Care Home: Mayfield

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What the care home does well One person who needed a fluid chart was seen to this in place, and had been totalled at the end of each day to show how much fluid had been taken. Because of their decreased mobility, the person concerned was said to be at high risk of pressure damage, and had been assessed as needing turned every two hours. There was a chart in place which showed that this was being done. A new staff office has been set up, so that the residents` sitting/dining room is not now where business takes place. This made for a much more calm atmosphere at lunch time for people. What the care home could do better: We found several areas of concern, some of which are carried over from the last inspection. These include care plans and risk assessments being incomplete or not done, residents care needs being unidentified, medication errors and risk assessments relating to a dangerous staircase being poorly completed. The CQC are obliged to make sure that residents are cared for by people who are fit to do so, and we have been been requesting the provider, Miss Sharon Cooper, to make sure an application is sent to us to register a manager. This has not yet happened, although the acting manager has been in post since October 2008. We had previously asked for a nursing needs assessment for one resident, and there was no evidence that this had been done. The serious health issues of another resident were unknown to the acting manager, and care plans relating to mental health, diabetes and kidney problems were not in place. We were concerned that one new resident with a mental health problem had been admitted to Mayfield, although the home is not registered to do this. The acting manager admitted that she had not considered this when making her assessment. We were so concerned about some of these issues that we will be taking legal advice about using our enforcement powers to make sure people are safe. Random inspection report Care homes for older people Name: Address: Mayfield Mayfield 99 Nursteed Road Devizes Wiltshire SN10 3DU two star good service 10/02/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alyson Fairweather Date: 1 6 0 4 2 0 1 0 Information about the care home Name of care home: Address: Mayfield Mayfield 99 Nursteed Road Devizes Wiltshire SN10 3DU 01380723720 Telephone number: Fax number: Email address: Provider web address: mayfieldcarehome@yahoo.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Miss Sharon Anne Cooper care home 20 Number of places (if applicable): Under 65 Over 65 0 17 dementia old age, not falling within any other category Conditions of registration: 1 0 No more than 20 service users to be accommodated at the home at any one time of which 2 service users may fall within the category DE(E). One named female service user, as detailed in the application dated 26th January 2006, may be accommodated at the home falling within the category DE. Date of last inspection Brief description of the care home Mayfield is a short drive from Devizes town centre. It is a detached Victorian residence with many period features. The home has been extended to include additional bedrooms. There is a stair lift to the first floor. One end of the first floor is split level and only accessible by another short flight of steps. Peoples bedrooms are located on the ground and first floor. Two could be shared rooms, but all are currently occupied as Care Homes for Older People Page 2 of 20 2 4 0 6 2 0 0 9 Brief description of the care home singles. Bedrooms have hand basins but no other en-suite facilities. There are bathrooms and toilets on both floors. One ground floor bathroom has an assisted bath. There is a dining room and separate lounge. The home has large gardens surrounding three sides of the property, and there are a number of off street parking spaces at the front of the building. Mayfield provides personal care and accommodation for up to 20 older people. The service first opened in 1983. It is privately owned and the current owner, Miss Cooper, has been in place since 2000. Miss Cooper employs a manager to run the home. Since the registered manager left in October 2008, an acting manager has been in place. To date, we have had no application from Miss Cooper to register the manager. Care Homes for Older People Page 3 of 20 What we found: We made an unannounced visit to Mayfield on 16th April 2010. We had previously had some concerns about the home, and had made another unannounced visit in June 2009 as a result of these concerns. Whilst our intention was to ensure that the home was financially viable, we also found other areas of concern, including health and safety issues. We had told the provider, Miss Sharon Cooper, about these concerns, and asked her to meet with us in August 2009 in our offices in Bristol. At that time she had told us that she had indeed had some financial problems, but that these were working themselves out. We explained our concerns about the lack of a registered manager, about some poor health and safety practice, and serious concerns about the health of one particular resident. She agreed to make sure these matters were dealt with, and to send us information when they were. Unfortunately, she has not done so. We decided to visit to see what improvements had been made. We checked the care plan for the person we had been concerned about before. This person had had several falls in the past, and we had asked the home to make sure that a nursing needs assessment was done, so that we could be sure the person was receiving the best care possible. We could find no evidence that this had been done. The acting manager said it had been, but was unable to explain why the assessment was not on the file. We looked at the record which is kept of any visiting professionals, and checked the dates between our last visit and this one. There was no record of any such visit either. We have again told the provider that she must ensure that this person has an urgent nursing needs assessment. We found that the health of the individual