Care Home: Holwell Villa

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What the care home does well People who live at Holwell Villa, their relatives, and people who work there were all pleased to tell us about the quality of the care provided. `The home is small and has a kind, friendly atmosphere` was a typical quote. `There are always enough staff on duty to give almost 1;1 care`. `The home does well by looking after the clients, giving them all they need to live a normal happy life, with confidence to know there is always someone around to give a helping hand`. `No-one need feel left out or lonely`. We saw excellent practice with respect to staff interacting with residents, engaging them in a variety of activities that suited them, from organised group entertainments to involvement in cooking and cleaning. Staff supported residents to go shopping and to go on outings to local places of interest. As well as photos, records are kept to show who was engaged in these activities, and how they responded. What has improved since the last inspection? The standard of care planning had improved, with good standards in personal care, and in consultation and co-working with health professionals to promote the wellbeing of the residents. There was good provision of mobility equipment, and staff had received training in moving and handling so they could help people in confidence and safety. The management of medication had improved, with staff receiving training in the safe administration of medication, and management making good arrangements for supplies and safe storage of medication. Provision of meals had improved, with residents and their relatives very pleased with the quality and variety of meals provided, as well as the presentation. Arrangements to control the spread of infection had improved, with all staff having received training, and advice having been taken by management about the provision of equipment in appropriate places through the house. Redecoration and recarpeting had carried on through the house, to provide a comfortable and pleasant environment for the residents. What the care home could do better: The service provided is very good and caring, with attention to details. It is well staffed and meeting the needs of the residents in a personal way. A great deal of work has gone into providing these improvements in a few months. The team need to continue to show they can sustain this level of service consistently. We made a recommendation with respect to the regular checking of recording of medication so that the Manager may see if there are any gaps and check promptly to ensure resident have received the correct medication. The management look after small amounts of cash on behalf of some residents, at their request. We recommended that the records kept of any transactions be checked regularly, to maintain accuracy. Key inspection report Care homes for older people Name: Address: Holwell Villa 119 New Road Holwell Villa Brixham Devon TQ5 8BY     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: Stella Lindsay     Date: 1 8 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Holwell Villa 119 New Road Holwell Villa Brixham Devon TQ5 8BY 01803854103 01803859669 howell.villa@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Barbara June Marlow,Mr Ronald Frank Marlow Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Females may be admitted from the age of 60 Date of last inspection Brief description of the care home The last key inspection was carried out on 8th August 2008. A Random Inspection was carried out on 14th August 2009. Holwell Villa offers accommodation with personal care to older people 60/65 , older people with a physical disability and older people with dementia. It is registered to provide a service for up to 17 people both male and female. The manager also accepts day care clients up to a maximum of two a day, when the home has the capacity to do this. The home is laid out over 3 levels and has Care Homes for Older People Page 4 of 26 0 0 0 Over 65 17 17 17 Brief description of the care home a passenger lift connecting the ground, first and second floors. With regard to private accommodation, there are 11 single bedrooms 2 of which have en suite facilities and 3 double bedrooms 2 of which also have en suite facilities. There are communal bathrooms and toilets throughout the home, including an adapted walk-in shower room. In terms of communal space, Holwell Villa has a lounge and a dining room as well as a front garden and a contained rear patio area with seating. The building is a large detached property located within walking distance of Brixham town centre with its range of shops and amenities. There is some parking to the front of the property with easy accessibility to the front door of the home. The inspection report was held in the homes office and was available, on request, to any interested person as was stated in the homes statement of purpose. Current weekly fees range from 326.00 to 390.00 pounds. 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 inspection took place on a Thursday in March 2010. The inspector was accompanied by an Expert by Experience. An expert by experience is a person who either has an experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Seven residents, some with help from family members, and twelve staff completed and returned these. The Manager sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 26 During our visit we spoke to six people who use the service and three regular visitors, the Manager and three other staff members. The expert by experience spoke to ten people who use the service and saw others in the lounge and dining room. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them, met with them and made observations if they were unable to speak to us. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Holwell Villa. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 26 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 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. This service is offered following suitable assessment, and residents may be confident that the home will be able to meet their needs. Evidence: The home offers a Statement of Purpose that provides information about the service and how it is organised, as well as feed back from people who had used the service, and the homes plans for the coming year. The Manager had produced a good assessment tool to provide an admission procedure. There was one resident who had recently been admitted to the home. Their admission had been arranged urgently, as a matter of safety, but they were able to visit for a day before moving in. A care plan had been provided by the social worker. The Manager expects to visit prospective residents first, to be able to assess their needs and capabilities in the environment they are accustomed to. During the assessment process, the manager produces a temporary plan of care, so that if all parties agree, Care Homes for Older People Page 11 of 26 Evidence: we can work to it when the resident moves into the home. One residents relative told us that their family member had been very unsettled at the time they moved in, but staff had plenty of time to reassure them, and they have settled over a few months. There is a good balance here, they said, The emphasis is on the human side. Care Homes for Older People Page 12 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. Personal care is provided in a consistent yet flexible way, in order to meet the individual needs of residents each day. Health care needs are monitored carefully, and professional help accessed promptly. Evidence: Each resident had a care plan, to record how their care needs were to be met, and drawn up in agreement with them and/or their family. We examined a sample, and found that they were clearly written, and included all the information that would be needed, included preferred bathing, continence and skin care, mobility needs, medication, and night care needs. These had been up-dated recently, and included advice from health care professionals, including the Continence Nurse. Records were kept of visits by District Nurses and GPs. Falls were recorded, and there was also an analysis, to show whether there were any pattern, and any action that could be taken avoid further falls. Risk assessments had been carried out, with respect to falls, poor vision, outings, and included advice for staff on how to minimise the risk. There was a nutritional assessment, and information about any issues that affected each person. We saw that Moving and Handling assessments were in place, and Occupational Care Homes for Older People Page 13 of 26 Evidence: Therapists had been consulted. Residents were helped to keep up exercises where these had been prescribed by a physiotherapist. Peoples religious and cultural preferences and past and present outside interests were recorded. We saw that the home had a sufficient policy on the safe administration of medication. We looked at the Medication Administration records, and saw that though they were mostly completed with care, there were some gaps. We recommended that these are audited regularly, so any apparent gaps may be explained. The Manager explained that one series of omissions was due to the improvement in a residents state of mind. This prescription should be reviewed by the person who prescribed it, normally the GP. Where a resident does not have capacity to decide whether they need a PRN (when required) medication, the reason for administering it should be recorded. The quality of relationships and interaction between staff and residents was very good, with residents personal dignity maintained at all times. The keyworker system ensured that residents each had a confidante of their own choosing from amongst the staff, so they may share any concerns. One relative told us that they had recently been through a bereavement, and had found that the manager and staff had been extremely supportive, which they greatly appreciated. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to live a happy and meaningful life, with choice in where they go and what they do. A good variety and quality of meals are provided. Evidence: Residents told us that they retired and rose at times of their own choosing. One person said, Sometimes I wash and dress and then sit in the lounge until it is breakfast time. The manager said that staff will encourage people to retire if it is getting late at night and they are seen to be sleepy rather than have to awaken them later from a deep sleep in an armchair in the lounge. Although there is no solely dedicated activities organizer there were many activities led by a member of staff who also works as a carer, or by people visiting from outside. These include exercises, armchair aerobics, seasonal craft work, singing sessions, dancing, artwork, and reminiscing sessions. Manicures are given to the ladies. Many of the activities are on a one to one basis or in small groups as it has been found that this works best. A large selection of DVDs is also available. A visiting relative said, there is a lovely heart to this home. The Manager lifts the mood, putting on music and getting residents up and dancing. Outside trips using either a staff members car or a Care Homes for Older People Page 15 of 26 Evidence: hired minibus include visits to the local museum, Paignton Zoo and local vantage points to enjoy the scenery and visit a cafe. We saw photos of residents on outings to the pub, Berry Head, and Brixham Museum, and some of dancing and crafts indoors, and a visiting musician. A record is kept of who joined in the various activities, how it went, and residents opinions and reactions. Anglican Holy Communion is normally available twice weekly and there