Care Home: Nesfield Lodge

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What the care home does well The home provides a comfortable and pleasant place for people to live. We saw that people have personal belongings such as photographs in their rooms and this helps to create a more homely environment. There is a large enclosed garden which means that people have access to safe outdoor area. The staff are kind and caring and treat people with respect. What has improved since the last inspection? At the last inspection we told the home that people`s bedroom doors should not be locked as this restricted people`s access to their rooms. This has been dealt with. What the care home could do better: The home has taken action to deal with the concerns about how people`s needs are being met. They must continue the work that has started on the care records to make sure that they provide accurate and up to date information about the care and treatment given to people. This will help to make sure that people get the right care and support. A more person centred approach to social care should be developed to make sure everyone living in the home gets the support they need to make the most of their abilities. The way people`s personal clothing is managed should be improved to make sure people`s dignity is not compromised. Staffing levels should be kept under review and changed to take account of people`s changing needs. Staff should be given more support to put their training into practice to make sure they are able to meet people`s needs. The company`s systems for monitoring the quality of the service should be reviewed to make sure shortfalls are identified and dealt with promptly. Key inspection report Care homes for older people Name: Address: Nesfield Lodge 45 Nesfield Road Belle Isle Leeds LS10 3LG     The quality rating for this care home is:   one star adequate 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: Mary Bentley     Date: 2 9 0 4 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: Nesfield Lodge 45 Nesfield Road Belle Isle Leeds LS10 3LG 08456044977 01132771347 nesfield.lodge@orchardcarehomes.com bob.stafford@orcharcarehomes.com Orchard Care Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Tina Garside Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Service users with Dementia - Code DE, Old Age, not falling within any other category - Code OP 2. The maximum number of service users who can be accommodated is 44 Date of last inspection Brief description of the care home Nesfield lodge is a 44 bedded care home situated in the Belle Isle area of South Leeds. It is a new build and was specifically designed to provide care for people with specialist dementia needs. It has been built within a local urban area with many local amenities at its disposal. The public transport systems are very accessible and there are regular bus routes to all areas of Leeds. Care Homes for Older People Page 4 of 26 Over 65 0 44 44 0 3 0 0 9 2 0 0 9 Brief description of the care home In September 2009 the weekly fees charged by the service ranged between £510 and £560. Please contact the home for details of the current charges. 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: one star adequate 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: The last inspection of this service was carried out on 30 September 2009. Since then we have received information about the service which raised concerns about how well peoples needs are being met. The purpose of this visit was to assess how well the home is meeting the needs of people using the service. On this occasion we did not ask the home to complete an annual quality assurance assessment (AQAA) as they had completed one prior to the inspection last year. We did not send surveys to people using the service. A visit to the home was carried out by one inspector, this visit was unannounced. We spent 8 hours in the home and during that time we spoke to people using the service, staff and management. We observed staff as they carried out their duties, looked at various records including care records and looked around the home. At the end of the Care Homes for Older People Page 6 of 26 visit we gave feedback to the management team. This report is based on the findings of our visit and information we have received about the service since our last visit from the home and from other organisations. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely enforcement action will be taken. 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 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 8 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 9 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. There are suitable systems in place to make sure people are given information about the service and their needs are assessed before they move in. Evidence: When we visited the home had temporarily stopped taking new admissions. The company sent a letter to people explaining that this was There have been some concerns raised surrounding internal communication, documentation and staffing levels that could negatively affect the quality of care provided The home is working with other agencies to resolve these concerns. When we visited in September 2009 we found that people were given information about the service and their needs were assessed before they moved in. The manager confirmed that when the home is open for admissions peoples needs will be assessed before they move in. Care Homes for Older People Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the care plans contain enough information to enable staff to meet peoples needs. Improvements are being made to make sure the plans include information about peoples abilities and preferences and to make sure there are accurate and up to date records of the care given to people. Staff are kind and respectful in the way they care for people. Evidence: During the visit we looked at four peoples care records. Everyone has a care plan setting out how their health, personal and social care needs will be addressed. The company has standardised paperwork which they use to assess and record peoples needs and the care files are well organised which makes information easy to find. Staff were having additional training on care planning when we visited. One of the senior care staff explained she was in the process of re-writing a persons care plan to include more detail about what they could do for themselves and what they needed help with. We saw in the records that the care plans and risk