Care Home: Green Meadows

What the care home does well We received many comments regarding the service and these were positive. They included "Very good care, well trained staff and good rapport with residents", "Very helpful staff who will give me help whenever I need it" "Rachel is very approachable and helpful" "all of the staff know what they are doing and you can always speak to whoever is in charge". We could see from the interactions we observed that staff have a good rapport with service users and understood their individuality and what support they needed. We observed lunchtime and people being supported to take their meals and this was carried out with appropriate interactions, which were valuing of the service users. The manager speaks with service users when she is on duty and has an open door policy . service users are always informed of who is in charge of the service at any time and they are able to raise issues with the senior person. Service users tell us they feel their views are taken seriously and that they are listened to .An ongoing quality assurance plan means that the provider and manager are continually evolving the service to meet service users needs. What has improved since the last inspection? The physical environment of the service has been upgraded and many areas have been redecorated which provides more comfortable surroundings for service users. A new computer and web cam have been purchased so service users can use this as a way of keeping in contact with family and friends. A recruitment drive has been in place which means that there will be a more consistent staff team which may provide better continuity of care for the service users. A key worker system is in place which means that service users have a named person who can assist them with recreational activities such as shopping and writing letters. This relationship means that the key worker is able to have a clear knowledge of the service users needs so can produce a care plan with the correct details which is meaningful and individualised to the service user. Staff recruitment procedures are robust which means that service users can be confident that the right people are being recruited to support them. What the care home could do better: The care plan system is very comprehensive and when it is completed will be easier for service users and staff to follow. Current arrangements with two systems in place may make it harder for staff to find the relevant records they need to refer to and more of a challenge for service user to be able to review the details that are held regarding them. Key inspection report Care homes for older people Name: Address: Green Meadows Green Lane Denmead Hampshire PO7 6LW     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: Kathryn Emmons     Date: 3 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Green Meadows Green Lane Denmead Hampshire PO7 6LW 02392255328 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: rachel.reed@hants.gov.uk Hampshire County Council care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category/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 Dementia - DE Date of last inspection Brief description of the care home Green Meadows is a purpose built care home providing accommodation for 42 older persons, including those with dementia. The home is owned and managed by Hampshire County Council. Accommodation is provided in four units across two floors, and benefits from a large landscaped garden and extensive views over the countryside. Each unit has a lounge dining room, small kitchen, bathroom and toilet, as well as residents? bedrooms. There are additional communal areas including a spacious lounge, smaller seating areas and a hairdressing salon, which is available to all residents. The service users also have the use of additional recreational space in the Care Homes for Older People Page 4 of 26 42 0 Over 65 0 42 Brief description of the care home old day centre facility. 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: We visited the service on Tuesday 30th June 2009 from 10am until 430pm. The AQAA (Annual Quality Assurance Assessment) arrived on time and we were able to use the information this contained to help us prepare for the inspection visit. The AQAA is completed by the manager and informs us of the improvements and changes to the service in the previous 12 months. We request a completed copy of this document every year. Nine people using the service were involved in our visit and they requested they be referred to in this report as service users. Prior to the inspection visit we sent out comment cards to the service for six staff ,three health care professionals and twelve residents. We received back three staff, two health care professional and six service user surveys. We also looked at our last key inspection report which was from an inspection in July 2007 and an Annual Service Review (ASR) inspection report from July 2008. We met with three staff and two visitors during our visit and gathered information from them regarding their views on the service. The registered manager Mrs Rachel Reed was present throughout the inspection visit. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 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 8 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 9 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. Pre admission assessments ensure service users can can be confident that their assessed needs are known and can be met when the are offered a placement at the service. Providing contracts means that service users can be clear on what services they can expect to receive and how this is to be provided. Intermediate care in not provided. Evidence: We looked at the admission details for one person who had been admitted into a Time to think bed , one person who had been admitted in to a reenablement bed then admitted into the service as a resident and one person who was admitted to the service as a permanent resident. We looked at these notes so we so we could see what information people received to help them make a decision to live at the service and what information the service obtained to decide they could meet the needs of the perspective resident. The re enablement beds and time to think beds are for people who had been living at home and need a little more support but did not need to be in Care Homes for Older People Page 10 of 