prior to the inspection and the manager told us that the chef had been off and recording less consistent. However for the rest of April records had been made and the manager said that there was no one in the home with major eating problems. He agreed to make sure that the system is continuous. We noted that care plans include details about dietary needs and we found, where checked, that staff had knowledge about peoples specific dietary needs and preferences. We also noted that the deputy has a role in monitoring peoples weight monthly in order to take action when needed. This information is recorded and available to all staff. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training in safeguarding and the reporting of incidents have improved so that the risk of incidents not being addressed have been reduced offering greater protection to people living in the home. The home has a complaints procedure and is creating an atmosphere in which people are listened to but more recording of minor concerns will provide more evidence that these are followed through to peoples satisfaction. Evidence: The home has a complaints procedure available in the front hall and in individual rooms. A record book is in the home for recording records though the manager said that no formal complaints had been made. The manager home does receive concerns at times although the one discussed a verbally with the manager had not been recorded in the log book or in the persons records. The manager gave a verbal account of how he had followed up the minor issue and agreed to ensure that a recording process for concerns is established for monitoring purposes. People spoken with during the inspection had varying levels of dementia but were generally positive about the care they receive. One matter worrying one person was being supported by a staff member and the changes in behaviour of another was being followed up with the care manager. Staff said that they feel able to report things to the senior carer and are confident that any matter they raised will be addressed. Care Homes for Older People Page 17 of 27 Evidence: On some previous inspection visits to the home within the last year the Commission had raised concerns about lack of referrals of incidents to the Commission and to Social Services. Since raising requirements the Commission has received more notification of incidents. The home had been involved in safeguarding procedures and these had now been closed. The manager had sent us information about another recent incident in the home and at the inspection gave us the reference to show that it had been referred to social services. The manager was waiting for this to be followed up at a planned review. Training in safeguarding was discussed with the manager. The home refers to this as POVA training. Records of training showed that staff had received training in the Autumn of 2009 as noted in the January key inspection. We noted that further training was planned for the management and the manager told us that more training would be planned for staff later in the year. 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. People living in the home are provided with a comfortable environment to live and increased attention to infection control procedures has decreased the risk of cross infection in the home. Evidence: The homes external appearance to the front of the home is attractive and items for disposal noted previously had been removed. Some items to the rear of the home still needed to be removed to provide a less cluttered look.This was discussed with the manager who was aware of the items for disposal. Since our last key unannounced inspection we have made several random inspections and in these have noted improvements to the environment.This has included new furniture in the dining room and more decorative items.Overall this has created a more homely environment with more items for stimulation. we noted that the home is clean and fresh in all areas viewed including all ground floor shared rooms and toilets and two bedrooms including en suite facilities on the first floor. The call bell system was discussed during the inspection with the deputy and after with the manager.We noted that the ring pull for the old system was at risk of being confused with that of the current system in the two rooms visited. The manager agreed to resolved this and reduce the potential of confused people pulling the wrong Care Homes for Older People Page 19 of 27 Evidence: cord. The manager agreed to address this. Following our last inspection we required that by 24/2/10 the registered person must ensure that periodic monitoring of infection control procedures are in place to ensure that risks of cross-infection are minimised . This was to ensure the safety of people living in the home. In the improvement plan the manager told us that weekly health and safety checks are done. We saw records of this during this visit and noted that matters regarding infection control had been raised showing that it is being monitored. The manager also said that all soap and towels have been removed and replaced with liquid soap and paper towels. On visit we found that this had been completed when we observed several shared facilities that were of concern on our last visit.This showed that the requirement had been met and a plan was in place to ensure that infection control is routinely monitored. One member of staff showed us he location of a new sluice room that had been planned when we last visited. However, we were not able to fully observe this as a delivery of incontinence aids had been made on the previous day and were to be moved to another store area. 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. People living in the home are support by caring,increasingly informed and trained staff but the programme of training and development of staff needs to grow and develop further to ensure that all needs continue to be met. The process of recruiting staff is now more rigorous to ensure that people living in the home are supported by care staff who have been fully vetted. Evidence: Staff levels in the home have been reviewed and increased at key times of the day to three carers. A discussion was held with the manager about the staff levels in the home and he demonstrated that he had monitored them and made changes to the rota to ensure that more care staff were in the home over the morning period and from 4-7pm. We noted that this was supported by the number of staff on shift during our visit and by the rotas. Following our last inspection we noted improvements in training in our report but required that by 24/3/10 the registered person must ensure that