Care Home: Hadrian House

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What the care home does well Staff are well trained, and provide good care and support to people who live at Hadrian House. Typical comments from residents were: `Staff treat me well` `staff are wonderful, they go out of their way to be nice` `staff are very good, they look after me OK`. People told us that they enjoy the food. Typical comments were: `the food is lovely, I`ve put on weight since I came here, I enjoy it that much`. `the food is marvelous` The home is kept very clean and tidy, and people`s clothes are laundered well. People receive good health and personal care, because there are good systems in place to ensure that staff know what, and how to provide the necessary care. There are organised activities for residents both inside the home, and outside of the home. Visitors are made welcome at any time during the day and evening. The service takes complaints seriously. What has improved since the last inspection? The manager and her team have worked hard to improve the written care plans for each person, and to ensure they are reviewed regularly. Controlled medication is now stored in the correct type of medication cupboard. Staff have attended training to ensure they understand what their roles and responsibilities are in protecting people who live at Hadrian House from abuse, being harmed, or placed at risk. Bedrooms have been refurbished and redecorated to improve the living environment of those at Hadrian House. People thinking of moving into Hadrian House are provided with information which is clear and up-to-date. The service has bought a Wii and TV to give residents the opportunity to use new technology games, and to watch DVDs. We saw one resident enjoying a game of 10 pin bowling on the Wii. What the care home could do better: The service should ensure the fridge that stores medicines requiring cold storage has the temperature checked daily. This makes sure that medicines are being stored at the correct temperature. The service should ensure that a risk assessment is undertaken if a resident is using bedsides. Individual risk assessments should also be carried out on people who live at Hadrian House who smoke. The service should look at how it can best meet the social and emotional needs of more dependent people living at the home, and those with complex physical or mental health needs. It should consider planning activities based on individual assessments and linked to the care plan. The service should improve the environment. The furniture in the communal areas is looking tired and worn, and `institutional`. The roof has leaked water into parts of the home leaving unsightly patches on the ceiling; and the decor does not always support the increasing number of people living in the home who have dementia care needs. The service should look at whether there is sufficient staff on duty to meet the care needs of people currently living at the home during the early evening, night time and week-ends. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hadrian House Garden Street Thurmaston Leicester Leicestershire LE4 8DS     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: Fiona Stephenson     Date: 0 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Hadrian House Garden Street Thurmaston Leicester Leicestershire LE4 8DS 01162694397 01162694397 ahorobin@leics.gov.uk www.leicestershire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leicestershire County Council Social Services care home 40 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is 40 The registered person may provide the following categories of service only: Care Home only - Code 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 Care Homes for Older People Page 4 of 29 Over 65 0 0 0 40 0 0 40 40 40 0 40 40 falling within any other category - Code OP Dementia - Code DE Learning Disability Code LD Mental Disorder, excluding learning disability or dementia - Code MD Sensory Impairment - Code SI Date of last inspection Brief description of the care home Hadrian House is a care home providing personal care and accommodation for forty older people, who may have associated conditions such as dementia, mental disorder, learning disability and sensory impairment. The home also provides two beds offering respite facilities and a rehabilitation unit. The forty single bedrooms are without en-suite facilities. The home has a central, and surrounding garden. The home is a two storey building, people living at Hadrian House can get to the first floor either by using the stairs or by using the passenger lift. Hadrian House is close to Thurmaston town centre where people who live at Hadrian House can use the shops, pubs and other amenities. The maximum weekly fee is £499.80. People living at Hadrian House have to pay extra costs for other services such as hairdressing and chiropody. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. This is the first key inspection to the home since July 2008, and was undertaken by the Care Quality Commission (formerly the CSCI). We (the CQC) visited on the 8th June 2009. The Registered Manager and the staff in the home helped us during the visit. The visit started at 9.00am and finished at 5.20pm. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to the people who live in the home and their relatives, - talking to staff and management, Care Homes for Older People Page 6 of 29 - watching how people are given support, - looking at records. We looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CQC, and it tells us what the provider thinks about the service they deliver to people who live at Hadrian House. We also looked at the surveys called Have your Say About.. which are sent out to people who live and work at Hadrian House. We received three surveys back from people who live at Hadrian House, and ten from staff. Of the three people who completed questionnaires who live at Hadrian House, two were very complimentary of the care and support they received. Their comments were: The care staff are loving and caring to me, the food is very good, all my needs are met with care. They supply a good standard of food with plenty of variety and choice. There is always drinks available. Staff are always cheerful and caring, residents are kept clean The third person said that the home feeds us well, and does domestic work for us, but felt that the home could look after us better. The ten staff who sent questionnaires back to us all said they had up to date information about the needs of the people they supported. The majority felt they had regular support from the manager to help them with their work. Six felt there was usually enough staff to meet the individual needs of people living at the home, with two people saying sometimes and two saying there is never enough staff. In what the home does well, staff commented: respects all residents promotes independence, good quality of care, ensuring all service users have dignity, privacy, choice dignity and respect for all celebrates special occasion, i.e. residents birthdays, especially 100th, special events e.g. world cup, St Patricks, Halloween the home provides a good quality service, very welcoming and friendly...good relationships with other professionals...responds well to emergency situations..identifies training for all staff to ensure care for residents is always of a high standard Comments on what staff felt the home could do better were: make better use of the garden; have awnings put up at the windows, have a covered seating ares (conservatory) more staff the home is at times very busy due to high demands, to ensure all needs are met to a very high standard and maintained it would be ideal to have a higher number of staff on duty. We checked all the standards that the Care Quality Commission has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. Care Homes for Older People Page 8 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The service should ensure the fridge that stores medicines requiring cold storage has the temperature checked daily. This makes sure that medicines are being stored at the correct temperature. The service should ensure that a risk assessment is undertaken if a resident is using Care Homes for Older People Page 9 of 29 bedsides. Individual risk assessments should also be carried out on people who live at Hadrian House who smoke. The service should look at how it can best meet the social and emotional needs of more dependent people living at the home, and those with complex physical or mental health needs. It should consider planning activities based on individual assessments and linked to the care plan. The service should improve the environment. The furniture in the communal areas is looking tired and worn, and institutional. The roof has leaked water into parts of the home leaving unsightly patches on the ceiling; and the decor does not always support the increasing number of people living in the home who have dementia care needs. The service should look at whether there is sufficient staff on duty to meet the care needs of people currently living at the home during the early evening, night time and week-ends. 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 10 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into Hadrian House are provided with both good written information, and opportunities to find out whether it is the right home for them. Evidence: People who wish to move to Hadrian House are given information to help them know what the service can offer them. This information is contained in a photocopied Statement of Purpose (a legal document the service has to provide to inform people of the service it is delivering), and Service User Guide. The documents have been written in a style that makes it easy for people to understand what they can expect when they live at Hadrian House. We looked at the care files of two people who are new residents at Hadrian House. We saw that before they came to Hadrian House a social worker had met with them and assessed their needs. We were also told that their family members had visited the home before they moved into Hadrian House to assess the suitability of the home for Care Homes for Older People Page 12 of 29 Evidence: their relatives. During our visit, we spoke with staff and watched how care was being provided to the new residents, and we were satisfied that staff had a good understanding of the needs of the people they were supporting. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Hadrian House are provided with good health and personal care. Evidence: We looked at how people living at Hadrian House are given the care and support they need. We looked at their care notes, spoke to staff who support their care, and talked to the people themselves. We saw that the care plans gave good written information about the people who live at Hadrian House. We saw that they had been updated when care needs had changed, although we noted that not all residents who could sign the amended care plans, were doing so. We spoke with staff and found that they had a very good understanding of the needs of each person living at Hadrian House, and knew how best to care for them. We spoke with residents who told us that staff and management at the home were very good. We also sat in the communal areas of the home and watched how staff support and talk to people who live there. We saw good communication between staff and residents, and saw that staff were sensitive to the needs of people who live there. Care Homes for Older People Page 14 of 29 Evidence: We looked at how medicines are given to people, and saw that they are given in a way that keeps people safe. We looked at how medicines are ordered and disposed of, and were satisfied that people living at Hadrian House get their medicines on time. We looked at the storage and record keeping for controlled drugs. Although the controlled medicines were being stored correctly, the record book should be bound, and the pages numbered and the one being used was not. We checked that medicines needing cold storage were being kept properly in a fridge. We saw that this was being done, but the temperature of the fridge was not being checked regularly to make sure the temperature was correct for the medicines being stored there. We were told that the thermometer had broken, and had as yet not been replaced. The day after our visit, the manager confirmed to us that a new thermometer had been bought and the fridge temperature was now being checked. She also told us that she had contacted their pharmacist who would be supplying them with the correct controlled drugs record book. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily life at Hadrian House is good. Evidence: We spent time watching the daily life of people living at Hadrian House. We saw that as much as possible, people were choosing what to do with their day. People living at Hadrian House had breakfast at a time that suited them. They chose whether to spend the day in their own room, or in either the large communal lounge or one of the smaller communal lounges. During our visit some activities were available for people to take part in. We saw one resident taking part and enjoying a game of bowling on the Nintendo Wii. We saw staff put music on the stereo, and saw residents humming or singing along to it. Later, we saw some residents sitting down to watch a film on the DVD player. We also saw people leave the lounge because they didnt want to see the film. We saw lunch being served, and saw that people had a choice of two meals. The people we spoke with who live at Hadrain House told us that they really enjoyed the food on the menu and the choices they had. We also saw tea being served. Residents can have hot food at teatime as well as sandwiches. We saw that people were Care Homes for Older People Page 16 of 29 Evidence: regularly offered hot drinks during the day. There is also a small kitchen area for residents who are still able to make their own drinks. We saw that residents benefit from having a member of staff whose role is to engage them in activities. These include activities such as sing-a-longs, film afternoons, trips out to the local supermarket and garden centre, and trips to places further afield. We asked how those with more complex needs have their social and emotional needs catered for, and found that they are not as well served as the more independent residents. Activities were being planned more as group activities rather than as oneto-one activities linked to what the care plan has indicated would help support a persons emotional and social needs. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hadrian House are well protected. Evidence: We spoke with people who live at Hadrian House who told us that they felt confident to speak to the manager or staff if they were not happy with any aspect of life at the home. One person told us they had done so, and felt the manager took their concerns seriously and acted upon them. We were told by the manager that there has been one formal complaint about Hadrian House since the last inspection. We were not able to see how this was being investigated because the complaint is current, and is being dealt with by a senior manager who is not based at Hadrian House. The CQC has not received any complaints about Hadrian House since the last inspection. Hadrian House management ensures that we at the CQC are kept informed of any event, illness or death that adversely affects the wellbeing of any person living in the home. We spoke with staff to find out whether they knew policies and procedures to follow if they had concerns that a person living at Hadrian House might be being abused. Staff Care Homes for Older People Page 18 of 29 Evidence: spoken with knew the different types of abuse, and were clear that they would report any concerns or allegations immediately. We looked at staff training records and saw that staff have received training in Safeguarding Adults. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is clean and tidy, but the decor and furnishings are looking tired and worn in places and there has not been enough consideration in looking at how the environment can support people with dementia. Evidence: We looked at some of the bedrooms, the communal rooms, the laundry, kitchen, and communal bathrooms and toilets. We saw that all areas of the home we looked at were very clean and tidy. We checked that staff have adequate protection when helping residents with personal care, and we were told they have good supplies of gloves and aprons. We also checked that clothes are cleaned in a way to ensure that infections such as MRSA and C.Diff are not spread, and we were happy that there are good infection control measures. We saw that the bedrooms had been nicely redecorated and new bedroom furniture had also been bought. Although the bedrooms looked nice, the service has not been given a budget to improve other parts of the home, and the decor is looking tired and worn. The living room furniture consists mainly of single arm chairs and coffee tables, and the chairs look dated and institutional. Care Homes for Older People Page 20 of 29 Evidence: The corridor on the first floor has a green carpet and green walls, and is quite dark. There are pictures on the walls but these are often either placed too high for people to see, or are too small or detailed for people with sight impairment or dementia to see or make out what the print is. There was little signage in the home to support the movement around the home for people with confusion or dementia; and given the increasing numbers of people coming to stay at Hadrian House with dementia (the AQAA told us there are currently 13 people with dementia), there has been little input in terms of making the environment more supportive for those with this condition. We also saw that in parts of the home water has leaked in from the flat roof, this was particularly noticeable in the hairdressing room. We were told that Leicestershire County Council were aware of this, but as yet the manager has not been given any date for when this will be sorted. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 provide good support, although there is not always sufficient staff on duty to meet the complex needs of the people who live at Hadrian House Evidence: We looked at the records relating to staffing - these included the staff rota, staff training files, staff recruitment files, and records providing information on staff meetings and supervision. We saw by looking at the files and by watching staff undertake their roles that they had been trained well to undertake the care and ancillary tasks expected of them. Staff also told us that they have received good training to support them in their roles. We looked at the staff rota, talked to staff and people who live at the home about whether they felt there were enough staff on duty during the 24 hour period. We were told that there was enough staff on duty during the morning shift to meet peoples needs because there are six care staff plus a laundry worker and bedmaker on the rota, so if a person is on annual leave or sick then there is still enough staff to support the needs of people well. We were told that the service aims to have four care staff on duty from 1.30pm to 9.30pm but due to annual leave and staff sickness this can often be reduced to three care workers. Staff and residents told us that this can be particularly stressful around Care Homes for Older People Page 22 of 29 Evidence: the time people living at Hadrian House wish to go to bed. Many like to go to bed before the night shift come on duty. With three staff we were told it is very difficult to do this without rushing residents. A staff member told us that it was difficult to provide good care in the evening because many people wanted to go to bed before 9.30pm and you feel rushed to get them into bed, and when you come down stairs people are putting their hands up and saying me next. There are two waking night staff. One resident said to us you dont see a member of staff for about an hour at night time because they have their security round to do. We looked at the AQAA to find out more about the needs of people who live at Hadrian House, and we saw that there are currently 29 full time residents and two respite care residents. Of the 31 people living at Hadrian House, a significant number require help with washing and bathing, and in going to the toilet. A large number of residents also have dementia or other mental health needs. Many require two members of staff to help them with their care during the day and night. When staffing is reduced to three at the week-end we were told by staff it is more difficult to manage the needs of residents because there is no laundry worker, and there has been no bedmaker, leaving care staff to do the laundry and make the beds as well as provide care. We were told a week-end bedmaker is due to start employment at Hadrian House. We checked the recruitment records of staff and saw that the service is ensuring that all the necessary checks on staff to keep people who live at the home safe, are being done. We saw that new staff have good induction training to enable them to work safely and effectively with people who live at Hadrian House. We saw that there are systems in place for people who work at the home to have formal supervision and team meetings. We saw that some of these meetings had not taken place, although we were made aware that there is always support on hand for staff if they are unsure about any aspect of their work. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hadrian House is managed well. Evidence: Angela Horobin is the registered manager of Hadrian House. She has a National Vocational Qualification in Care to level 4, and the Registered Managers Award. She has many years of experience working in care and at Hadrian House. The service is in the process of being sold to another provider. People living at Hadrian House, their relatives, and staff have been involved in consultation meetings regarding the changes. The process is taking longer than expected, and management at Hadrian House are working hard to provide support and reassurance through the change process. We were told by staff and residents that they felt supported by the management team. During our visit we saw evidence of residents coming into the management office and expressing their opinions and views. We saw that the manager listened to Care Homes for Older People Page 24 of 29 Evidence: what they had to say. The service has systems in place to audit the quality of care being received. It both formally and informally listens to the views of people who live at the home, and acts on their views where possible. We checked the monies of people who live at Hadrian House that are held by the service. We saw that the service kept each individuals money separate to other people living in the home, and that there was an accurate record of money in, and money out. Receipts were held to account for money going out. We checked health and safety systems in the home, and saw that there are good systems in place to support the health and safety of people living at Hadrian House. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 The provider should ensure that where possible, people living at Hadrian House sign their care plans, and the review of their care plans. The fridge housing medication requiring cold storage, should have daily temperature readings to ensure it is at the correct temperature for the medication being stored there. The service should use the information they have about the social interests of people and use this to help plan more individualised activities. Particular consideration should be given to people with dementia, and any other person living at the home with complex needs. The provider should consider how the environment can be adapted to more effectively support the increasing number of people being admitted to the service with dementia. The provider should consider upgrading the decor and furniture in the communal areas of the home, and look at how a less institutional environment can be achieved. The provider should look at fixing the flat roof to ensure that water does not leak through the ceiling. Page 27 of 29 2 9 3 12 4 19 5 19 6 19 Care Homes for Older People 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 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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