concerned had deteriorated, and they were mostly now cared for in bed. The records showed that the person needs two carers for hoisting and lifting. The mobility assessment on file were marked Go, Caution or Stop and were allocated coloured stickers to match - green amber and red. The resident was allocated four red stickers and a yellow, indicating high risk. The records showed that the person had a bed bath only and never a shower or bath. They were occasionally helped with feeding, but could swallow fluids. A fluid chart was in place, and this had been totalled at the end of each day to show how much fluid had been taken. One assessment said that staff should ensure the persons mouth is cleaned after meals. There was no mention of this in the daily notes, and we have told the provider to make sure that staff record this important part of their daily routine. Because of their decreased mobility, the person concerned was said to be at high risk of pressure damage, and had been assessed as needing turned every two hours. There was a chart in place which showed that this was being done. The persons weight chart said: Looks underweight. No weight had been recorded since 2008, although there were various records saying: Underweight or approx. weight on various dates throughout 2009 and 2010. When we asked the acting manager why no accurate weight had been recorded, she told us that they do not have the appropriate scales. Lack of knowledge of residents weight can lead to poor nutrition not being recognised, and underlying illnesses not being picked up. We have told the owner that Care Homes for Older People Page 4 of 20 she must provide scales which can accurately weigh all residents, and that they all must be weighed on a regular basis. The records in February 2010 showed that the person had skin tears on both knees. There was a diagram of where these skin tears were. However, when we asked the acting manager how this had happened, she did not know. There was a form on file called Safe Handling Instructions. There were no signatures of staff and no dates given, making it difficult to know who had done the assessment and when. There were some coloured stickers on the form, sometimes used by staff on risk assessments, but these stickers did not evidence an accurate risk. There was a falls assessment in place, but the system used was confusing and consisted of Yes, No, Sometimes and NA. People doing the assessment had counted the ticks made against each heading, but only on one page, and had not counted the ticks on the second page. This meant that the risk was underscored and therefore inaccurate. We have told the provider that all risk assessments must be accurate and up to date. We have also said that all staff who complete risk assessments must have training in how to do it. We recommend that the homes assessment process is further developed to give a consistent scoring method. We looked at the care plan for a new resident who had recently moved into the home. Staff from Mayfield had visited the person in their previous accommodation, and the resident had visited Mayfield, and said they wanted to stay. There was an assessment done by Mayfield staff on 19th March 2010. There was no Community Care Assessment on file, and the acting manager said she hadnt seen one, although she knew that the referral had come from the adult social care team. When we asked how they knew that they could offer care and support to someone whose needs were unidentified, the acting manager said she just thought she could manage to do it. We have told the provider that in future she must make sure she has an up to date assessment from the people who refer them before she admits any resident. The new resident had come from a home which had been registered to care for people with mental health problems, which Mayfield is not. One assessment on file mentioned the fact that they had mood swings, and the words Bi-Polar were recorded. Many of the homes assessment forms were not filled in, including those for cognition, depression, communication, emotional assessment and mood. This means that it is difficult for staff to know when any underlying mental health problem is exacerbated and is extremely important for anyone who has Bi-Polar Disorder. There was no care plan relating to mental health. detailing how this manifests itself and how it impacts on the persons daily life. There was no risk assessment in place. The provider has been told to make sure that this is done. The old care records from the previous accommodation said that the person had diabetes. These old records showed that if the diabetes was not controlled, the persons mental health could be affected. The old records showed this to be a high risk factor. When we looked at the new files, there was no diabetes care plan detailing how to manage things on a daily basis, and no risk assessment in place. We had earlier seen the resident have a plate of ice cream for dessert at lunch time, and when we mentioned this to the acting manager, she simply said: Oh. It should be OK though. The provider has been told to make sure that a care plan and risk assessment are put in place for this resident. This should include any dietary restrictions. Care Homes for Older People Page 5 of 20 Information from the previous accommodation mentions kidney problems. When we asked about those, the acting manager did not know what it meant for the resident, but was aware that they had recently had an X-ray, although the results were not yet back. When we looked at the new files, there was no care plan detailing any problem with the persons kidneys detailing how to manage things on a daily basis, and no risk assessment in place. The provider has been told to make sure that this is done. Old records showed that there was a need for specialist mouth care as there was a high risk of infection and deterioration. There was nothing on Mayfields documentation to indicate any knowledge of mouth care, and how to manage the situation on a daily basis. There was no risk assessment in place. The provider has been told to make sure that this is done. The