26 Evidence: hospital. They are also for people who had been in hospital but needed a little more support before they went home or were thinking about living in a care home home but needed time to decide if this was the right choice for them. We could see that often information was given by a care manager to the service and this included a comprehensive assessment of all medical issues ,contact details care needs and social situation.During out visit a senior support worker was undertaking a home visit to carry out an assessment of a prospective service user. The manager confirmed that where possible the service would always carry out an assessment if there was not sufficient information in the assessments they had received from the care managers. Currently the service do not confirm in writing to the service user that the assessed needs can be met. This needs to be carried out so the prospective service user can be confident that their care needs will be met if they decide to live at the service. We saw contracts in place for two of the service users details we looked at which confirms what services the service user could expect. A couple of the service users we spoke with said they had been able to visit the service to help them decide if the felt confident the service could provide them with how they would like to live. The manager confirmed that the service will admit people for short stays such as respite care, renablment and in to the time to think bedsbut does not provide intermediate care. Care Homes for Older People Page 11 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. When the new care plan system is fully implemented information will be easier to access for care plans. However, all information is in place over the two sets of documents and service users can be confident their individual needs are known and met. Risk assessments ensure risks are minimised for activities service users undertake. Medication systems keep service users safe and ensure staff receive regular training. Staff have a clear understanding of upholding service users right to privacy and dignity and understand how to provide individualised care. Service users are satisfied with access to health care professionals. Evidence: Three service users care plan information was looked at. Since the last inspection a new format for producing care plans and maintaining other records had been implemented. At the time of our visit many of the service users had had their records moved to the new system but none had been completed fully so we looked at both sets of records to inform us of the details in place. The records include details such as nutritional assessment ,body maps to show any knocks or injuries or wounds, hobbies and social support needs, care plans, daily records, risk assessments and details Care Homes for Older People Page 12 of 26 Evidence: regarding how residents wanted to receive their care. Three of the service users we spoke with said they had been involved in their care plans and we saw signatures in place for a set of care plans for one of these service users. We could see that reviews had taken place and all service users care needs had been reviewed. Included in care plan files were risk assessments for activities service users undertake. These included mobility needs risks of falls and how to prevent them. Information was in sufficient detail for staff to be clear how to support the service user safely. We looked at medication charts for all of the service users living at the home . Medication sheets were completed and we saw no signatures missing . Senior staff support service users with their medication and all of these staff had received training. In some instances we saw that service users were able to administer their own medication in the form of creams and inhalers. Records were in place for these medications to ensure service users took their medications safely.Residents we spoke to about medication were happy with how they received their medications and comments included never had a problem with medication, given what I need at the right times and They all know what they (staff)are doing with the tablets. Staff records we looked at showed us that staff had received training in medication administration. All of the service users are registered with a local doctors surgery and the manager said they had a good working relationship with the local surgery. At the time of the visit we saw one of the doctors visiting the service. Service users we spoke with said they were satisfied with the support they received from the doctors and that staff at the service would always call a doctor if the service user was unwell or had requested to see a doctor. One service user said they had recently see an optician who had visited the service and we saw in two other care files prescriptions from the optician for new glasses. The manager informed us that all service users had access to dental services and two service users we spoke with confirmed they had been told they could see a dentist if they needed to. The manager confirmed that when necessary the district nursing team visit the service to provided nursing care such as wound dressings and blood tests for service users. We saw notes which evidence that a chiropodist visits the service every six weeks. We observed interactions between staff and service users through out the visit. We saw that staff were polite and respectful to service users. We asked five of the service users for their views on how staff spoke to them and upheld the service users right to privacy and dignity. We were told I am very happy living here as it suits me in many ways , I find the staff very good and they take care of me as best they can The Care Homes for Older People Page 13 of 26 Evidence: service provides a home from home atmosphere to ensure the happiness and well being of all of the clients, I have never had anyone just walk in my room they always knock, They are always polite even when they are busy and you need more help than normal. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are satisfied with the control they have regarding making decisions on how they live their lives. A full activity programme is in place which meets service users varying abilities. service users individuality and right to express their personal spiritual beliefs is acknowledged and supported. Dietary preferences are catered for. Service users have control over who visits them and visitors are made welcome by staff from the service. Evidence: The ethos of the service is for service users to make as many decisions as possible regarding how they live their lives at Green meadows. We spoke to several service users and asked them how much choice they felt they had regarding how they spent their time. The response was very positive with comments such as I pretty much spend my time as I want and, Its my home , my room so I do what I want and get help when I need it. Part of the care plan assessment covers the service users life history ,social likes and dislikes and also covers any religious and cultural preferences they have. We asked service users through comment cards and when we met with them during the visit , if they felt there was enough activities for them to be involved in. We were told there Care Homes for Older People Page 15 of 26 Evidence: are planned activities ,I like most of them, We do plan a few trips out but I dont know where we are going, I am able to to go to the shops but they will help others who cant, I join in with the bingo and quizzes . We also saw a residents activities board which was advertising forthcoming events. We also saw from the duty rota that there are two activity co ordinators who support service users to carry out activties which they find useful and enjoyable. Two service users we spoke with said that they were able to see the local vicar when they visited.The AQAA we received from the service indicates that all service users are of the same denomination. The manager advised that any religious beliefs would be supported and service users would be assisted to continue to follow their faith and belief. The staff we spoke with were clear on equalities and diveristy and different cultural needs of service users. The AQAA records comprehensive work being carried out in this area an example being providing videos and magazines in laungauges which are not English for service users. We saw visitors coming into the service and noted that they had to sign a visitor book. This means that staff can see who is in the service and ensure service users remain safe and can choose who they have visit them. We spoke to two visitors during our visit and they told us they were always made to feel welcome at the service and were able to visit when they chose to. We spoke with service users regarding the meals provided at the service .We received positive comments and also positive comments were received in all comment cards we viewed before we visited the service. There are several dinning areas around the home and we viewed the lunchtime meal being served in one of these. All food is placed in a hot trolley and service users were able to chose what meal they had , the size of the portion and where they sat. A nutritional screening tool is maintained for all service users so staff can monitor that service users can have their nutritional needs met. Monthly weights are also recorded. One service user we spoke with said the food here is wonderful and another Its all lovely and always hot and tasty. Specialised diets such as sugar free and high fibre are provided and there is always choice of meals at each meal time. One service user said In the evening there arealways extra sandwiches , biscuits and hot drinks. Care Homes for Older People Page 16 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. Service users can be confident that their concerns will be listened to and acted upon. Safeguarding training , staff awareness and polices keep service users safe. Evidence: We could see from staff records and from information in the AQAA that safeguarding adult training had been carried out recently. Service users we spoke with said they were sure if they had any worries the staff would address these. We asked two staff what they would do if they were informed of an allegation of abuse. The staff were able to answer this correctly. This means that staff have a good awareness of what practices and behaviors may be abusive and are confident to challenge these practices and report them appropriately. Service users we spoke with said they felt safe living at the home and the comment cards we received confirmed this . There is a complaints procedure on display and also within the statement of purpose and service user guide. Service user comment cards all indicated that service users knew how to raise issues. The complaints procedure was clear to follow and included details of who to speak to and timescales the service worked to to investigate any concerns. . A visitor we spoke to said they were sure if they raised an issue the staff would be very receptive to resolving the issue. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean and comfortable home. The decor is satisfactory and the ongoing maintenance enables the quality of the environment to be improved. Staff understand how to reduce risk to service users form possible cross infection and using moving and handling equipment. Evidence: The home is divided into four main areas so people can have a sense of smaller group living rather than one large home. Each area has a living room and dining area and a wing of bedrooms. There is a large sitting area on the ground floor where activities and large groups of people can meet together. Service users we spoke with said they were happy with their rooms and that found their was a choice of bathrooms to use and could have either a shower or bath. Plans are in place to continue to upgrade the building and new windows are being fitted which provide extra safety for service users. The decor of the parts of the home we saw was good and service users told us they had been able to make choices regarding decor is some parts of the home. The kitchen where main meals are prepared is restricted for service users but there are kitchenettes on each group wing where service users are able to make drinks and Care Homes for Older People Page 18 of 26 Evidence: snacks. We saw that the home was clean and tidy and furniture was in good repair. There are large gardens and during our visit we saw several services users sitting out on the patio where sun umbrellas and seating had been provided. We saw staff carrying out personal care tasks and noted they were wearing gloves and aprons. Two staff we spoke with told us about the action they took to minimise the spread of infection and could explain what training they had so they can use the moving and handling equipment. This means that staff have received training in order for them to provide safe support to service users and to be aware of how to reduce the risk of cross infection. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are cared for by trained and enthusiastic staff. Robust recruitment procedures keep service users safe .Ongoing training means service users will receive care which is in accordance with current care practices. Evidence: We discussed the recruitment procedures for new staff with the manager. We were told that no staff started work until all of their recruitment checks had been carried out and were satisfactory.We looked at three recruitment files and these included 2 written references, a CRB(Criminal records bureau check) and a written application form. We also saw three sets of notes which were taken when the person was interviewed for the job. This means that service users can be confident that the right people are employed to support them. We spoke to two staff regarding their training and induction. We saw an in depth induction work book is in place and both staff members told us they received training on areas such as such as first aid, moving and handling and fire safety. Many of the staff have a NVQ (National Vocational Qualification) in Care. This provides them with more knowledge and skills which may enable them to provide an increased quality of care and support to service users. We asked staff if they felt there were enough staff on duty and if they had time to carry out their work in a timely and unrushed manner. The response back was positive and one staff said Sometimes it can be quite busy in the morning but we all help each other, other times its quieter and you can spend more time chatting with the service Care Homes for Older People Page 20 of 26 Evidence: users. There is a key worker system in place with each service user having a named care member who will assist them with keeping their rooms tidy, do shopping for small items and assist with letter writing . We looked at the duty rota and saw staffing levels were consistent. There has been some agency use but service users we spoke with did not feel this had affected their care. During our visit we saw an agency carer come to work at the service for the first time. We saw that they were shown around and told what to do in the event of a fire. This means that service users are kept safe and are able to be confident that even agency staff know how to respond in an emergency. Comment cards and discussion with service users during our visit provided very positive comments except one, which was Sometimes I get the wrong laundry back. We have raised this comment with the manager who will look into the issue , no other service user said they had any issues with the laundry service. Comments on the visit included, staff are very very good couldnt ask for better, Im OK here as they are all kind to me and I wouldnt want to be anywhere else Whenever you see the staff they always have time to speak to you and dont rush you and I was worried about coming here but i dont want to leave everyone is marvelous. Care Homes for Older People Page 21 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. Service users live in a home which is managed by a competent and experienced manager. Quality assurance systems and reviews enable the provider and manager to continually evolve the service. Health and safety arrangements keep service users safe. Financial arrangements enable service users to have control over their moneys and for those unable to do this , have safeguards in place. Evidence: The registered manager has been in post at the service of the past 10 years. We received positive comments regarding the manager from both staff and service users. Visitors we spoke with said the whole management team were professional and approachable. Health care professionals who we sent comment cards to provided positive comments regarding the manager and how the service operated. During our visit service users made comments such as Rachel is very good you can ask her anything and she does visit you each time she is working , I find the manager very good she knows what is going on and is always trying to improve it here. The responsible individuals representative visits the service monthly to see how the service Care Homes for Older People Page 22 of 26 Evidence: is operating and look at the improvements the manger is making. This fits into the service quality assurance programme which also included service user and staff meetings. The manager explained that the service users are in control of the service and their views are important to help shape how the service moves forward. One example the manager gave was plans to provide a specialist care bed for people who may need additional help with mobility and their care and would require a purpose built ground floor room. A web cam is being introduced so service users can speak with family and friends and a local volunteer will be visiting the service to assist the service users with using the computer. The service do not look after anyones finances. All of the people who are able to look after their money do this themselves and those service users who are unable all have a relative or friend who invoices are sent to. Polices and procedures are regularly reviewed by the manager and staff have time made available so they can read these. We could see that health and safety risk assessments were in place and environmental risk assessments are updated regularly. We looked at the accident book to ensure all incidents had been recorded and matched with what we had read in the service users care files. Accurate recording was in place which means service users can be confident that the importance of them living in an environment which is constantly reviewed to minimise risk is acknowledged. The manager has plans in place to continue to move the service forward through consultation with the service users and staff . This means that the manager has a clear understanding of the need to continually evolve the service. Care Homes for Older People Page 23 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 24 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 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). 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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