Care Home: Gratwick House

What the care home does well Residents say staff are kind and helpful and there are always sufficient numbers of them. Residents say they were treated with respect and that staff were patient and polite. One resident survey said `I feel they do everything well and I would not want to leave`. Another said `Gratwick looks after it`s residents to a very high standard, tending them with care and sympathy`. Staff like working here, they say the care is of a high standard and they are well supported to do their jobs. One staff survey said `Gratwick House strives to care and comfort all it`s residents. It takes time to listen to them and takes time to match their care with their individual needs`. There are activities every day. People say they have enough to do. Care plans are detailed and written to reflect individual needs and preferences. On ongoing training programme supports staff to be competent and confident in their roles. What has improved since the last inspection? The home have refurbished their laundry room. This has improved the hygiene in this area. They have fitted automatic door closures to all the bedroom doors allowing those who wish to have their doors open to do so more safely. What the care home could do better: The registered person must ensure the home is free from odours. Medication practises must be improved to ensure the health and well being of residents. Robust recruitment practises must be followed to ensure the safety of residents. Key inspection report Care homes for older people Name: Address: Gratwick House 55 Norfolk Road Littlehampton West Sussex BN17 5HE     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: Liz Palmer     Date: 2 8 0 1 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 26 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 26 Information about the care home Name of care home: Address: Gratwick House 55 Norfolk Road Littlehampton West Sussex BN17 5HE 01903716022 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): gratwickhouse@btconnect.com Mrs June Alice Hitchens,Mr Michael John Hitchens Name of registered manager (if applicable) Mrs Lorraine Barclay Type of registration: Number of places registered: care home 22 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 who can be accommodated is: 22 The registered person may provide the following category/ies 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 categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Gratwick House is a care establishment registered to provide accommodation for up to twenty-two residents over 65 years of age. Mr and Mrs M and J Hitchens privately own the service and Mrs Lorraine Barclay is the registered manager in charge of the day-today management of the establishment. Gratwick House is situated in a quiet residential area approximately one mile from the town centre of Littlehampton and a Care Homes for Older People Page 4 of 26 Over 65 22 0 Brief description of the care home quarter of a mile from the seafront. It is within walking distance of local shops. The care home is a large, well-converted detached property with a paved front garden and a large secluded rear garden with flower borders and shrubs. The accommodation is arranged in three double and sixteen single rooms on two floors with a lift providing access between all but one of the rooms. Six of these rooms have en-suite facilities. Two lounges and a dining room provide the communal space. Care Homes for Older People Page 5 of 26 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 inspection included a visit to the home over a period of five hours, starting at 9.30am. During this time three staff were spoken to and the registered manager assisted with the inspection. Three service users were met and spoken to privately, others were met and observed during the inspection. Care plans, medication records, policies and staff records were sampled. Other information used to make judgements about the standard of care in the home included the homes Annual Quality Assurance Assessment (AQAA) that they completed and returned to us. We also received four surveys from residents living in the home, three from visiting social and healthcare professionals and two from care staff employed by the home. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 26 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 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are assessed to ensure that only those whose needs can be met are admitted to the home. Gratwick House does not provide intermediate care. Evidence: We looked at the Statement of Purpose and Service User Guide. We saw they had been recently reviewed and were up to date. Details of the fees were included as were any extra charges such as for outside entertainment. One activity that is charged for was not listed, the manager agreed to amend this. Two of the professional surveys indicated they were satisfied with the arrangements for assessments, one stated the home could realise their limitations and take appropriate clients. Two initial assessments were looked at, they were detailed and contained a full medical history, information about the persons care needs, a social Care Homes for Older People Page 9 of 26 Evidence: history and details of their interests and hobbies. Risk assessments are part of this process including assessing any equipment needed. People are able to visit the home prior to moving in although this does not always happen due to the personal circumstances of the individual. One person told me they were unable to visit first but it didnt matter. All four of the surveys returned from residents stated that they received enough information to help them decide if the home was right for them. They also stated they had all received written information about the homes terms and conditions. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their health and personal care needs met in a way that respects their views and upholds their right to privacy. The actions of staff regarding administration and recording of medication could put people at risk. Evidence: Three care plans were looked at. These are drawn up from the initial assessments undertaken prior to moving in. They were detailed and seen to be kept under regular review. They contained information about support needed for washing and dressing and personal preferences about food and drink. Risk assessments were seen and these covered risks such as falls, manual handling and any equipment needed. These were clear, detailed and kept under review. Three residents were spoken to privately in their rooms. Residents said they were treated with respect and that staff were patient, friendly and kind. They said they felt safe and well cared for. Two people told us that she can use their call bells to get staff Care Homes for Older People Page 11 of 26 Evidence: assistance whenever they like. They told us staff come immediately, one resident pressed his bell while we were there to prove his point and staff responded immediately. The four surveys received from residents were all positive. They all said they always receive the care and support they need and three stated that the home always makes sure they get the medical care they need, one said they usually did. Staff were observed interacting in a respectful and kind manner to residents. During lunch time staff were attentive to peoples needs and responded in a relaxed manner. Two surveys from professionals visiting the service, one a doctor and another a social worker stated on their surveys that peoples social and healthcare needs are always met. They said the home always seeks advice and acts on it in. They said dignity and privacy is always respected. One added I am always impressed with the level of support and care given to all the care users, even when their needs increase. Another comment was Tailors care plans to individual needs. Always ask for reassessments when appropriate. An anonymous survey from a visiting professional indicated that social and healthcare needs are sometimes met and the home sometimes seeks advice and acts upon it. They also said peoples dignity and privacy is never respected. Residents told us they could get medical assistance if they needed it and care plans showed us details of medical needs being followed up as necessary. District nurses and General Practitioner (GP) attend as necessary. The lunchtime administration of medication was observed. The records of four residents were looked at. The staff member administering told us that it is decided at the start of the morning shift who will be responsible for administration and this person will keep the keys to the cupboard until they are handed over to the night shift. She told us only those trained in the safe handling of medication and deemed competent by the manager are allowed to administer. During the lunchtime medication round we noted that for one persons medication administration record (MAR) a record for a tablet being destroyed was made with no explanation as to why this was necessary. On another date it was recorded as O meaning other, however no description of this was recorded. For another person prescribed a regular laxative there were several consecutive records that they were refusing their medication or sleeping at another time when a similar medication was prescribed for. This person may have been at risk as they were not receiving their Care Homes for Older People Page 12 of 26 Evidence: medication as prescribed by their GP. Another resident was prescribed a pain relief three times a day. The records showed they mostly had this in the morning and were refusing it the other two times. This person may have been at risk as they were not receiving their medication as prescribed by their GP. This was discussed with the manager at the time. Another MAR showed that a resident had refused a medication for most of January. This medication was prescribed to be taken 3 times a day. When offered by the staff member on duty during the inspection the resident accepted their medication. When we queried this with the staff member she replied its a matter of offering. This was discussed with the manager who agreed that a consistent approach was vital to ensure that residents receive the medication they are prescribed. We were informed by letter that the home addressed both these matters with the GP the day after the inspection and the medications were reviewed and a new prescription provided. We were also informed that the medication policy has been reviewed and updated to ensure staff complete MAR correctly. When not in use the medication trolley is stored in a large walk in cupboard which is kept locked when not in use. There is a special cabinet for storing controlled drugs. The storage and recording of controlled drugs was seen to meet the standards required by the Royal Pharmaceutical Society guidance. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a wide range of activities on offer in the home and they are happy with the choices. People are satisfied with the food provided. Evidence: In the homes AQAA they state that activities are offered seven days a week. There are weekly residents meetings where they discuss the activities and day to day running of the home. Minutes of resident meetings were sampled and seen to show that residents opinions are sought and acted upon. The activities programme includes a variety of outside entertainment such as musicians, sing a longs and hand massages. These are charged for and a list of who attends and the fees charged is kept. We asked the manager what happens if someone wants to sit in the lounge when a chargeable activity is on but does not want to join in the activity. The manager stated this has never occurred because there is another lounge and the dining room is also used. Non chargeable activities are run by the staff and they include bingo, puzzles, music and movement and crafts. People spoken to said they were satisfied with the activities. Two said they did not join in much but that they were offered the choice. During the inspection people were observed enjoying a painting activity with staff in the dining room. Care Homes for Older People Page 14 of 26 Evidence: Three of the surveys returned by residents stated the home always arranges activities that they can take part in. One said they usually did this. When asked on the survey What does the home do well? one person commented good entertainment. Two people told us that they can use their call bells to get a cup of tea or for any reason and staff respond promptly. Staff confirmed this. People were also observed helping to clear away after lunch, wiping tables, for example. Personal preferences, hobbies and interests are recorded in care plans. These are encouraged. People were seen reading their daily newspaper which one resident said was brought to them by staff each morning. There is an open visiting policy and families can stay for meals. The service user guide states a small fee is charged for this, the provider told us that he has never charged anyone. Residents said their visitors are always made welcome and offered a cup of tea by staff. Residents spoken to said they enjoyed the food. Three of the surveys returned by residents said they always liked the food and one said they usually did. Residents can choose where to eat and some prefer to eat in their rooms. There was evidence of fresh fruit and vegetables available on the day. Food preferences, dietary requirements, likes, dislikes and nutritional requirements are recorded in residents care plans. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to complain and are protected by the homes policies for safeguarding them. Evidence: The home has a complaints procedure in place, a copy of which is included in the Statement of Purpose and also displayed in the hall of the building. Residents are also reminded about how to complain on a three monthly quality assurance questionnaire given to them by the home. Residents also have an opportunity to air their views at the weekly residents meetings. Residents spoken to said they would speak to the manager if unhappy about anything. All four of the residents surveys stated they knew who to talk to informally if they were unhappy and also how to make a formal complaint. Training in the safeguarding of vulnerable adults is carried out as part of the induction process and ongoing training programme. The manager trains the staff and staff are tested to show competency. Staff spoken to were aware of the policy and were confident about their responsibilities within it. The surveys returned by two staff stated that they knew what to do if the had any concerns about the service. Records show that complaints are taken seriously, recorded and acted upon by the manager in a timely manner. Care Homes for Older People Page 16 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a clean and safe environment. They would benefit from it being free from odours. Evidence: On arrival at the home there was a strong odour of urine. The manager was very surprised when we told her this as she said no-one had ever mentioned it before and the carpets are cleaned on a monthly basis. We also noted that the wall paper in the hall was worn and peeling in places. The manager stated this was next on the refurbishment list as part of the plans to replace the central heating system. She said the entrance hall would be redecorated and a new carpet purchased. The dining area was clean and comfortable. The lounges were clean and enough seating was available. The seating was made of a wipe clean fabric. The provider informed us after the inspection that over the last four years they have started a programme to completely redecorate and refurnish the home. So far they have decorated the two lounges, dining room, the hall, stairs and landing and seven rooms. He also said the building has been painted outside and re-roofed Bedrooms were clean and tidy and personalised with individual belongings. Residents said their rooms were kept clean by staff. No odours were noticed in the three bedrooms visited. Care Homes for Older People Page 17 of 26 Evidence: At the last inspection we noted that the laundry was in need of redecorating and the floor needed to be covered with an impermeable covering. This was seen to have been completed. At the last inspection we saw that the lounge and several bedroom doors were wedged open with wooden or plastic wedges. A requirement was made regarding this. During this inspection we saw that all doors were fitted with automatic closures enabling people to have their doors open if they wished and still protect them against the risk of fire. Care Homes for Older People Page 18 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and regularly supervised. At the point of employment not all staff were recruited under robust recruitment procedures. Evidence: The rotas showed staff are deployed in sufficient numbers to meet the needs of residents. For example, at lunch time anyone needing one to one assistance received it without waiting. Residents said they are never rushed and there were always plenty of staff on duty. They said call bells are responded to quickly including at night. Staff spoken to also said they never rushed their care with residents and staff covered for each other during holidays or sickness. The files of three staff employed since the last inspection were looked at. We saw that people had undertaken a skills for care induction programme and had received mandatory training such as Fire Safety, Manual Handling, Health and