Care Home: Gretton Court Nursing Home

What the care home does well Staff at the home gather information about people, before they come to live in the home. This helps to make sure that the home can meet people`s needs and provide the care they need. People told us that the home had provided them with enough information to help them make decisions about moving in and a health care professional commented that `each person is assessed as an individual`. People receive the health and personal care they need from caring staff and medication is generally managed safely. Both people who returned surveys told us that they `always` got the care and support they needed and comments included `the staff are excellent, always there to listen and care`. Health care professionals who returned surveys told us that people`s health care needs were `always` and `usually` met by the home. Comments about what the home does well included `provides good dementia care. Contacting health professionals to help with care when needed` and `when I visit residents they have always been treated with dignity and respect`. Activities regularly take place, people are given choices about daily life and are provided with an appealing and varied diet. Comments made by people included `the activities are there, but unfortunately my husband is not one for joining in`, `it is nice to see more activities going on` and `the meals are really good, nutritional, plentiful and a good variety`. Complaints and safeguarding procedures are in place and being followed, ensuring that people`s concerns are dealt with properly and people are protected. People who returned surveys told us that they `always` knew who to speak to if they were unhappy and that they knew how to complain if they needed to. A health professional told us `when I have pointed out concerns they seem to have been addressed promptly`. Overall the home provides a comfortable environment for people to live in. Work is being undertaken to update the furnishings and fittings, some of which are looking a little dated and worn. Both people who returned surveys told us that the home was `always` fresh and clean. Staff are employed safely and training is being provided to help staff do their jobs. A high number of care staff have already achieved a National Vocational Qualification (NVQ) in care and a lot of training is planned for the coming year. There are enough staff on duty to provide the care and supervision people need. What has improved since the last inspection? Improvements have been made to people`s care records. There is now more `person centred` information available and risk assessments were more up to date. The manager also has plans for further improvements and was able to show us an example of what she wants everyone`s care records to be like. Some new activities have been introduced, including two `day centre` type sessions each week and a `memory cafe`. The activities programme for March showed that games, a `cafe` session, gardening, exercises, bingo, work on memory books and entertainment from visiting entertainers had taken place. Comments made by people included `it is nice to see more activities going on`. Since the last inspection a significant amount of work has been done to update the home`s fire protection systems, refurbish the staff room, create a new en-suite respite room and provide a modern shower room. More re-decoration and re-refurbishment is planned in the near future. A new manager has been employed and has registered with us. Comments made to us included `since (the new manager) started she has made a positive impact and although she has had her work cut out for her, standards and staff morale are improving` and `I have already seen improvements in the home`. We saw a large improvement in the frequency and recording of routine health and safety checks. Regular tests of fire equipment, hot water temperatures and the safe fitting of bed rails now take place. A consultant has also been employed to train and advise staff on manual handling practice. This will help to make sure that people are moved safely. What the care home could do better: Staff have received training on completing and using nutritional assessments. However, the actual assessment tools haven`t yet been completed and put in place for all of the home`s residents. Although medication at the home was being stored and administered safely, we found quite a number of occasions where staff had not recorded on the medication administration record (MAR) if people had taken their medication. This is very important, so that there is a clear and accurate record showing what medication people have taken and any problems that have occurred. The home would benefit from developing more one-to-one and sensory activities that everyone can enjoy and looking at how activities and stimulation can be built into the day, even when the activities coordinator is not working. We also saw that some people`s meals had gone cold by the time they were served. However, the management agreed that this was not acceptable and that a `hot trolley` would be provided so that food could be kept warm. Staff told us that they `regularly` meet with their manager for support. However, records showed us that staff are not currently receiving formal supervision as often as we would recommend. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gretton Court Nursing Home 1 Heather Grove Hartlepool TS24 8QZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Martin     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Gretton Court Nursing Home 1 Heather Grove Hartlepool TS24 8QZ 01429862255 01429279005 andrea.atkinson@hospitalofgod.org.uk www.hospitalofgod.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Andrea Atkinson Type of registration: Number of places registered: The Hospital of God at Greatham care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia, Code DE - maximum number of places 33 Date of last inspection Brief description of the care home Gretton Court is located in Heather Grove, Hartlepool. The home is now owned by The Hospital of God at Greatham and is registered to provide nursing care for up to 33 people with dementia. The home was purpose built approximately 15 years ago. It provides private bedrooms and a variety of communal facilities, such as bathrooms, lounge and dining areas, courtyard gardens and spacious grounds. A car park area is Care Homes for Older People Page 4 of 26 Over 65 33 33 Brief description of the care home located in front of the home. Up to date information about fees and terms and conditions should be sought directly from the home. 