assessments are generally kept up to date. Care Homes for Older People Page 11 of 26 Evidence: Conerns had been raised about how peoples nutritional needs were being met. The home has taken action to address these concerns. For example, nutritional risk assessments have been updated, a number of people have been referred to the Dietician and charts have been put in place to record peoples dietary intake, fluid and food. When we looked at the charts we saw that fluid intake was being recorded in both fluid ounces and millilitres, on some charts both units of measurement were being used. This is confusing and makes it harder to accurately assess peoples intake. We asked staff why they were measuring in fluid ounces when the charts showed that the record should be in mls (millilitres). It was apparent they had not been given clear instructions on how to complete the charts. We also saw that they way the chart was laid out made it difficult for staff to record accurately what people were eating. This was discussed during the visit with a member of the companys senior management team. She said she would deal with it. However, the charts did show that people were receiving adequate amounts of fluids. We looked at how often peoples weight was being monitored and saw that when people are identified at being at risk they are now weighed every week. However, there was no chart to record weekly weights and staff were not sure where to record this information. This was dealt with during the visit and a chart to record weekly weight was put in place. While talking to staff we found that some did not fully understand metric weight measurements, (kilogrammes) and there was no conversion chart available to show them what the measure meant in imperial measurements. The weighing scales can show weights in either measurement but the staff we spoke to were not aware of this. This was discussed and during the visit a conversion chart was provided. Concerns had been raised that people were not getting the help they needed with personal care. During the visit we saw that people looked well clean and well cared for. The records showed that people have access to a range of NHS services and visits from GPs and district nurses are recorded. We saw that requests for specialist equipment had been made, for example, pressure relieving mattresses had been requested for people identified as being at risk of developing pressure sores. We saw some evidence that people or their representatives are involved in planning and reviewing care. However, their was no information to show that peoples capacity to make decisions had been assessed and was taken into account when planning care. For example, in one persons records there was consent to medication form which had Care Homes for Older People Page 12 of 26 Evidence: been signed by their relative. There was no information to show that the persons capacity to make this decision had been assessed or that the decision had been made in their best interests. This was discussed with a member of the senior management team during the visit. She told us the company is in the process of developing new care documentation which will reflect the requirements of the Mental Capacity Act. During the visit we saw one of the senior care staff giving out medicines. They were doing this safely and we did not identify any concerns about the way peoples medicines are managed. The atmosphere in the home was relaxed and we saw that staff were kind and patient in their interactions with people. The showed respect for people, for example we heard one person being asked whether she wanted a male or female carer to help her get dressed. This judgement is based on the evidence that the organisation is taking action to address the concerns about the way peoples health and personal care needs are met. They have given assurances that they will continue to provide additional resources to make sure the necessary improvements are made. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are activities organised for people to take part in but a more person centred approach to social care should be developed to make sure everyone gets the right support to make the most of their abilities. Evidence: Daily routines are flexible for example people can go to bed and get up at times that suit them. We saw evidence of this during the visit, some people were being helped to get up around 10:30 am. The care records we looked at had information about peoples past lives, their experiences and their interests. The staff we spoke to knew about the people they are caring for and understood their different needs. There is information displayed about planned activities, for example events are planned for Fathers day and Ladies day at Ascot. Photographs are displayed showing people enjoying events that have taken place. The home has developed links with a local school and some of the childrens paintings were on display. The home does not have an activities organiser and care staff are responsible for supporting people to take part in planned events and spend their time meaningfully. Care Homes for Older People Page 14 of 26 Evidence: During the visit we saw that there was not a lot going on for people to engage with. During the morning on the first floor there were no activities, the radio was on. Staff interacted with people as they went about their duties but this was often task led, for example when helping someone to have a drink. On the ground floor in the afternoon we saw two people playing dominoes with support from staff and some people visited the hairdresser. There was a black and white film on the television but it wasnt clear how many people were actually watching it, several people were asleep in their chairs. People with dementia can find it difficult to concentrate in group activities and need more one to one time. Staff understand this but said they do not always have enough time to spend with people individually. We observed meal service at lunch time on the first floor. There was a choice of two main courses and the meal service was well organised. Staff were available and helped or prompted people discreetly. One person did not want the first meal they were given and staff offered an alternative meal which was also refused. Staff said they would offer the person a sandwich later. There are snack foods available for staff to offer to people and we saw that evidence in the records that people are offered snacks outside of set meal times. However, there is no snack or finger food around for