persons mobility was assessed as poor, and they have to use the stair lift to reach their upper floor bedroom. There was no risk assessment in place about using this equipment, and the provider has been told that this must be done. Mayfields assessment says that the person smokes a lot. The acting manager says that they always smoke outside and not in the building. There was no risk assessment relating to what might happen if they smoke indoors. The acting manager says that the resident hands over their cigarettes and lighter at 9.30 pm. However, there is no such agreement on file, and on one occasion, a note on the file said that a carer had explained that they were not allowed to smoke inside, and that their cigarettes would be taken away from them. We have told the provider that all people who smoke must have a signed, agreed plan about how this is managed. They must also have a risk assessment in place. When we asked the acting manager why she hadnt been aware that these care plans were not in place, particularly in light of their serious nature, she said that she couldnt look at every care plan, and that she trusted the seniors to do their job. She agreed that mental health, kidney problems and diabetes should have been made priority for staff in care planning. Great care must be taken by the provider to ensure that restrictive practices are not used with residents. We spoke to the acting manager about this, and she assured us that this would never happen, even though staff had written that they would take someones cigarettes away. When we asked about any training she had had in the Mental Capacity Act Deprivation of Liberty Safeguards, she admitted that she had not had any. We therefore recommend that she contacts Wiltshire County Council in order to access this training. We asked about staff training in mental health issues, and the acting manager said they had all done general mental health training, such as dementia. There had been no training delivered in mental disorders, and we have told the provider that she must ensure that all staff have training in mental health, with specific reference to Bi-Polar Disorder, and how this affects people. Old medication records brought to the home with the new resident showed that Lithium tests had been done in November 2009. Lithium is a drug often prescribed for people with Bi-Polar Disorder, and it requires frequent blood tests to check the blood count, Care Homes for Older People Page 6 of 20 kidney function and thyroid function. There was no recent record of any checks, and no mention of any Lithium on the new records. When we asked the acting manager about this, she said she wasnt sure, but thought it wasnt currently being prescribed. We went to check the Medication Administration Records and found that there was no prescription for Lithium although other psychotropic drugs were being used. We saw that there had been recent occasions where the persons psychiatric medication had not been recorded as administered. The acting manager was sure it had been given, but it had not been signed for as done. She said she has frequently told staff about this, but they continue to leave spaces in the records. We have told the provider before that she must make sure that every time medication is administered it must be signed for, and have said this to her again. The Medication Administration Record is provided by chemists with dates on it for one month at a time. Each date has a time and a place for staff to sign when medication is given to anyone. The record we looked at had been altered by staff, with handwritten changes to the dates. Unfortunately, these had been wrongly entered, so that there were two dates marked 9th April. This means that all medication signed for on this date and afterwards, were entered on the wrong date. Nobody had seen this or corrected it. The acting manager was unaware of the error. We have told the provider that the medication administration record must be accurate and any handwritten changes must be witnessed by two staff members. A new staff office has been set up, so that the residents sitting/dining room is not now used by staff for care planning etc. and has made for a much more calm atmosphere at lunch time for people. The sitting room and dining room have been divided up, making a larger area for residents to sit in. There was a board in the sitting room, which gave the names of staff members on duty that day. Unfortunately, this was dated for the previous day, so did not give a true reflection of which staff would be available. Because many residents have an element of confusion, we have recommended that this board accurately reflects the days staff team. When we visited the last time, we told the provider that we were concerned about a steep, winding staircase leading from the hall. Staff reported that this is never used by residents. There is a closed door leading to this staircase, but anyone who wished to could access it. We spoke to the acting manager about this. She said that the home had been aware of the hazard for some time, but had not reached a satisfactory conclusion about how to ensure there was no danger to residents. When asked if there was a risk assessment in place, we were told there wasnt. We asked for this to be done, and for them to seek advice about how to make it safe. At our meeting with the provider she said she had done this, would update it, and send us a copy. She had not done so. When we asked to see the risk assessment at this visit, the acting manager showed us one she had done after our last visit. However, this had only been done for the top three stairs, which are on a bend. The main risk factor was, as we had pointed out last time, that the door on the ground floor is unlocked, and the stairs are open and very steep and winding at the top. Any resident opening the door would be met with these stairs. If they did climb them, there is a gate across the lower half of the upstairs door, so they would not be able to go anywhere but down again. There is a great risk that this could lead to a serious accident. Care Homes for Older