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: This was an unannounced key inspection, which took place on 8th April 2009. The inspection was completed by one inspector, who spent nine hours at the home. It was the second inspection since the home was taken over by The Hospital of God at Greatham. The home completed a self-assessment for us in November 2008. It is our policy to only ask homes to complete a self assessment once a year, so a new self assessment was not requested before this inspection. We also sent a selection of surveys to the home, to be handed out to people who live and work there. Two people who live at the home, three staff and two health professionals who visit the home completed and returned surveys to us. The results of these surveys have been included in this report where appropriate. Care Homes for Older People Page 6 of 26 During our visit to the home we spent time looking around and observing care practice. We spoke to some of the people living at the home, talked to staff and spent time with the new manager and the care services manager. At lunchtime we watched how meals are provided and looked at the food people ate. We were shown how medication is stored and administered and we looked at a selection of other records kept by the home. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Improvements have been made to peoples care records. There is now more person centred information available and risk assessments were more up to date. The manager also has plans for further improvements and was able to show us an example of what she wants everyones care records to be like. Some new activities have been introduced, including two day centre type sessions each week and a memory cafe. The activities programme for March showed that games, a cafe session, gardening, exercises, bingo, work on memory books and entertainment from visiting entertainers had taken place. Comments made by people included it is nice to see more activities going on. Care Homes for Older People Page 8 of 26 Since the last inspection a significant amount of work has been done to update the homes fire protection systems, refurbish the staff room, create a new en-suite respite room and provide a modern shower room. More re-decoration and re-refurbishment is planned in the near future. A new manager has been employed and has registered with us. Comments made to us included since (the new manager) started she has made a positive impact and although she has had her work cut out for her, standards and staff morale are improving and I have already seen improvements in the home. We saw a large improvement in the frequency and recording of routine health and safety checks. Regular tests of fire equipment, hot water temperatures and the safe fitting of bed rails now take place. A consultant has also been employed to train and advise staff on manual handling practice. This will help to make sure that people are moved safely. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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. Staff at the home gather information about people, before they come to live in the home. This helps to make sure that the home can meet peoples needs and provide the care they need. Evidence: In their last self assessment the home told us that all potential residents are assessed prior to admission, to ensure all needs will be met. During our visit we looked at some peoples care records. These contained assessments, including information from other professionals. For example, from the local social services department who were working with one of the people concerned. People who returned surveys told us that the home had provided them with enough information to help them make decisions about moving in. A health care professional commented in a survey that each person is assessed as an individual. 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. People receive the health and personal care they need from caring staff and medication is generally managed safely. However, staff need to keep more accurate records of the administration of medication. Evidence: We spent time observing the care that people were given. Staff spent time supervising people, chatted with people and helped them in friendly and nice ways. People were treated kindly and personal care was carried out in private. Both people who returned surveys told us that they always got the care and support they needed and comments included the staff are excellent, always there to listen and care. Each person who lives at the home has a record of the care they need. This includes assessments, care plans, risk assessments and records of the care people receive. Since the last inspection the manager has identified ways in which these records could be improved and has started to make changes. We were shown an example of what the manager wants everybodys care records to be like. These records were more person centred, containing more information about peoples preferences and individual Care Homes for Older People Page 12 of 26 Evidence: personal care needs. The manager also wants care staff to have more involvement in maintaining peoples care plans and records. However, these ideas had not yet been fully put into practice at the time of this inspection. We looked at a selection of peoples current care records. These had also improved since the last inspection, with more detail being available about peoples needs and risk assessments being more fully completed and up to date. However, some of the records we looked at still didnt contain nutritional assessments. The manager explained that staff had just completed training on using a nutritional screening tool and that the paperwork was soon to be put in place. Records showed us that people got help from other professionals when they needed it. For example, visits from their doctor, chiropodist and psychiatrist. Health care professionals who returned surveys told us that peoples health care needs were always and usually met by the home. Comments about what the home does well included provides good dementia care, i.e. communicating, recognising needs, feeding, toileting etc. Contacting health professionals to help with care when needed and when I visit residents they have always been treated with dignity and respect, always examined and history taken in own room. We looked at how the home stores and administers medication. Regular medication audits are completed by the care services manager to make sure that medication is being stored and administered safely. We looked at the records of one of these audits and found that it had been completed thoroughly. Records showed that fridge and room temperatures were monitored to ensure that medication was stored at safe temperatures. The medication trolleys were clean and tidy and creams and eye drops were dated when opened. We also checked the controlled drugs register and stock balances, finding these to be accurate and up to date. However, we found quite a number of occasions where staff had not recorded on the medication administration record if people had taken their medication. This is very important, so that there is a clear and accurate record showing what medication people have taken and any problems that have occurred. