Care Home: Orchard Lodge

What the care home does well The care staff friendly and supportive and were able to demonstrate that they have a good understanding of the people they care for. They also endeavor to provide a comfortable homely environment for the people living in the home. What has improved since the last inspection? Small changes have been implement provide better privacy screening in the shared bedrooms. Staff are beginning to receive the training and supervision they require to carry out their roles. What the care home could do better: The practices for record keeping in the home should be robust and detailed in regard to the assessment, care planning and supporting information so that service users receive the care that they require. The arrangements for the people living in the home to receive their prescribed treatments or medication should be safe and protect the individuals concerned. The practices for the recruitment and employment of staff, including training should be implemented robustly to protect the people living in the home from being supported by inappropriate staff. Key inspection report Care homes for older people Name: Address: Orchard Lodge 36 Baskerville Road Sonning Common Reading Berks RG4 9LS     The quality rating for this care home is:   zero star poor 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: Ruth Lough     Date: 1 4 0 6 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 29 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 29 Information about the care home Name of care home: Address: Orchard Lodge 36 Baskerville Road Sonning Common Reading Berks RG4 9LS 07855261889 01613709080 nageeb@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Nageeb Aubdool The registered provider is responsible for running the service care home 11 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 1. The maximum number of service users to be accommodated is: 11 2. 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: Dementia (DE) Date of last inspection Brief description of the care home Orchard Lodge is a small private family run care home that can offer support to 11 residents who have a primary need of dementia. The home is situated in a quiet residential area of Sonning Common and is able to access the local healthcare and community facilities there. The home does not have a lift to the first floor which means that some of the residents must be able to manage stairs safely and independently. Care Homes for Older People Page 4 of 29 Over 65 0 11 0 2 1 1 2 0 0 9 Brief description of the care home Current fees range from £462.70 to £700.30 per week. Residents are charged separately for hairdressing, toiletries, and some activities as and when they occur. Care Homes for Older People Page 5 of 29 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: zero star poor 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 was an unannounced key inspection process generated from concerning information received by the commission about the home. Following the last Key Inspection in November 2009 the home was rated as providing an Adequate or 1* quality of service and 3 requirements and some good practice recommendations were made to improve the outcomes for the people living there. The registered manager was present when we visited the service on 14th June 2010, between 09:55 and 16:30. During the day the records for care planning, recruitment, and administration of the service were assessed. We observed the residents going about their daily lives and we met with 7 staff and 1 relative who were present in the home. From this inspection of the service there were a number of key areas identified that will Care Homes for Older People Page 6 of 29 need to improve significantly as to protect and support the people living there. To ensure that the provider takes those steps, 5 requirements were made, 2 of which are in reference to areas found not to be met during the last inspection process. This has been recognized as consistent poor practice and therefore the commission is considering taking enforcement action as to ensure that the provider meets their legal responsibilities. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. Care Homes for Older People Page 7 of 29 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 29 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 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service cannot be assured that they will have their needs assessed thoroughly before they are offered a place in the home. Evidence: During the last inspection visit it was identified that there were deficits in the quality of the processes carried out to assess if the home is able to meet prospective residents needs. We were informed by the Provider/Manager at the time that a new document tool and records were going to be implemented to ensure that complete information is obtained about individuals needs before that are offered a place in home. We were informed during this inspection visit that during the last 7 months, there have been a very small number of residents admitted to the home. We looked at 2 records for those who have been admitted during that period, one of whom was due to commence a respite stay on that day. This was to see if the process is sufficiently Care Homes for Older People Page 10 of 29 Evidence: detailed, ensures that holistic information is obtained and that prospective residents are involved with the decision to use the home. The records that were reviewed showed that there was an inconsistent approach to assessing individuals needs. For one person the information was adequate to identify that the home would be able to meet their needs. The other lacked clarity of what the purpose of the stay in the home would be and the supporting evidence that key information had been sought. Neither new residents had been previously referred to the home via a local authority or had provided information from an assessment process carried out by one. Care Homes for Older People Page 11 of 29 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. The people living in the home cannot be certain that they will receive the personal