People Page 7 of 20 The acting manager said she had totally misunderstood, and thats why she only risk assessed the top three steps. There was also no risk assessment in place about the likelihood of anyone leaning over or falling over the half gate. We have again asked for a risk assessment relating to the safety of the staircase. We recommend that advice is sought from Wiltshire Fire Brigade. We had previously been concerned at the providers failure to make an application for a registered manager. The acting manager has been in post since October 2008, when the previous manager left. The provider assured us at our meeting in August 2009 that the application would be sent in by the end of the year. On 20th October 2009, we wrote to the provider telling her she must make an application to register a manager. On 22nd February 2010, we sent a formal letter to the acting manager giving her six weeks to get the application in or tell us why there was a delay. A copy of this letter was also sent to the provider, Miss Cooper. The cut-off date was 5th April 2010. Neither of them responded. When we asked, during this visit why the application had still not been received, the acting manager said she was waiting for her CRB, which had expired. We discussed the time lapse between her taking up post and the application. We asked if she had checked her progress on-line, but this had not been done. She said her manager application is ready to go whenever her CRB is received. It is an offence under Section 11 of the Care Standards Act 2000 for a person to manage an establishment or agency without being registered with the Care Quality Commission (the CQC) in respect of it. We will therefore be taking legal advice about their failure to make an application to register. Meanwhile we have again told the provider that she must make an application to register a manager. The day to day running of the home is done by the acting manager. However, when we arrived at Mayfield, the acting manager was cooking lunch. She said she sometimes has to help out if staff are off for any reason. We said we were concerned about some of the things she had not done, and said that it was difficult to be the manager and do carer and cooking tasks. She agreed, and said she would talk to the provider about it. It is recommended that arrangements should be made for staff cover to be made available when needed, so that the acting manager does not have to do carer and cooking duties. During this visit, we spoke to the acting manager about her failure to meet previous requirements, and failure to make an application to register. We discussed her lack of knowledge of Deprivation of Liberty Safeguards, and her failure to be aware that vital care plans and risk assessments were not in place. We were extremely concerned to see that the acting manager had offered a placement in Mayfield to a person who fell outside of their current registration category of Older People, three of whom may have dementia. The new resident has a diagnosed mental health problem and has for many years been cared for both in psychiatric hospitals and in residential accommodation which is registered to care for people with mental health problems. When we asked the acting manager if she had considered the registration category when assessing potential clients, she said she had never even thought about it. When we asked Care Homes for Older People Page 8 of 20 about mental health training she admitted that staff had not had specific training. We intend to have an urgent management review, and to seek legal advice on all of these issues, but meantime we have made several requirements so that we can be sure that people are safe. We discussed the previous financial difficulties with the acting manager. She confirmed that the provider, Miss Cooper is in constant contact with the bank, and that that sufficient food is being bought for residents, that the bills are being paid and that staff are being paid. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 20 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 A nursing needs assessment must be sought urgently for the resident who has had frequent falls. So that the residents needs are known and can be fully met. 24/07/2009 2 9 13 Any medication brought in to 24/07/2009 the home by family must be recorded on the medication record and medical advice sought regarding its appropriate use. So that people are safe when taking medication. Not assessed at this inspection. 3 9 13 All medication must be stored securely. So that that residents are safe from any risk of having medication which is not intended for them. Not assessed at this inspection. 24/07/2009 4 9 13 All medication must be recorded on the MAR when given to a resident by staff. If it is not given for some 24/07/2009 Care Homes for Older People Page 10 of 20 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action reason, the reason must be recorded. So that people can be sure they have had their prescribed medication. 5 9 13 All medication must be given 24/07/2009 as prescribed until written authorisation is received. So that people can be sure their medical practitioner is aware of any medication changes. Not assessed at this inspection. 6 19 13 A risk assessment must be put in place with regard to the staircase in the ground hallway. So that people can be kept safe. 7 26 13 Bathrooms must not contain 24/07/2009 any toiletries which might be used communally. So as to prevent any potential cross infection. Not assessed at this inspection. 8 26 13 All bathrooms and WCs must 24/07/2009 have single use towels and soap. So as to prevent any potential cross infection. 24/07/2009 Care Homes for Older People Page 11 of 20 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Not assessed at this inspection. 9 26 13 Each bedroom must have a towel for people to dry their hands. To avoid the risk of any infection. Not assessed at this inspection. 10 26 13 All equipment provided for 24/07/2009 the use of residents must be kept clean. To avoid the risk of any infection. Not assessed at this inspection. 