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities regularly take place, people are given choices about daily life and are provided with an appealing and varied diet. Evidence: Gretton Court currently shares an activities coordinator with another home. This means that the coordinator shares her time between the two homes, spending approximately two/three days each week at Gretton Court. Since the last inspection the manager has introduced some new activities, including two day centre type sessions each week and a memory cafe. We saw the activities programme for March, which showed games, a cafe session, gardening, exercises, bingo and working on memory books took place. We also saw that entertainers had recently visited the home and that a monthly newsletter was being produced. Comments made by people included the activities are there, but unfortunately my husband is not one for joining in and it is nice to see more activities going on. The records we looked at showed that activities take place regularly, but they also showed that it tends to be the same people taking part a lot of the time. We visited on a day when the activities coordinator was not working in the home and other than chatting to staff when they were available, listening to music or watching the Care Homes for Older People Page 14 of 26 Evidence: television there did not appear to be a lot of entertainment or stimulation for people who were unable to entertain themselves. The home would benefit from developing more one-to-one and sensory activities that everyone can enjoy and looking at how activities and stimulation can be built into the day, even when the activities coordinator is not working. In their last self assessment the home told us we provide a homely environment, encouraging relatives to visit as they would at home. We saw lots of people visiting during our inspection and they confirmed that this is the case. Both people who returned surveys told us that they always like the meals at Gretton Court. Comments included the meals are really good, nutritional, plentiful and a good variety. During our visit we saw people being given drinks and snacks during the morning and afternoon. The snacks included biscuits and fresh fruit. We observed the lunch time meal. People were offered the choice of chicken and mushroom pie or lamb casserole with vegetables or potatoes, with sago for pudding. The food looked nice, was provided in reasonable portions and people ate it happily. Staff sat and helped people to eat individually. However, we noticed that in one dining area the food was brought to the dining area on a trolley or tray. Some of the meals were not given to people for some time and were not kept warm. We discussed this with the homes management, who agreed that a hot trolley or similar device was needed. 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. Complaints and safeguarding procedures are in place and being followed, ensuring that peoples concerns are dealt with properly and people are protected. Evidence: When we visited information telling people how to report any complaints or concerns was displayed in the homes reception area. People who returned surveys told us that they always knew who to speak to if they were unhappy and that they knew how to complain if they needed to. A health professional told us when I have pointed out concerns they seem to have been addressed promptly. Staff said that they knew what to do if someone had concerns about the home. One staff member commented if any concerns come to my attention I discuss with my manager and act accordingly. Since the last inspection the home has notified us of appropriate accidents and incidents. Where appropriate the home has also reported incidents to the local council, using local procedures for safeguarding adults. Up to date staff training on safeguarding adults has also started and the manager intends for this training to be updated regularly. 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 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 provides a comfortable environment for people to live in. Work is being undertaken to update the furnishings and fittings, some of which are looking a little dated and worn. Evidence: Gretton Court was purpose built approximately 15 years ago. The new owners have recognised that the home needs some investment to maintain it and to make sure that people have a pleasant place to live. In their previous self assessment they told us that they have already spent money redecorating, putting down new carpets in some parts of the home and working on the homes gardens. Since the last inspection a significant amount of work has been done to update the homes fire protection systems, refurbish the staff room, create a new en-suite respite room and provide a modern shower room. More redecoration and refurbishment is planned. The Hospital of God at Greatham employs a full time property manager, who deals with maintenance for the organisation. A range of contractors are used by the property manager to deal with most repairs. Since the last inspection the management have also decided to employ a housekeeper/caretaker, who will carry out the more day-to-day tasks, such as changing light bulbs and touching up paint work. Care Homes for Older People Page 17 of 26 Evidence: During our visit we saw gardeners working on the homes grounds and saw cleaning staff on duty in the home. In their previous self assessment the home told us that they had in place procedures to help prevent the spread of infection and that staff had received training in infection control. Both people who returned surveys told us that the home was always fresh and clean. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed safely and training is being provided to help staff do their jobs. There are enough staff on duty to provide the care and supervision people need. Evidence: No new care staff have been recruited since the last inspection. This meant that we couldnt check if new staff had been recruited properly. However, the manager assured us that the recruitment of any new staff would include obtaining a criminal records bureau (CRB) disclosure and two written references before they started work. Employment records have been improved to include information about peoples CRB disclosures and the other checks that take place. This work has included an audit of existing records, which have been improved where possible. Staff who returned surveys told us that the required checks had been completed before they started work at the home. In their last self assessment the management told us that over 82 of the homes permanent care workers had completed a national vocational qualification (NVQ) in care and this was confirmed during the last inspection. The manager has started to put in place new staff files for training and supervision. These will provide clear records of the training staff have completed. Records currently show that staff still need training in some areas. However, recent training had been provided in fire safety and manual handling and the manager was able to show us the training plan for the Care Homes for Older People Page 19 of 26 Evidence: coming year. Planned training includes manual handling, first aid, medication, infection control, safeguarding adults, the mental capacity act and deprivation of liberty. Staff who returned surveys were asked about the training Gretton Court provided. Two staff told us that their induction training had covered what they needed to know very well and the other said mostly. They all said that they were provided with training that was relevant and kept them up to date. When we asked if they were given training that helped them understand and meet the individual needs of people living at the home, two said yes and one said no. A health care professional commented I still think that work needs to be done in staff development. Staff told us that they regularly meet with their manager for support. However, records showed us that staff are not currently receiving formal supervision as often as we would recommend. During our visit we saw that staff had time to provide the supervision and care people needed. Both people who live at the home and returned surveys said that staff were always available when they needed them. In surveys staff were asked if there were enough staff on duty to meet peoples needs. Two staff said always and one said usually. Staff rotas confirmed that appropriate numbers of staff are usually on duty at the home. 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. The home is being well managed, with lots of improvements having being made since the last inspection. Regular checks are in place to make sure that the home is a safe place to live and to help make sure that things are done properly. Evidence: Since the last inspection a new manager has been employed and registered with us. During our visit the manager showed that she was enthusiastic and committed to working with people with dementia. She was also able to show us the changes that have been made since the last inspection and tell us about the plans that she has for further improvements. Comments made to us about the new manager included since (the new manager) started she has made a positive impact and although she has had her work cut out for her, standards and staff morale are improving and I have already seen improvements in the home. The new manager is receiving regular support from the care services manager and appropriate management support systems appear to be in place. Care Homes for Older People Page 21 of 26 Evidence: We looked at the records the home keeps for people who need the homes help to manage their personal money. We found that since the last inspection the home has made significant improvements to these records. There are now accurate and comprehensive records available, showing what peoples money has been spent on and including receipts where possible. Clear maintenance records are now available in the home. We looked at a selection of these and confirmed that maintenance inspections and services for things like legionella testing, fire equipment and lifting equipment are up to date. This means that the homes equipment is being well maintained and is in safe working order. The records also showed that regular checks of the homes fire equipment and fire safety systems are taking place. Since the last inspection new thermostatic valves have been fitted to the homes hot water outlets and weekly checks of the hot water temperatures are being carried out. This helps to make sure that hot water is at a safe temperature for people to use. Staff have received training on the safe use of bed rails and guidance information, risk assessments and maintenance checks are now in place. Staff have started to receive up date training in manual handling and a consultant has been employed to make sure that people are moved by staff in safe and appropriate ways. The care services manager, director and trustees visit the home regularly and complete monitoring checks and audits. During our last inspection we looked at the records of these visits, finding that they were thorough, included consultation with staff and people who live at the home and picked up on things that were not being done properly. 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 Staff must keep a clear and accurate record of the administration of all medication on the medication administration record. This is very important, so that there is a clear and accurate record showing what medication people have taken and any problems that have occurred. Without this record it is impossible to know if people have been receiving the medication they need. 30/06/2009 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 1 7 Nutritional risk assessments should be completed on admission and should be reviewed regularly. Care Homes for Older People Page 24 of 26 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 2 7 Care plans should be more person centred and contain more information about peoples personal and social care needs. Although the manager had started to make these improvements, the planned changes had not been fully implemented at the time of this inspection. The home would benefit from developing more one to one and sensory activities that everyone can enjoy and from looking at how activities and stimulation can be built into the day, even when the activities coordinator is not working. Food should be kept at an appropriate temperature and served to people while still hot. People should not have to eat meals that have become cold. The planned refurbishment work should continue, to ensure that people have a well maintained, comfortable and pleasant place to live. Staff should receive formal supervision a minimum of six time a year, in accordance with the National Minimum Standards. 3 12 4 15 5 19 6 36 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!