care, medication and support that they require. Evidence: All of the residents who were observed during the inspection visit appeared appropriately dressed and supported with their personal grooming. A relative to who we spoke to expressed that they had no concerns about the quality of the personal care support that their relative receives. At the last inspection it was found that the documented care planning was weak in parts. There was also a mix of template tools and methods of keeping the information which could be difficult for staff to ensure instructions are followed of how to deliver the care and support that people need. The Provider/Manager informed the commission at that time that new recording tools would be implemented as soon as possible to be able to achieve a consistent approach to providing support in the home. We reviewed 4 care planning records, including those identified previously to see what Care Homes for Older People Page 12 of 29 Evidence: had been implemented and if there was comprehensive information for staff to deliver the care which residents may need. What could be seen from all the sampled care records was that new care planning tools had been implemented of which the majority were detailed and informative of how staff were to achieve meeting individuals needs. The topics of care range from personal care, dressing, mobility and supporting their mental health. Included was information about individuals chosen daily routines and personal choices of how they want the care to be provided. However, it was apparent that for one new resident this had been developed without comprehensive information from an initial assessment process and it was unclear of how they had obtained the information to develop an appropriate care plan. For another, information of an ongoing monitoring task carried on behalf of the District Nursing team had not been identified in the care planning as to continue to being carried out. Most of the records had only been implemented in the latter months and two showed evidence that they had been reviewed recently. The supporting monitoring records that accompanied the care plans were also reviewed. We looked at what is routinely used and at the records for any specific needs that individuals may have. These appear to be those relevant to moving and handling, a general risk assessment, dependency (Waterlow) score, a nutritional assessment and fire safety. However, there was a significant concern in regard to some of these records as a number had not been reviewed or updated and the risk assessments did not fully support they had been carried out using recognized good practice guidelines. Information is kept to show that residents were supported to obtain any medical care or treatment they may require. Practitioners are encourage to complete part of the care records to provide detail of what treatment or activity was carried out with their patient and any instructions for staff to follow. The practices for medication administration were discussed and reviewed to see if they are managed safely and that residents obtain what they are prescribed. The home use a Monitored Dosage System prepared by the local pharmacy, with additional medications for as required or short term treatment. They continue to use a dedicated secure cabinet for the storage of medications and the MAR(Medication Administration Records) charts. A sample of these records were assessed to see if staff are recording appropriately any actions taken. We could see that at least 3 residents had not received their medications as prescribed and that a satisfactory explanation had not been record why this had not occurred. Care Homes for Older People Page 13 of 29 Evidence: The storage practices for eye drops or the policies or procedures for medication administration were not reviewed during this inspection. However, information about the training provided to staff for this was and will be outlined later in this report. Care Homes for Older People Page 14 of 29 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. The people who use the service are given some opportunity to exercise choice over their lives and how they wish to conduct their lives. Meals and menu planning appear to meet their health needs and personal choices and support is given when required. Evidence: We looked at what the service has in place to ensure that individuals choices and wishes of how they want to be cared for, the social contact they participate in and how they want to conduct their lives is supported. The care planning records and those held in the home for activities were reviewed. We were also informed by staff, residents and relatives of what has occurred or is intended to be provided. We could see that personal choices and interests had been noted and that any chosen daily routines are now incorporated in the new care planning records. However, none of the care records had individual activity plans for each person or had recorded any outcomes from any involvement they may have had. Ensuring that this is recorded and included in the planned care would aid staff to find and provide suitable activities for individuals particularly those with dementia or short term memory loss. We were shown records supporting that a planned formal activity is carried out in afternoon each day, the names of those who participated and the theme of the activity are Care Homes for Older People Page 15 of 29 Evidence: noted. However, it could be seen that some topics are repeated frequently and there is at times a lack of variation. During the day residents were seen to have papers, books or other items they were interacting with and at other times sitting quietly and not involved in any activity. We were informed that there were no organized activities outside of the home, only those which were arranged for individuals by their families. Staff have continued to provide events or celebrations reflecting either individuals birthdays or calendar dates which residents have enjoyed. We were informed by the provider of the planned coffee mornings, barbeques and other activities which would be provided in the future. We looked and the