11 31 8 An application must be sent to the CQC in order to register a manager. So that a fit person is in day to day charge of the home. 12 33 26 The provider must make 24/08/2009 monthly monitoring visits to the home and produce a report of these. Copies of the reports must be sent to the CQC until further notice. So that we know the provider is monitoring progress. Not assessed at this inspection. 24/09/2009 24/07/2009 Care Homes for Older People Page 12 of 20 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 13 38 13 An up to date fire risk assessment must be put in place. So that risks to people in the event of a fire are minimised. Not assessed at this inspection. 24/07/2009 14 38 13 All equipment such as hoists 24/07/2009 and chairlifts which is used by residents must be serviced on a regular basis. So that people can be moved safely. Not assessed at this inspection. Care Homes for Older People Page 13 of 20 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, 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 3 14 The provider must obtain a copy of the assessment made relating to needs prior to offering a placement. So that people can be sure the home can meet their needs. 30/04/2010 2 7 15 All people with mental disorder must have a clear care plan about how this manifests itself and how it impacts on their life. They must also have a risk assessment in place. So that residents can be cared for by people who know their needs. 30/04/2010 3 7 15 All people who have kidney problems must have a care plan in place outlining how this affects, or does not affect, their daily lives. They must also have a risk assessment in place. So that residents can be cared for by people who 30/04/2010 Care Homes for Older People Page 14 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 know their needs. 4 7 15 All people with diabetes must 30/04/2010 have a care plan in place about how this is managed on a daily basis. This must include dietary information. They must also have a risk assessment in place. So that residents can be cared for by people who know their needs. 5 7 13 All people who have been 30/04/2010 assessed as needing to use the stair lift must have a risk assessment in place So that residents can be transported in a safe manner. 6 7 15 All people who smoke must have a signed, agreed plan about how this is managed. They must also have a risk assessment in place. So that residents rights are respected and any risk is considered. 7 7 18 All staff completing risk assessments must have training in how to do so. So that residents are cared for by staff who know how to measure risk. 8 7 13 All risk assessments must be 30/04/2010 clearly rated and evidenced, with clear guidance on how to mitigate the risk. Page 15 of 20 30/04/2010 16/06/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 So that residents are cared for by staff who are aware of the risks. 9 7 15 All people who have teeth and mouth problems should have a care plan in place about how this is managed on a daily basis. They must also have a risk assessment in place. So that residents can be cared for by people who know their needs. 10 7 13 Where an assessment is made about mouth care, saying the mouth should be cleaned after meals, staff must record that this is done. So that residents are sure they get the support they need. 11 8 14 The owner must provide scales which can weigh accurately all residents, and all residents must be weighed on a regular basis. So that any weight loss or gain can be recorded and any underlying illness investigated. 12 8 18 All staff must have mental health training,with specific reference to bi-polar disorder, and how this affects people. 16/06/2010 16/06/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 16 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 So that residents can be cared for by people who understand their condition. 13 8 13 A nursing needs assessment 30/04/2010 must be sought urgently for the resident who is cared for mainly in bed. So that the residents needs are known and can be fully met. This is the second time we have made this requirement. 14 9 13 The Medication Administration Record must accurately reflect the date. When handwritten changes occur, the changes must be witnessed by two staff members. So that clear records are kept of when peple get their prescribed medication. 15 9 13 All medication must be recorded on the Medication Administration Record when given to a resident by staff. If it is not given for some reason, the reason must be recorded. So that people can be sure they have had their prescribed medication. This is the second time this requirement has been made. 30/04/2010 30/04/2010 Care Homes for Older People Page 17 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 16 18 13 A risk assessment must be put in place regarding the half door at the top of the staircase. So that people can be kept safe. A risk assessment must be put in place with regard to the staircase in the ground hallway. So that people can be kept safe. This is the second time we have made this requirement. 30/04/2010 17 19 13 30/04/2010 18 31 8 An application must be sent to the CQC in order to register a manager. So that a fit person is in day to day charge of the home. This is the second time we have made this requirement. 14/05/2010 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 2 7 19 Risk assessments should be further developed to give a consistent scoring method. The board which is kept on the wall in the sitting room and tells residents about that days staffing, should be changed daily so that residents have an accurate picure of who will be supporting them Page 18 of 20 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 31 Arrangements should be made for staff cover to be made available when needed, so that the acting manager does not have to do carer and cooking duties. The acting manager should have training in the Mental Capacity Act, Deprivation of Liberty Safeguards. 4 31 Care Homes for Older People Page 19 of 20 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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