Care Home: Heaton House

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What the care home does well Assessments are completed for potential new residents prior to admission to ensure that their care needs can be met in the home. Residents privacy and dignity is promoted. Residents see the chiropodist, dentist and optician as they need to. There are opportunities for residents to participate in social and recreational activities based on their individual needs. Residents are encouraged to maintain contact with family and friends as they wish. A varied diet is provided. Policies and procedures are in place to enable residents or their representatives to raise any concerns about the care being provided and to ensure that residents are protected from abuse. Residents live in a clean and homely environment, decorated and furnished to a good standard. Staff are deployed in suitable numbers to meet residents needs safely. Staff are suitably trained to support residents. What has improved since the last inspection? The AQAA informs us that staffing levels have increased `for greater individual personalisation of care and improved activities` and that `two staff have completed the Activities Coordinator course to improve continuing contact with the residents and a further staff member has enrolled to begin the course in October this year`. All senior staff have undertaken Mental Capacity Act training that will increase their knowledge with regards to protection and residents rights. New carpets have been provided in all communal areas, the majority of the building has been redecorated, new seating has been provided in the main lounge, the ground floor assisted bathroom has been refurbished and new garden furniture provided. Two residents expressed satisfaction with the improvements made stating, "its lovely" and "your in the best place". Recruitment processes have improved and now comply with the law and offer protection to residents. What the care home could do better: The home has a high incidents of falls at times and this must be monitored including the effect this has on individuals. Where necessary records must be maintained that demonstrate that residents received treatment, advice and other services from any required health care professional if they complain of pain as a result of a fall. This must occur to ensure residents health needs are met promptly and in full. Key inspection report Care homes for older people Name: Address: Heaton House 20-22 Reigate Road Worthing West Sussex BN11 5NF     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: Lesley Webb     Date: 0 8 1 0 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 28 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 28 Information about the care home Name of care home: Address: Heaton House 20-22 Reigate Road Worthing West Sussex BN11 5NF 01903700251 01903504503 care@heaton-house.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Clive Neil-Smith,Mrs Sally Mary Neil-Smith care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 14. 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 over 65 years of age (DE(E)), Date of last inspection Brief description of the care home Heaton House is a care home registered to provide personal care and accommodation for up to fourteen people over the age of 65 with a dementia type illness. It is located in a residential area of Worthing, West Sussex near to local amenities including a post office, shops, churches and public transport. The premises are a detached property on two floors, both of which are served by a passenger lift. There is a garden at the rear of the home, which residents can access. Residents bedroom accommodation comprises of two double and ten single bedrooms Care Homes for Older People Page 4 of 28 Over 65 0 14 14 0 1 2 1 0 2 0 0 8 Brief description of the care home on both floors. All bedrooms have en-suite facilities of a toilet and washbasin, and all but three also have a shower facility. There is one communal bathroom with a toilet, an assisted bath and an assisted shower facility. On the ground floor are two lounges and a dining room. A combined Statement of Purpose and Service Users Guide is available to reference. The fees charged at the time of the inspection are £100 per day. Additional charges are made for hairdressing, chiropody, newspapers and dry cleaning. Care Homes for Older People Page 5 of 28 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 this home on Thursday the 8th of October 2009, arriving at 10.00am and staying until 3.30pm. The purpose of this inspection was to assess how well the home is doing in meeting the Key National Minimum Standards and Regulations. The registered manager was not present, with the deputy offering assistance throughout the visit. During our visit to the home we examined the care records of three residents and recruitment records of three staff. We also looked at other documentation maintained in the home such as medication records, staff training and supervision records and health and safety records. We also indirectly observed interactions between residents and staff. Care Homes for Older People Page 6 of 28 Prior to our visit the home supplied us with a copy of its Annual Quality Assurance Assessment (AQAA) and nine residents completed questionnaires and forwarded them to us. Information from all of the above sources was assessed and used to help us form judgements on the quality of service provided to people living at the home. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The home has a high incidents of falls at times and this must be monitored including the effect this has on individuals. Where necessary records must be maintained that demonstrate that residents received treatment, advice and other services from any required health care professional if they complain of pain as a result of a fall. This must Care Homes for Older People Page 8 of 28 occur to ensure residents health needs are met promptly and in full. 