Care Home: Lennox Lodge

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What the care home does well Lennox Lodge provides a homely, friendly atmosphere for its residents. The registered provider visits the home on a daily basis, and has invested in the home to ensure that all residents bedrooms, and communal rooms provide a comfortable, well maintained, and homely environment. The registered manager carries out thorough pre-admission assessments for all prospective residents, to ensure that the home and knowledge and skills of staff can meet the prospective residents needs. Care plans are well designed, and clearly indicate each residents likes, dislikes, and wishes. Food in the home is both varied, nourishing, and well presented and specialised diets and preferences are also catered for. Any concerns or complaints are welcomed by the management of the home to ensure they can continue to improve in the services offered by the home and to meet residents individual needs and wishes. Staff recruitment procedures are thorough to ensure that residents are not placed at risk from staff who have not been appropriately vetted. Staffing levels are good and the registered manager is aware of the need to keep staff rotas under review, to ensure that when more residents move into the home their needs can be met. Residents said that there are always staff available to meet their needs. There are up to date health, safety and fire risk assessments in place for each room in the home. Residents talk highly of Lennox Lodge, saying they are treated kindly by both management and staff. Residents are able to maintain their independence, and are supported by staff to do this. What has improved since the last inspection? Care plans are more informative and working towards being person centred, to show that each resident is treated individually, being able to express their own wishes, likes, dislikes, preferences and choices. The home has developed more activities for residents, taking into account their interests. There is evidence of more entertainers and skilled people being brought into the home to provide more specific activities for the residents. There is evidence both via the complaints file and from discussion with residents, that any concerns or complaints would be passed to management. Residents said they would be confident in making a complaint should the need arise. The registered provider is continuously investing in the premises, and since the last inspection has ensured that the back garden is safe for residents to use, by placing handrails in strategic places, to reduce the risk of residents falling, and to provide an aid to moiblity and providing residents with a lawned area they can enjoy. While the quality assurance system still needs to be developed there is evidence available that the views of the residents and their relatives are sought, so the home can improve the quality of service it offers. All accidents are recorded in the accident book, which corresponds with entries made in the individual residents daily reports. Requirements made at the last key inspection have been met. What the care home could do better: While daily reports have improved since the last key inspection there is still someimprovements to be made to ensure that personal hygiene needs of residents are being fully met. Where errors occur that could lead to risk, the manager needs to be quicker in reporting these to the appropriate authorities. Generally the home is kept in a clean and hygienic condition, but offensive odours in two bedrooms must be addressed, to prevent these odours pervading into corridors, and affecting other residents living in the home. Offensive odours need to be addressed proactively to prevent the risk of cross infection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lennox Lodge 37 The Highlands Bexhill-on-sea East Sussex TN39 5HL     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: June Davies     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 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 27 Information about the care home Name of care home: Address: Lennox Lodge 37 The Highlands Bexhill-on-sea East Sussex TN39 5HL 01424215408 F/P01424215408 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Guy Haddow care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 27. 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). Date of last inspection Brief description of the care home Lennox Lodge is a care home registered to provide accommodation for up to 27 Older people. The home is a large detached property situated in a quiet residential area of The Highlands, approximately three and a half miles north of Bexhill on Sea. Accommodation is provided over three floors with level access only to the front of the home. There is a shaft lift that serves all floors in the home, enabling easy access to bedrooms for the residents. Residents have a choice of communal areas where they can sit, including a comfortable conservatory, that opens onto the back garden. The village Sidley is approximately half a mile away, which can be accessed via the local bus service. Care Homes for Older People Page 4 of 27 Care Homes for Older People Page 5 of 27 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 unannounced Key Inspection took place on the 15th April 2009 over a period of seven hours. At this inspection, the inspector spoke with the Registered Provider, Registered Manager, staff and residents, and viewed documents relating to key standards inspected. Some parts of the inspection involved observing the administration of medication at lunch time and auditing mediation via the Monthly Administration Records, carrying out a tour of the communal rooms, dining room, communal bathing and toilet faiclities, laundry room, some of the bedrooms and back garden. During the course of the inspection the inspector observed activites taking place and how staff respected the privacy and dignity of residents. Some information contained within this report was obtained from the Annual Quality Assurance Assessment sent to the Commission by the registered manager. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: While daily reports have improved since the last key inspection there is still some Care Homes for Older People Page 8 of 27 improvements to be made to ensure that personal hygiene needs of residents are being fully met. Where errors occur that could lead to risk, the manager needs to be quicker in reporting these to the appropriate authorities. Generally the home is kept in a clean and hygienic condition, but offensive odours in two bedrooms must be addressed, to prevent these odours pervading into corridors, and affecting other residents living in the home. Offensive odours need to be addressed proactively to prevent the risk of cross infection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. Residents move into the home knowing that staff will be able to meet their assessed needs. Evidence: Two pre-admissions assessments were viewed at this key inspection. Both documents gave comprehensive information in relation to physical, personal and social care needs of each prospective resident. The registered manager stated that from these preadmission assessments she is able to ensure that the home has the facilities and that staff have the knowledge to meet the prospective residents needs. Care Homes for Older People Page 11 of 27 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. Residents know that their likes and dislikes are reflected in their personal care plans and that potential risk are managed. The registered manager and staff have good working relationships with all external health care professionals. Medication in the home is well managed but further policies and procedures need to be put in place to ensure that residents are not placed at risk. Staff respect the privacy and dignity of residents, and talk to them in a professional and kindly manner. Evidence: The inspector viewed the two care plans relating to the pre-admission assessments viewed previously under choice of home. Care plans were informative in relation to physical, personal and social care needs of the residents. Care plans and risk assessments had been reviewed and up dated as and when required. The inspector spoke to two residents who said that the registered manager sits with them to review their care needs. Care Homes for Older People Page 12 of 27 Evidence: There was evidence that residents have access to external health care professionals as and when required and these visits are recorded in the care plans. In one care plan viewed there was some concern that staff had not followed the plan of care in relation to personal hygiene care. This was discussed with the registered provider and registered manager, both stated that they hold regular staff meetings, and constantly remind staff to follow the individual care needs of residents and that they would again take this matter up with care staff, and ensure more detailed daily reporting takes place. None of the residents in the home are receiving treatment for pressure areas. The registered manager ensures that the continence nurse is kept informed of new residents, and where there are areas of concern, she calls upon the continence nurse for re-assessment. Where residents need the services of the community psychiatric nurse, this is done through referral from the residents own general practitioner, and there was evidence of a community psychiatric nurse visit in one of the care plans viewed. There is evidence that residents get the opportunity to take part in regular exercise. The registered manager has made arrangements for an external fitness instructor to come into the home regularly to do armchair exercises with the residents and on the day of the inspection, the inspector observed several residents walking around the garden of the home. Each care plan contains evidence that nutritional assessments take place on a regular basis. The inspector observed administration of medication at lunchtime and viewed Monthly Administration Records. Medication is well managed in the home, with evidence of appropriate recording on Monthly Administration Records. Staff administer medication in accordance with The Royal Pharmaceutical Society guidelines for care homes. The are several policies and procedures relating to medication these are up to date and give staff clear guidelines. It was noted however that the home does not have policies and procedures in place for PRN (as required medication) or for homely remedies. This was pointed out to the registered manager who said that she would obtain guidance from CQC website, and ensure that these policies and procedures are put in place in the home. During inspection of one care plan it was noted that there had been a medication error, for one of the residents, investigations into this are still taking place in the home, and the registered manager has raised a Safeguarding Vulnerable Adults alert. Since the last key inspection the registered provider has supplied an appropriate medication fridge that runs at the correct temperature. Staff were observed treating residents with respect, talking to them in a professional and friendly manner. Staff were observed escorting residents to toilet and ensuring toilet doors were closed. Residents told the inspector that staff are always very kind to them. One resident said that staff always respect her privacy and dignity when bathing. Care Homes for Older People Page 13 of 27 Care Homes for Older People Page 14 of 27 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 able to make choices in regard to food, social activities and daily living routines. Visitors are welcome into the home at any time, and residents can say who they wish to see. The meals in this home are good offering both choice and variety and catering for special diets. Evidence: During this key inspection the inspector gained evidence both from care plans and residents, that every resident is able to make choices in regards to social activities, daily living routines and personal and social relationships. From two care plans viewed the inspector noted that residents social interests and hobbies are recorded. One resident said how she likes to go out of the home to visit her hairdresser