Safety, First Aid and Safeguarding Vulnerable adults. We saw that proof of identity and any authorisation needed for overseas workers was in place. One of the staff files seen had a Criminal Record Bureau (CRB) check that had been undertaken by their previous employer. It was dated April 2007 and their employment at this home commenced in November 2008. No further criminal record checks were undertaken and no risk Care Homes for Older People Page 19 of 26 Evidence: assessment of this was recorded. This person had two personal references, no references from a previous employer were taken up. Another employee started work on 26th January 2008. Their CRB was dated 15th April 2008 and the two references were dated 5th March 2008 and January 28th 2008. One was from a relative and another from a family friend. No references from previous employers were taken up. Both of these people are overseas workers and the manager stated it was difficult to get employment references. The third file looked at had a CRB undertaken by a previous employer dated 26th January 2009. Their employment at this home started on 3rd August 2009. There was no evidence that the home had requested any references for this person. On their file we saw a letter of recommendation from a previous employer that had been given to the person at the end of their employment. There was also a letter dated June 1st 2009 from a college admissions department stating the person was undertaking National Vocational Qualification (NVQ) level 3. The day after the inspection the responsible individual sent us written confirmation and documentary evidence that CRBs had been applied for in respect of all staff who currently did not have one for this home. The manager also informed us that she has received clearance for these people from the Independent Safeguarding Authority. Staff files showed that staff had regular supervision with the manager and annual appraisals also take place. Staff told us they felt well supported and found the manager approachable. The surveys from staff also confirmed this. Records showed staff are up to date with training held externally such as First Aid, Food Hygiene and Manual Handling. Other training is provided in house by the manager, for example, Safeguarding Vulnerable Adults, Fire Training, Palliative Care and Care Planning. Currently just over 50 of the staff have achieved NVQ level 2 or above. Care Homes for Older People Page 20 of 26 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. Overall the home is well run, by an expereienced and suitably qualified manager. Management decisions about recruitment practises may have placed people at risk. Evidence: The registered manager has managed the home since 1995. She has acheived a City and Guilds in Advanced Management for Care in 1998 and completed the Registered Managers Award in 2003. In 2008 she acheived a Certificate in Dementia Care and this year has completed certificates in Infection Control and Health and Safety at Work. The home sent us their AQAA when we asked for it. The detail was very brief and did not tell us everything we needed to know and did not give us much indication of improvements they plan to make. When asked in the AQAA what they could do better they answered nothing or n/a meaning not applicable or we stayed the same. Staff and residents are consulted on the running of the home at weekly resident Care Homes for Older People Page 21 of 26 Evidence: meetings and monthly staff meetings. The home sends out three monthly questionnaires to staff, residents and relatives. We looked at a sample of these and they were very positive. The residents questionnaires included information about how to make a complaint. The staff and residents spoken to said they thought the home was well run. Information in the staff and resident surveys confirmed this. One of the professional surveys stated The home is very well run and I have every confidence in the manager and staff to deliver an excellent service to the residents. The management decisions made regarding recruitment (as described in the Staffing section of this report) could have put people at risk. The manager and provider rectified this and other shortcomings immediately after our inspection. The manager stated they did not hold any money on behalf of residents and that they were supported by their relatives in this matter. We sampled records for fire safety, these were up to date. Fire training had been provided by West Sussex Fire and Rescue in June 2009. The manager stated that fire safety and evacuation is discussed at monthly staff meetings. Care Homes for Older People Page 22 of 26 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 23 of 26 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 9 13 A written record must be 30/03/2010 kept of all decisions made regarding the administration of medication that is prescribed to be taken as required. To protect the health and well being of service users. 2 9 13 A record must be kept of all decisions made regarding medication not given as prescribed. To protect the health and well being of service users. 30/03/2010 3 26 16 The home must be kept free of offensive odours. So service users have a clean and pleasant environment to live in. 30/03/2010 4 29 19 All new staff must be recruited under full and robust employment checks. 30/03/2010 Care Homes for Older People Page 24 of 26 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 To protect the people who use the service. 5 29 19 All existing staff without a 30/03/2010 CRB from this provider must have a detailed risk assessment on file, demonstrating the decision to not apply for an up to date CRB. To protect the people who use the service. 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 25 of 26 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). 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