there is a rolling programme of staff training which is kept under review and includes meeting more specific and individual needs of current residents. This is to ensure that individual needs are met.In the improvement plan the manager said that staff will receive relevant training. He said staff had been given training in infection control, mental Care Homes for Older People Page 21 of 27 Evidence: capacity, health and safety, deprivation of liberty, dementia, fire, bereavement, moving and handling, first aid, pova and food hygiene. We found that the manager has reviewed the training needs of the staff and has records of training that staff have received and of planned training for the coming months. Where checked we noted that the training he told us of had been provided. We noted that the forthcoming training plan included health and safety, first aid, food hygiene, dementia, infection control, protection and bereavement. He said that this training was planned to take place with other homes and that further training would be planned to included more medication training for all of the staff. Some staff as identified in the health and personal care section still need their competence to be monitored regarding medication. The manager had a plan to achieve this. A discussion was held about the need to ensure that the training included other areas of needs that relate to individuals and to ensure staff have received training in mental capacity. The manager agreed to address this and to review the training plan to ensure all staff had training planned. Records showed that staff had received fire training on April 2010 with four more staff planned to do it. Staff said that they had received training before Christmas including dementia and health and safety and fire training since. They said moving and handling happened each year. A discussion was held with the manager about induction of staff and we noted that he was developing the system. He agreed to check the national requirements regarding this. After the inspection of June 2009 we made an immediate requirement that the manager must have evidence of aPOVA first check or a fully completed CRB check before people start working in the home. In January we found in the evidence viewed that this had been followed up and that employment checks were mostly being completed but that there was not enough evidence that all references were obtained from original sources or obtained before employment.At this inspection we sampled records for four people who had been or were in the process of being recruited by the registered manager. Our conclusion was that there was written evidence to demonstrate that necessary records of checks had been completed fully. 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 service is now managed by a registered manager developing systems and consultation to improve the service ability to meet peoples needs and is making good progress. Increased quality assurance through monitoring has aided this and the management of health and safety of residents and staff in the home. Evidence: The manager of the home has been registered since the last inspection, has reviewed his own training needs, is receiving updating training and is planned to undertake more. He agreed to include medication training in this. The management of the home includes a Head of Care. Staff comments about the management were that they were more open and approachable and they could ask for help and were confident that they would get it and that issues would be addressed to meet peoples needs. Systems and procedures observed in the home are more organised than previously found in the home. Staff supervision is developing and staff meetings are being planned. The management has planned to introduce a key working system to increase the input and involvement of care staff in monitoring and planning care. Care Homes for Older People Page 23 of 27 Evidence: At the last key unannounced inspection overall we found that the quality assurance system was not extensive enough to ensure that systems are fully monitored and effective. We found that a consultation process was beginning and feedback had been obtained about food. But more feedback about the service was needed. The manager had a short term action plan but did not have a development plan available to interested parties based on the homes quality auditing and consultation. The manager had agreed to address this and we found at this inspection that action was taking place in respect of it. We had required that by 12/3/10 the registered person must ensure that the quality assurance system is broad enough for peoples needs to be consistently met. This was so that monitoring systems are in place to identify action required to maintain standards of care provided. The manager responded in an improvement plan which included a range of plans to improve the service based on our requirements however he did not give enough information about how he is developing the the overall quality assurance in the home. At this inspection we considered the quality assurance system now available in the home. This was discussed with the manager at this visit and made observations of checklists and systems in the home. We noted that the local authority improvement officer had also been involved in the home. We found that the level of monitoring in the home has increased with action being taken where issues are identified. As stated in other sections of this report for example the manager had improved the processes for the recruitment of staff and the admissions process. Other monitoring found in place included, care plans, health and safety, staff levels, staff training, and medication. The manager was aware that monitoring of the service was ongoing and would continue to develop. There was also a discussion about the need to include monitoring of night shifts. We have concluded that the service has taken sufficient action to meet the requirement although further work is needed for it to be fully embedded in the homes practices. Discussions and records show that health and safety is monitored routinely in the home and action plans produced. From our sampling we noted that the home has taken action to improve infection control.We looked at various records of servicing and checks and found that these are recorded to have been done within the timescales required.Information was much more organised than at our last visit and easily accessible. Fire training was provided in April 2010 with further plans are in place for staff who did not attend. 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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