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 9 of 28 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 28 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. Potential new residents are individually assessed prior to an admission to ensure that their care needs can be met in the home. Intermediate care is not provided in the home. Evidence: Prior to our inspection the home sent us its Annual Quality Assurance Assessment (AQAA). With regard to assessment processes it states The prospective resident has an individualised pre admission assessment to ascertain whether the home is able to meet their needs, to achieve the desired outcomes, this is also discussed with the relatives and carers. They are able to spend an initial trial period before any decisions are made and that we are focused on achieving the best possible and most positive outcomes for the individual. During our visit to the home we looked at the pre admission documentation for three residents, including the newest person to move into the home and spoke with the Care Homes for Older People Page 11 of 28 Evidence: deputy. Evidence from these sources supports the contents of the homes AQAA. For example all of the residents files we examined contained evidence that assessments of need have been completed before residents moved into the home and that in some cases discussions with relatives have taken place in order to gather as much information about individuals as possible. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. All state they received enough information about home to help decide if it was right for them before they moved to the home. Heaton House does not offer intermediate care. Care Homes for Older People Page 12 of 28 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. In the main care planning ensures residents needs are met safely. The health needs of residents at risk of falls are not always monitored safely and consistently. Care planning and evaluation must include for incidents of falls and how to manage acute pain. This will ensure residents needs are met safely. In the main medication systems offer protection to residents. Residents privacy and dignity is promoted. Evidence: With regard to health and personal care the homes AQAA states as what it does well All care plans are reviewed, evaluated and amended as the individuals needs change, ensuring at all times a person centred approach, and that all their health needs are met and each is protected by the homes medication policy and procedure. We sampled three residents care plans and associated documentation such as risk assessments and health records and were able to evidence some elements of the AQAA but not others. For example care plans and associated risk assessments were in place for each resident. For one resident accident records detail ten falls in 2009. The same resident has a falls risk assessment in place dated 31.12.08. We could find no Care Homes for Older People Page 13 of 28 Evidence: evidence that this has been reviewed or of a care plan being in place for the management of falls. The deputy checked the computerised care planning system and was also unable to provide evidence of this. We also noted that four of the accident records state that the resident complained of pain as a result of falls. We could find no evidence that medical advice had been sought by the home on any of these occasions. Again the deputy checked the homes records and could not produce evidence of this and informed us that medical advice had not been sought. We discussed this situation with the deputy as staff employed at the home are not medically qualified to make this decision. We informed the deputy that a requirement would be made regarding this in order to reduce any potential risk to residents. As at our previous inspection we found that the home helps residents access health care services to meet their needs. Records viewed evidence residents are registered with a local General Practitioner and have access to other health care professionals, including district nurses, via the surgeries. A record of appointments with health professionals is kept and it shows that residents see the chiropodist, dentist and optician as they need to. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. Eight state they always receive the care and support needed and one that they usually. Five state they always get the medical care needed and four that they usually. Two additional comments were recorded under What could the home do better of informing relatives on changes to medical care and outcome of any doctors visits relayed to relatives to keep us fully in the picture of medical issues. We looked at the systems for management of medication. A record is maintained of medication being administered. A system is in place for recording medication entering the home however we found for some medication this had not been followed. The deputy confirmed that most medication is ordered on a 28 day cycle but that some medication is carried over from the previous month if still in date. The deputy confirmed a stock record is not maintained but said that she would implement this to aid monitoring systems. Controlled drugs are stored in a separate facility to that of other medication that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 as amended in 2007. Medication that is required to be stored at lower temperatures is kept in individual plastic containers in the homes main fridge in the kitchen. This facility is not lockable Care Homes for Older People Page 14 of 28 Evidence: with access available to all staff. We discussed this with the deputy who agreed to purchase lockable facilities to promote safe keeping. As at our previous inspection staff were observed to deliver care, which maintained the residents privacy, dignity and respect. Residents have access to a telephone with some residents having their own telephone in their bedroom. All residents were seen to be well presented, with coordinated clothes, hair brushed and male residents were freshly shaved. Care Homes for Older People Page 15 of 28 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. Residents are enabled to exercise choice in their lives. There are opportunities for residents to participate in social and recreational activities based on their individual needs. Residents are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. Evidence: With regard to daily life and social activities the homes AQAA informs us under what we do well We support and provide a life style for each resident that suits their individual needs, supporting and