meals and the management of the provision of good food and nutrition in the home. This was because of some concerns about the quality, quantity and availability of nutrition and food provided being forward to the QC (Care Quality Commission). There was also a concern about the equipment in the kitchen not working and staff having the competencies and skills to cook main meals when the cook was not working in the home. The cook, who was present during the inspection, provided information about the planned menu and how individuals choices and dietary needs are accommodated. The arrangements for how groceries and other stores are obtained was discussed and the provision of meals for the home at weekends or when she is not on duty were outlined. The midday meal was observed and it could be seen that residents are encouraged to join others to eat together and staff confirmed that only one resident currently requires full support and one who needs partial assistance at meal times. All the residents appeared to enjoy what had been provided. It was unclear of how the staff in the home use the information from the nutritional risk assessments carried out on individuals is used within the meal and menu planning for the home. Care Homes for Older People Page 16 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents and relatives cannot be certain that their concerns or complaints will be listened to and acted upon. Staff have now been provided with the necessary training to support their knowledge to protect the people living in the home from possible abuse or harm. Evidence: We looked at the processes in place for how the staff in the home manage any complaints, concerns or comments made about the service. This was because the commission had been informed that a formal concern made to the home had not been acknowledged or responded to. We have been informed that residents are provided with a copy of the complaints process which could be seen on display in the bedrooms that were reviewed during this inspection. In addition the Provider/Manager stated they had acted upon advice given at the last inspection to implement a complaints log to monitor trends of concerns made. The record did not include any complaints made since the last inspection process or the concern expressed to the commission prior to the visit to the home. The Provider/Manager said he was unaware that a complaint had been made to the home. There were areas of concern seen at the last inspection process and in the visits subsequently made by the local social services that not all staff had undertaken the Care Homes for Older People Page 17 of 29 Evidence: necessary training or retraining for safeguarding residents from abuse. The Provider/ Manager had previously stated at the last inspection visit that new staff had been provided with some knowledge within their initial induction programme and established members of the staff had revisited the topic. Information given during this inspection visit supports that the majority but not all of the staff team currently employed have recently received training. For one member of staff, although indicated that they had participated there was no certificate of completion held to support this and we were unable to verify with the individual, as they were not present during the day, that they had attended. Care Homes for Older People Page 18 of 29 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 adequate 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 comfortable for residents and meets the majority of the current needs of the people who live there. Evidence: The home is not purpose built and has limited personal and communal spaces. During the last inspection it was identified that there were a few areas of improvement that could be implemented and from what could be seen some steps have been made to meet them. The screening in shared rooms has been lengthened to offer greater privacy to the occupants when personal care and support is given. Some repairs to commodes and light pulls have been replaced to reduce the risk of either injury to service users or minimize cross infection. The concern about suitable heating in the upstairs bathroom has not yet been addressed and throughout the home there remains a mixture of quality of furniture, fittings and decoration. The Provider/Manager stated that plans were in progress to update the bathrooms and toilets, although no definitive date or actions had been decided. There has been no significant change to the facilities for residents with the exception of the rear garden has been improved for them to use. None of the bedrooms have en suite facilities and as there is no lift the first floor bedrooms can only be used by people who able to manage stairs. Care Homes for Older People Page 19 of 29 Evidence: Bedrooms, bathrooms and the communal spaces appear to be kept clean, and tidy by staff. The laundry room was also clean and tidy, and the protocols for cleaning commode pans there as there are no separate sluice facilities, are in place. Overall the programme of refurbishment and repair is slow to be implemented. During the inspection process one resident had a fall in the ground floor bathroom and although not necessarily attributed to the condition of the floor covering there, it could be seen that some damage or wear and tear to it compromised the management of the control of infection. Care Homes for Older People Page 20 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes staffing levels do not always meet the needs of the people they support and some have not had the necessary training they require to carry out their roles. The recruitment process is now carried out adequately but evidence is not kept to confirm that other employees are fit to work in the home. Evidence: The commission had been provided prior to the inspection visit with concerning information in regarding staffing at the home. During the last inspection process in November 2009 there were a number of issues raised about the quality of the recruitment practices and the training provided to staff. Following that inspection, we were informed by the Provider/Manager that the