people to help themselves to. Making food available in this way has been shown to be an effective way of encouraging people to eat more. This was discussed and the management team said they would address it. Care Homes for Older People Page 15 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. There are suitable systems in place to make sure that complaints are taken seriously and acted on and to make sure people are protected. Evidence: The company has a complaints procedure. Information about the complaints procedure is displayed in the home and included in the service user guide. Three referrals have been made to the local authority safeguarding adults unit this year. The investigations have been completed in two cases and the third is still in progress. The home has co-operated fully with these investigations and is taking action to address the areas where shortfalls were identified. Staff spoken do during the visit were aware of the different ways in which people can be abused and understood how the safeguarding training they had received related to their day to day working practices. For example, they told us that not giving people the help they need when they need it is a form of abuse. They understood how to report any concerns they might have within the organisation and were aware of the whistle blowing policy. However, when asked about reporting concerns outside of the organisation they were not sure who they should contact. This was discussed. Care Homes for Older People Page 16 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. The home is clean and provides a safe and comfortable place for people to live. The home should continue to keep the laundry systems under review to make sure peoples personal clothing is laundered to an acceptable standard. Evidence: When we visited the home was clean, tidy and free of unpleasant odours. At the last inspection in September 2009 we told the home that peoples bedroom doors should not be locked at this was restricting peoples access to their bedrooms. This has been dealt with. We saw that people have personal belongings, such as photographs, in their rooms. The home has some patio doors at ground floor level. One is in the lounge and gives access to an enclosed garden. The other is in a bedroom which and leads directly onto the car park. The home told us the doors are locked when not in use but do not have alarms fitted. In order to improve security we recommend that alarms are fitted. Concerns had been raised about the way peoples clothing was laundered. When we looked around we saw that some clothing was stained and some peoples whites had turned grey. The manager told us that the home has now made changes to the way they use the laundry products to resolve this problem. The laundry assistant told us the new system had just started a few days before we visited but already there was Care Homes for Older People Page 17 of 26 Evidence: an improvement. We talked to the manager about the way peoples personal clothing is labelled, the home is using a marker pen to put peoples initials and/or room numbers on their clothes. This is not good practice. The manager told us the she would contact the companys purchasing department who would be able to provide proper labels for peoples clothing. Concerns were raised by professionals visiting the home that protective equipment such as gloves and aprons were not easily accessible. The home has put a checking system in place to make sure these items are readily available to staff and visiting professionals. This will help to reduce the risk of cross infection. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are usually enough staff to meet peoples needs. Staff are being provided with training however they need more support to put this training into practice so that they can apply their knowledge and develop their skills. Evidence: When we visited there were 37 people living in the home and there were 6 care staff on duty. The manager was on duty but not included in the numbers. There were also 2 staff in the kitchen, one doing housekeeping and one in the laundry. The manager told us the number of staff on duty has been increased and there are now 6 care staff on duty all day, from 8:00 am until 8:00 pm. The manager told us that when necessary agency staff are used to make sure there are enough staff on duty. The home has some vacancies for care staff and interviews had been arranged for the week following our visit. The duty rota is organised so that staff generally work 3 days on and 3 days off, these are 12 hour days from 8:00 am to 8:00 pm. This should be reviewed as it may not be in the best interests of people living in the home or staff. Working with people with dementia can be demanding and staff need regular rest periods. Some staff said they found it hard, particularly when they are getting toward the end of their third day. This was discussed. Care Homes for Older People Page 19 of 26 Evidence: The manager told us that the home had been using staff from other departments, such as the kitchen, to cover care duties but they are no longer doing this and staff are now working in their allocated departments. Staff told us that staffing levels have improved but said they would like to have more time to spend with people in one to one activities. They said there is a high staff turnover which makes it harder to give people continuity of care. The manager told us that there has been a lot of staff training in recent weeks. This was supported by the training records and confirmed by staff. However, from our discussions with staff it was clear they need more support to put the training into practice. We looked at three staff files to check the homes recruitment procedures. The manager told us the companys policy is that interviews are conducted by two people and an interview record is completed. One member of staff told us they had been interviewed by one person and when we checked the file we saw that the interview notes had not been signed. The manager confirmed that the interview had been carried out by the deputy manager on her own. In the same persons file we saw that two written references had been obtained, however one was a personal reference and the other only confirmed dates of employment with a previous employer. The manager told us that the companys Human Resources department are responsible for obtaining references. However, the registered manager still has a responsibility to make sure the references are satisfactory. This was discussed. In the two other files we saw that the required checks had been completed before new staff started work, however, there was no interview record in one of the files. The manager told us that when new people start work they have a week induction training before they join the care staff and then they shadow a more senior member of staff for approximately a week before they are included in the care staff numbers. Staff we spoke to confirmed this. The home has a programme of NVQ (National Vocational Qualification) training and staff were being enrolled on the day we visited. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to make sure the home is managed properly however the quality monitoring systems should be improved to make sure planned improvements are implemented and maintained and to make sure people experience good quality outcomes in all areas of the service. Evidence: The registered manager has been in post since the home opened in 2009. She has a lot of experience caring for people with dementia and is clearly committed to providing good quality outcomes for people. However, she has limited management experience and this is her first management position. In response to the concerns raised the company have provided additional management support. An experienced administrator has been allocated to the home and this will enable the manager to concentrate on the delivery of care. It was not clear at the time of the visit if a permanent administrative support worker will be appointed. An experienced manager from another home, owned by the company, is Care Homes for Older People Page 21 of 26 Evidence: providing support with staff training and supervision; she was in the home on the day we visited training to staff on care planning. A project manager from the company has been allocated to the home and will be spending at least 3 days a week there for the foreseeable future supporting the manager and focusing on care practices. In addition the area manager is visiting the home at least twice a week to monitor the quality of the service and provide support. The company has quality monitoring systems in place which include monthly visits by a senior manager. The purpose of these visits is to look at the quality of the service, identify areas for improvement and agree an action plan with the home manager to address shortfalls. The effectiveness of these quality monitoring systems has been called into question because the concerns raised with external agencies had not been identified and dealt with by the company. The company acknowledges there have been shortfalls in their auditing systems and are taking action to deal with this. They have put an action plan in place to address the shortfalls in the service. We have asked them to provide with a monthly report on their progress so that we can check that improvements continue to be made. In the past two weeks the company has carried out audits of various aspects of the service including medication, training records and peoples money. The visiting administrator told us she had also checked to make sure the staff files were in place and said a more detailed audit of the staff files was planned. The manager told us that team supervisions have been taking place to make sure staff are made aware of their responsibilities, particularly with regard to record keeping. Records of these supervisions were seen. However, some staff told us they felt communication from management could be improved, they said they are getting different information from different people and this does not help them to be clear about their roles and responsibilities. This was discussed. We did not identify any concerns in relation to the management of health and safety during our visit. Care Homes for Older People Page 22 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 23 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 1 8 12 The records of the care and treatment provided to people must be up to date and accurate. To make sure proper provision is made for peoples health and welfare. 25/06/2010 2 33 26 The Commission must be provided with copies of the monthly reports carried out in accordance with the requirements of this regulation. So that we can check that the required improvements continue to be made. 10/09/2010 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 7 The care records should include information about peoples capacity to make decisions. When people lack capacity and Care Homes for Older People Page 24 of 26 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 decisions are made by others in their best interests this should be recorded. 2 12 A more person centred approach to social care should be developed so that everyone gets the right support to make the most of their abilities and spend their time meaningfully. Snack foods should be available around the home so that people can help themselves and are not solely reliant on staff offering them snacks. Information on how to report concerns to external agencies should be made available to staff. To improve security alarms should be fitted to the external patio doors on the ground floor. The home should continue to monitor the effectiveness of the changes made to the laundry systems to make sure peoples clothing is laundered to an acceptable standard. The system for naming peoples personal clothing should be improved to make sure peoples clothes are returned to the right people when they have been laundered. Staffing should be kept under review and adjusted to take account of peoples changing needs. The review should take account of the experience and skills of staff as well as the numbers. This will help to make sure there are enough suitably trained and competent staff available to meet peoples needs. The companys recruitment procedures should be followed at all times, interviews should be carried out by 2 people and interview notes should be available in the files. The systems for monitoring the quality of the service provided should be reviewed to make sure that shortfalls are promptly identified and dealt with. This will help to make sure that people using the service experience good quality outcomes. The systems for staff supervision should be reviewed to make sure staff are getting the support they need to put their training into practice and are clear about their roles and responsibilities. 3 15 4 5 6 18 19 26 7 26 8 27 9 29 10 33 11 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. © 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. 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