enabling continuing contact with family, friends and the local community. This enables each resident to exercise choice over their lives both within the home and outside, leading active lives where possible. Good, wholesome and appetising meals are always the highlight of the day, the residents are given a wide choice, offering special diets as necessary. Eg diabetic meals, Gluten free meals, dairy free, etc. We recognise the importance of personal and social relationships and are always respectful of their need for privacy. Individual religious and spiritual needs are met both within the home, and supported to attend services if required. Care Homes for Older People Page 16 of 28 Evidence: Evidence gained through our inspection process supports this statement. For example records confirm residents are offered a choice of activities on a daily basis such as crafts, table games and bingo. During our visit staff were observed supporting residents to participate in a game of bingo, others were seen watching television and another singing and dancing to music. All residents appeared happy with the activities on offer. The AQAA also informs us that since the last inspection staffing levels have increased for greater individual personalisation of care and improved activities and that two staff have completed the Activities Coordinator course to improve continuing contact with the residents and a further staff member has enrolled to begin the course in October this year. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. Three state the home usually and five that the home always arranges activities they can participate in. One person did not respond to this question. The care and support provided was observed to enable residents where possible to exercise choice whilst at Heaton House. All residents manage their own finances usually with help from family or a solicitor. They can bring personal possessions to the home to help them feel more at home. Daily routines are flexible, for example residents were observed to be able to start the day at the time they chose, move around the home freely and choose to join in with activities or not. Staff confirmed if residents do not like what is on the menu there are always a range of alternatives. A six week menu is in place. Lunch on the day was chicken casserole, mashed potato and vegetables, followed by home made pineapple upside down cake and custard. We ate the same meal as the residents and found it to be well presented and tasty. Residents were indirectly observed eating their lunch in the dining room, which was nicely laid out with small tables decorated with tablecloths and flowers. It was a relaxed environment taking into account the different length of time that individual residents would need to finish their meal. Care Homes for Older People Page 17 of 28 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. Policies and procedures are in place to enable residents or their representatives to raise any concerns about the care being provided and to ensure that residents are protected from abuse. Evidence: With regard to complaints and protection the homes AQAA states We have a clear and accessible Complaints Procedure, which Residents, Relatives and Friends are confident with, and that any complaint will be taken seriously and promptly investigated. They would be fully supported by all staff in making any complaint. Staff are trained appropriately to ensure all Residents and Staff are protected from all forms of abuse. Evidence gained through our inspection process supports this statement. For example all nine residents surveys that we received confirm that residents know of someone they can speak to informally if not happy and how to make a formal complaint if needed. We saw the complaints procedure on display in the home. The deputy informed us that there have been no formal complaints received by the home. Policies and procedures for safeguarding adults are in place and the deputy informed us all staff have received training in this area. The deputy also informed us that all senior staff have undertaken Mental Capacity Act Care Homes for Older People Page 18 of 28 Evidence: training. The deputy demonstrated knowledge with regards to protection explaining we speak to families and relatives and have details of other agencies we can contact if concerned. Also being aware of residents, changes in needs, have regular staff who notice changes and keep people informed of what to look out for. Care Homes for Older People Page 19 of 28 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. Residents live in a clean and homely environment, decorated and furnished to a good standard. Evidence: With regard to the environment the homes AQAA states We ensure that the home environment is well maintained and that it is at all times a safe and homely place to live in. The home is maintained appropriately to reduce risk of infection and cross infection. Staff are trained in infection control and are aware of the importance of prevention. Facilities within the home provide for and are available to meet all the needs of the residents and exceed the requirements of the NMS, and the proposed Regulations 2009 requirements. The home complies with the requirements for Fire Protection and the requirements of the local Environmental Health Service including the regular monitoring of the hot water temperatures where residents have access. We ensure that the home is always clean and hygienic. The secure garden is safe and well maintained. Evidence gained through our inspection process supports this statement. For example all areas of the home that we viewed were clean, free from odours and maintained to a safe standard. Since our last inspection new carpets have been provided in all communal areas, the Care Homes for Older People Page 20 of 28 Evidence: majority of the building has been redecorated, new seating has been provided in the main lounge, the ground floor assisted bathroom has been refurbished and new garden furniture provided. Two residents expressed satisfaction with the improvements made stating, its lovely and your in the best place. Nine residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. Seven state the home is always fresh and clean and two that it is usually. Care Homes for