are fortnightly visits from several other denominations when a short service with bible study is given. Relatives told us that this home is good at involving residents visitors, including finding biscuits and colouring books for great grandchildren. Staff told us they try to give the support residents need to live a normal life, and take them out on a regular basis, to town for shopping. One person said they welcome and enjoy the task of laying tables for meals. The staff are lovely and give me jobs to do during the day, so I dont get bored, they said. We saw them baking chocolate muffins and a fruit flan with a staff member during the afternoon. All the residents who spoke to us commented favourably on the food. They said, Food very nice, Good chef, Good food here, and plenty of fresh veg. On the day of the visit the chef was off duty, and another staff member prepared an excellent meal of very tender roast pork, with both roast and creamed potatoes, accompanied by peas, brussels sprouts, swede and carrots. One resident said, The food is nice, and theyll fix me up with something different if I dont like whats being cooked. We saw that the food was plentiful, well presented, hot and tasty, and most diners cleared their plates. Dessert was a choice of home made rhubarb crumble with custard, mousse, or ice cream. People could choose where they ate their lunch. Where the diner needed assistance this was given in a sensitive and respectful manner. We were told that at teatime there was usually a choice of soup, sandwiches, sausage rolls and various items on toast or, for instance, cauliflower cheese. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service feel safe and well supported. They are protected by well trained and motivated staff. Evidence: Of our ten respondents to our surveys, all said they knew who speak to if they were unhappy. Eight said they knew how to make a formal complaint, but said they had not needed to. Staff had received training in the Protection of Vulnerable Adults. They told us they would take any concerns or anxieties to the Manager, and they would be confident that she would take effective action if the need arose. One carer said, We are really open, and two said they would speak directly to any colleague they were concerned about as well as informing the manager. The Manager had been proactive in requesting professional assessments for some residents for their capacity to make certain decisions. One is being referred to the Court of Protection for the safe management of their finances. Not long after this Manager took over the running of Holwell Villa, there had been a safeguarding alert due to concerns by health professionals about gaps in care records, staff skills in moving and handling, and some infection control issues. We saw that the home had responded positively to this situation, provided training for staff, and the guidance and practice was now good. Staff told us that, Since our new manager took over, I have seen a vast improvement in the standards and personal care in this home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holwell Villa provides a safe and comfortable environment for the residents. Evidence: The premises were homely, tidy without being austere and with a good standard of cleanliness, decoration and internal repair. New carpets had been provided in the lounge and dining room, and much of the house had been redecorated. A new electric hoist had been provided, so that people who could not weightbear could be transferred from bed to chair more smoothly. The home had also provided pressure cushions and mattresses and slide sheets, in consultation with health care professionals, in order that vulnerable residents would avoid developing pressure sores. There was a choice between a lounge with a large screen television (which was on continually during the visit) and a Quiet lounge that also serves as a dining room. Both rooms were welcoming and furnished with comfortable armchairs. The dining furniture in the Quiet lounge was modern and comfortable. The bedrooms visited were clean, well decorated and some contained items of personal memorabilia such as family photographs. Bedrooms did not have locks on their doors, but some residents had lockable storage space. There should be suitable locks on doors, so that residents can prevent other people coming in, without being at risk of locking themself in. There are three rooms which may be shared. We met two people who were sharing. Relatives confirmed that this suited them, and that they had been consulted. Mobility Care Homes for Older People Page 18 of 26 Evidence: equipment had been stored in their room, which was used by another resident. This impinged on their personal space, and the Manager agreed to find an alternative place to keep it. All ten people who responded to our surveys said the home is always fresh and clean. No unpleasant odours were present. Antiseptic gel was available at the front door. We saw liquid soap and paper towels installed in bedrooms where personal care was delivered. The Manager told us that these were over time being provided in every bedroom, as well as each communal toilet. There were plans to provide a new sluice, which would incorporate a commode pot washer. Antiseptic gel had been provided in toilets without hand wash basins. Advice had been received from the Torbay Care Trusts Infection Control nurse. The laundry was well organised. Its floor and walls were clean and the storage space for clean items was protected with a plastic curtain. Guidance for staff was displayed, to ensure that they were able to maintain hygienic conditions. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have developed a good understanding of the residents needs, and are employed in sufficient numbers to meet their needs. Evidence: A written rota is kept, showing that as well as the manager, there are normally four care staff in the mornings and three in the afternoons. This will include other senior staff. Additionally there is a cook every day, plus an afternoon cook who works from 5 - 8pm on weekdays, and a cleaner employed four mornings per week. A relative told us in a survey that Holwells ratio of staff to residents allows a very high level of personal care and attention, and residents benefit from staff being able to sit with comfort and reassure them when needed. The staff themselves told us they found there were enough of them to meet residents needs. I have worked in other homes, and I am happier here because of the way the staff look after the service users, said one, while another said, there is always someone around to give them a helping hand. Another relative who had visited many times over a prolonged period was pleased to tell us that staff were so understanding when people were disturbed. Their caring natures were much appreciated. The night staff are said to respond to the call bell immediately or as soon as possible. Because of the number of residents who may be wakeful during the night, two staff are on waking night duty, with management always on-call. Care Homes for Older People Page 20 of 26 Evidence: We looked at the documents relating to the recent appointments of two staff. All the checks necessary to ensure the safety of residents had been applied for, while one reference needed to be requested again. We saw that new staff had been given suitable induction training. Most staff have achieved NVQ level 2 or 3 in care, with two having already achieved level 4. Staff who returned surveys to us were all very satisfied with the training that was provided to enable them to do their jobs. This had recently included Dementia Awareness, and palliative care, as well as health and safety, management of medication, and food hygiene. The Manager supplied records showing the on-going planning for continuing the programme of training. She told us that some staff are enjoying working towards a level 2 Dementia care course, and others wish to engage in this training. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holwell Villa is well run in the best interests of the residents. Evidence: The Manager had achieved NVQ level 4 in care and was awaiting a start date to work towards the Leadership and Management qualification. She has previous experience of managing care homes, and at the time of this inspection she was preparing her application to register with the CQC. Staff who returned surveys to us paid tribute to their manager. A typical quote was Since our new Manager took over she has made many good changes to the home in order to benefit the residents. Another said, From previous homes I have worked in, I would regard this as the best for the care of the residents. The home feels like a caring home, not just a business for making money The home has been proactive in gathering feedback from residents, relatives, and visiting professionals. The findings were presented in the Service Users Guide. Responses made by management to the surveys had included redecoration of the home, the reintroduction of a keyworker system to enhance the one to one attention Care Homes for Older People Page 22 of 26 Evidence: offered to residents, and improvement in the choice of meals available, with menus produced on a weekly basis so that residents can pick what they want to eat. The home looks after cash on behalf of some of the residents, which they found useful. Records were kept of each transaction, though there were slight inaccuracies. The staff told us they are well supported to do their jobs well. There is open discussion on an informal basis. Formal supervision sessions had not been carried out since June 2009. The Manager has introduced a new document for recording supervision. We saw that an annual appraisal had been carried out. The Manager told us that her intention is to provide individual supervision to staff at eight weekly intervals, and to carry out appraisals six monthly. We saw that safe working practices were maintained in the home. Staff had been trained in moving and handling, and there was a first aider on duty at all times. Professional fire safety training had been delivered on 29/03/2009, and was due to be delivered again at the time of this inspection. The Fire alarm system had been professionally serviced on 05/09/2010. Accidents had been recorded and reported, and analysed to see whether anything could be done to prevent repetitions. The Manager told us that safety of the environment including window restrictors is checked daily. All staff had received in-house training in health and safety, infection control and food hygiene, while external training in First aid, Moving and handling and fire safety had been provided. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The medication records should be audited regularly, to ensure accuracy and accountability of administration of drugs, to promote residents good health. When medication is administered PRN (as required) to people who do not have the capacity to make this decision, the reason for giving it should be recorded, to maintain accountability. Locks should be fitted to bedroom doors that are suitable for the occupant, for their privacy and security. When cash is held on behalf of residents for safekeeping, two staff should sign each transaction is the resident is unable to do this themself, for added accountability, and the records should be audited at regular intervals to ensure accuracy. Staff should receive regular recorded supervision, to give them feedback on their performance, an opportunity for the manager to ensure they are up to date in their awareness of policies and guidelines, and to document any concerns or training needs. 2 9 3 4 24 35 5 36 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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