and that staff support her in doing this. She told the inspector, that when she wants to go into town to buy toiletries and clothes, there is always a member of staff to accompany her. From talking to residents and viewing activity lists in the home there are variety of Care Homes for Older People Page 15 of 27 Evidence: activies offered from care staff and external entertainers and specialists coming into the home on a regular basis. There is a lot of emphasis placed on residents being able to make choices in regard to activities they take part in, and activities they choose to do. The registered manager has ensured that the home has a policy and procedure in place in regard to visitors, and this states that visitors are welcome at any time. The majority of residents do not manager their own financial affairs, and have elected relatives or solicitors to do this on their behalf. During a tour of the home, the inspector noted that residents are able to bring personal items into the home with them, this includes small items of furniture, pictures, ornaments, photographs. Should they wish to do so residents are able to have access to their own care plans. The inspector observed a lunch time meal, and found that residents were offered choices, to meet their likes and dislikes and specialised dietary requirements. One resident prefers to have their meal liquidised and inspector noted that this is presented in an appetising and attractive manner. Menus are on a four week rotating schedule, and each day offer good nourishing choices. Menus are also compiled taking into account the residents likes, dislikes and preferences. Mealtimes are taken in an unhurried manner, with many residents using mealtimes as a socialising period. None of the residents require assistance from care staff with eating. Care Homes for Older People Page 16 of 27 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. Residents know their complaints will be listened to and acted upon. Staff have good knowledge of Safeguarding Vulnerable Adult issues which protects residents from abuse. Evidence: The home has an up to date complaints policy and procedure, this is displayed in the main hallway. Since the last key inspection six complaints have been received by the home. On viewing the complaints file the inspector found that all complaints have been recorded, investigated and responded to within the time limits. Two residents spoken to said that they would know how to complain if they needed to. Policies and procedures in relation to Safeguarding Vulnerable Adults and Whistle blowing have been reviewed and give staff clear guidelines on what actions they should take if they suspect that abuse has taken place. The registered manager has also obtained a copy of Sussex Multi-Agency Policy and Procedures for Safeguarding Vulnerable Adults and this is available in the office for staff to refer to. A Safeguarding Alert referral has recently been made in regard to a medication error. From information available this has been correctly logged and appropriate action has been taken. All prospective new staff are Protection of Vulnerable Adults Register checked and also Care Homes for Older People Page 17 of 27 Evidence: have a Criminial Records Bureau check prior to taking up employment in the home. Up to date Safeguarding Vulnerable Adults training has been arranged for all care staff to take place on the 14th May 2009. Care Homes for Older People Page 18 of 27 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. The standard of the environment is good providing residents with an attractive and homely place to live. The procedures for infection control are generally good, but more attention must be paid to ensure there are no offensive odours in the home. Evidence: The location and layout of this home is suitable for its stated purpose. The home is well maintained, and provides a homely and comfortable place for residents to live. Work has taken place in the back garden since the last key inspection and there are now hand rails in place, to safeguard residents from falling and to assist with their mobility. Residents have a patio area that has a table, chairs and umbrella, where they can sit when weather is fine. There is a bird aviary with a variety of birds, that residents enjoy watching. A garden shed has been moved to a more suitable site, and there area where the garden shed was has now been laid to lawn. There is a bult up flower bed planted with seasonal flowers. The home itself is clean and well presented, with good decoration and furniture in communal lounges, dining room and conservatories. Some work needs to done in one conservatories, as at one time this was used as a residents smoking room, and there is Care Homes for Older People Page 19 of 27 Evidence: still an odour of cigarette smoke. The bedrooms in the home are very well furnished and decorated and all have en-suite facilities. The inspector did note that two of the bedrooms have an offensive odour and a requirement is being made in regard to these odours. The laundry room is in a clean a tidy condition, and is supplied with two industrial washing machines, which offer sluicing facilities, there is also a seperate washing machine that is used entirely for kitchen washing. Red alginate bags are used for foul linen. Linen bags are used for transporting linen around the home. The laundry room has hand washing facilities, with liquid soap and paper hand towels. Clinical waste is well managed. ensuring there is now risk of cross infection. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient numbers to ensure the residents needs are met, this was evidenced from staff rotas and talking to residents. Staff qualifications and training ensure that staff have the skills and knowledge to meet residents assessed needs. Recruitment practices in the home are good ensuring that staff are appropriately vetted, and that residents are not placed at risk. Evidence: From viewing staff rotas and talking to residents there are sufficient staff on duty during each shift to meet with the residents needs, and for staff to spend social time with the residents. One residents said there is always a member of staff available if I need help, another resident said there are always staff available to help me. There are sufficient ancillary staff on duty to ensure that residents receive good nutritious food, and to ensure that the home is kept clean, and well maintained. Over 50 percent of staff have either acheived their NVQ level two or above or are working towards this qualification. Two staff are waiting for their NVQ files to be verified, and another two members of care staff are waiting to enrol onto NVQ level Care Homes for Older People Page 21 of 27 Evidence: two. The inspector viewed two staff files and found them to be well ordered with both containing all necessary information, including two references, a Protection of Vulnerable Adults register and Criminal Records Bureau check. Both files contained at least three forms of identification. The registered manager has sourced East Sussex Country Council to carry out mandatory training, which includes Moving and Handling, Infection Control, Safeguarding Vulnerable Adults, First Aid, Food Hygiene and Handling Medication. The registered manager has arranged for some of these courses to be delivered in house. Fire training is carried out on a regular basis in house. Included in this fire training is the evacuation process. All new staff carry out an initial induction when starting work in Lennox Lodge, and then complete a Skills for Care based induction within the first six weeks of their employment. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager provides clear leadership throughout the home, and has good understanding of what needs to improve in the home. The registered manager does have a quality assurance system in place, but this needs to be developed further, to ensure that the best quality of care is provided for the residents living in the home. Residents personal allowances are well managed and kept safely and securely. The policies and procedures of health and safety in the home are followed by management and staff ensuring that residents are not placed at risk. Evidence: The registered manager has obtained her City and Guilds Management and Care Qualification, she is about to update this with NVQ Level 4. Since the last key inspection the registered manager has worked hard to meet the National Minimum Standards, and requirements made at that inspection have now been met. Residents spoken too said that the registered manager is kind, and always has time to spend Care Homes for Older People Page 23 of 27 Evidence: with them. Throughout the inspection the inspector observed that staff, residents and relatives have access to the office at any time. Through good leadership the home has a positive atmosphere, where residents are able to maintain their independence and staff are willing to train to gain more knowledge and skills. The manager has developed a Quality Assurance System in the home but some work is still required to ensure that the views of stakeholders are sought, and that the registered manager records her monitoring of systems used in the home, and that the home has a clear recorded annual development plan in place. The inspector was shown that regular Health, Safety and Fire risk assessments are carried out for every room in the home. In some cases the home is requested to keep safe, residents personal allowances. Each resident is given a personal allowance book, where incoming and outgoing monies are recorded. Where purchases are made on behalf of the resident, receipts are kept. At the present time both monies and account books are kept together but securely. The registered manager will in future make sure that account books are kept seperately from monies held for safekeeping. From viewing staff records the inspector found that all staff receive regular formal supervision at least six times per year. The registered manager also ensures that regular staff meetings are held and these are recorded. As mentioned under staffing section in this report all staff will either being receiving or updating their Health and Safety mandatory training, in Moving and Handling, Fire Safety, Food Hygiene and Infection Control. From information obtained through the Annual Quality Assurance Assessment and viewing maintenance certificates all appliances used in the home have up to date maintenance carried out. Fire points, emergency lighting and hot water delivery are checked on a regular basis and appropriately recorded. All windows throughout the building are fitted with window opening restrictors. The premises is secure, with the main entrance door at the front of the home being kept locked at all times. The back garden of the home is secure, and residents are unable to gain access to the front of the building. Cleaning materials are kept in COSHH cupboard that is kept locked at all times. The accident book showed that all accidents are recorded, and record of accidents is also made in the daily record of residents care plans. The home has up to date Health and Safety policies and procedures, that staff have access to. All new staff receive induction which includes health and safety. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 8 12 (1) The registered person must 27/05/2008 ensure that personal hygiene care is recorded appropriately; to record `all care given? is not helpful or adequate. Daily records when well written, help to ensure a consistent approach and good quality of care for the residents. Care Homes for Older People Page 25 of 27 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 26 16 The registered person shall 21/05/2009 having regard to the size of the care home and the number and needs of service users keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste. All parts of the home must be kept free of offensive odours, to ensure there is no risk of cross infection. 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 33 Quality assurance systems need further development to ensure that all areas are covered, and that residents receive the highest standard care and service. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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