Older People Page 21 of 28 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 deployed in suitable numbers to meet residents needs safely. Staff are suitably trained to support residents and recruitment processes offer protection. Evidence: With regard to staffing the homes AQAA states We ensure all Residents individual needs are met by providing adequate numbers of appropriately trained staff are on duty at all times. Maintain a staff duty rota to ensure an appropriate mix of staff skills. Our recruitment policies and practises ensure the support and protection of our Residents. IE POVA and CRB checks, References and employment history. Care staff are supported by ancillary staff Cooks and domestic staff. Provide a very high staff to Resident ratio 1 to 4 on all day shifts. We provide training and training opportunities for all staff. We adopt and practise an Equal Opportunities Policy. Evidence gained through our inspection process supports this statement. For example staffing rotas that we looked at confirm that three care staff are allocated on shift during the day and that separate domestic and kitchen staff are also in place. With regard to staffing levels the deputy informed us, We like to have three staff on duty so we can take residents out, even if this is just a walk in the garden, we aim for best quality care we can. Nine residents completed questionnaires and returned them to us before our Care Homes for Older People Page 22 of 28 Evidence: inspection. Some of these had been completed with assistance from relatives. Three state there are usually and six that there are always staff available when needed. Six state staff always and three that staff usually listen and act on what they say. Additional comments were recorded of Welcoming, friendly and caring staff Kind and patient with my mother Good staff to client ratio and The staff are very caring of residents who are mentally impaired to varying degrees. There is a respectful attitude to residents. We examined the recruitment records of the three newest members of staff to commence employment at the home. Application forms and references were in place for all. We did note that the homes application form does not ask for full employment history and it does not state one reference must be from the most recent employer. The deputy said she would amend the form immediately. The staff files also included evidence that a POVA first and a Criminal Records Bureau (CRB) disclosure had been obtained prior to the member of staff commencing work. The majority have received training in areas including fire, first aid, moving and handling and cross infection. Sampling of staff records indicates that induction training is in place which assists new staff in getting to know the service and how they are expected provide safe care. The AQAA informs us that the majority of care staff hold a National Vocational Qualification (NVQ). Care Homes for Older People Page 23 of 28 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. In the main management of the home is meeting residents needs safely. Quality monitoring systems are in place that allow the home to measure if it is meeting its aims and objectives. Staff are receive supervision that supports them to understand their roles and responsibilities. Evidence: With regard to management the homes AQAA states The Manager ensures the home is run and managed competently and for the best interests and outcomes for all the Residents and ensures the Residents are safeguarded by the financial and accounting procedures used in the home. Each Residents financial interests are safeguarded as are their health, welfare and safety, and is promoted by all staff. All staff have an appropriate Induction programme into the home, emphasising the best interests of the Residents at all times. Evidence gained through our inspection process supports this statement. For example we found that a previous requirement relating to recruitment practices is now met and Care Homes for Older People Page 24 of 28 Evidence: that improvements have been made in other areas such as the environment and training. The registered manager, who is also one of the Registered Providers has completed the Registered Managers Award and NVQ Level 4 in Care. She was not present during our inspection with the deputy assisting us when needed. The deputy demonstrated knowledge and understanding appropriate to her position. A quality assurance system is in place. It was evidenced that feedback about the service provided has been sought from residents through residents surveys. Minutes from staff were viewed and it was evident that people are given the opportunity to influence how the home is run. The home sent us its AQAA when requested. The contents of this are detailed, informative and demonstrate quality monitoring and reviews undertaken by the home. We discussed obtaining the views of others such as GPs, district nurses and relatives with the deputy. She said she would pass this information on to the registered manager. As at our previous inspection residents are encouraged to retain control of their own finances for as long as they are able to do so, and if unable then this responsibility is taken on by a relative or another responsible person external to the home. When items are purchased on behalf of residents the cost is added to the monthly invoice. All staff files that we looked at contained written evidence that staff receive formal, one to one supervision. We sampled a number of health and safety records, finding all to be in good order and up to date. Care Homes for Older People Page 25 of 28 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 28 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 8 13 In line with Regulation 13(1)(b) the registered person must be able to demonstrate through the homes records that residents received where necessary, treatment, advice and other services from any required health care professional if they complain of pain as a result of a fall. This must occur to ensure residents health needs are met promptly and in full. 08/11/2009 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 Care Homes for Older People Page 27 of 28 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. 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