deficits had been met. We looked at the records and information about the staff compliment, the recruitment practices and the training provided to see if sufficient skilled and experienced carers are employed to meet the needs of the residents. The duty rota for the current and previous two weeks were reviewed to see what is planned and actually carried out in regard to staff working in the home. From what could be seen the intention is to provide the minimum of 2 carers present to support the residents at all times, including at night. Additional members of the staff team appear to be present during the working week for domestic and catering roles and Care Homes for Older People Page 21 of 29 Evidence: from information given by the Provider/Manager additional management support has recently been implemented, to lead the care provision and administration of the service. The rotas we reviewed had been amended and changed several times and it was evident that some staff were working very long hours and on at least one occasion, one member of staff was on their own at night. Also clarity should be recorded to show that those members of staff who are on a limited visa permit only work the hours they are permitted to. We looked at the recruitment and employment practices carried out as to ascertain that the deficits seen at the last inspection process have been rectified. A sample of 3 records were reviewed which included 2 who had joined the staff team since the home has been under new ownership in June 2009, and one who had commenced working there prior to this. From what be seen there had been some improvement in the recruitment process with the standard of record keeping supporting they are beginning to evidence that the detail in the application forms for work history is assessed and an interview process is carried out. However, there was no evidence that for one employee who had been working in the home for over a year that a Criminal Records Bureau and Protection of Vulnerable Adults list check had been carried out or that recent changes to their status to work in the UK had been verified. Additionally supporting evidence that they had had the training they required to carry out their role had not been retained. The records for managing the training needs of all the staff, and copies of certificates available for the 3 members of staff used to assess the employment practices of the home showed that there were gaps in insuring that they had had sufficient training to carry out their roles. Only within the last 6 months has some progress been made to provide training, and during the last few weeks this has included medication and Safeguarding Adults. However, it was concerning that some members of staff appear not to have had training for basic safe working practices such as moving and handling. Also it was evident during the day of the inspection that staff had not administered medications as prescribed even though they had apparently recently had training to be able to do so. Care Homes for Older People Page 22 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always run in the best interests of the people living there. Evidence: Recent concerns received by the commission highlighted that the management of the service was possibly inconsistent and that at times staff were unsupported to carry out their roles. The Provider/Manager was able to give information that in recent weeks the management hours had increased and this could be seen in the developments with imputing new care planning tools for some of the residents, and staff meetings and training that have occurred. However, the deficits identified within this inspection process show that progress has been slow to rectify some of the concerns seen during the last inspection and actions to maintain the safety and wellbeing of the residents may have put them at risk from harm. Care Homes for Older People Page 23 of 29 Evidence: The Provider/Manager did provide information that there is a process in place for consulting with residents and relatives, last carried out in April but as yet not analyzed. The deficits seen previously in November 2009 in regard to the use of Control of Substances Hazardous to Health Regulations (COSHH) 1988 items in the home has been addressed as they now have the respective information and instruction for staff. The issues identified throughout the report including those in regard to medication administration, environment, staff training and recruitment practices all contribute to the final rating for the management and administration of the service. Care Homes for Older People Page 24 of 29 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 29 19 The registered person should 31/12/2009 not employ a person to work in the home that he has obtained full and satisfactory evidence that they are able to do so. You should ensure that you have obtained satisfactory evidence including professional references from previous employment in a care provision and that the person is able to work. 2 30 18 The registered person should 31/03/2010 ensure that the persons employed in the care home receive the training appropriate to the the work they are to perform. You should ensure that there is a staff training and development programme that meets the recognised standards for people employed in a care service provision. Care Homes for Older People Page 25 of 29 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 3 14 The registered person 28/08/2010 should ensure that they shall not provide accommodation to a service user unless the needs of the individual have been assessed thoroughly. You should ensure that records are kept to support that the assessment of individuals needs has been carried out thoroughly before a decision is made to offer them a place in the home. The Registered Person 28/08/2010 should maintain a record in respect of each service user which is kept up to date and reflect the individuals assessed needs. You should ensure that the care planning records and the accompanying processes for monitoring of individuals well being are accurate and reviewed regularly to ensure Page 26 of 29 2 7 17 Care Homes for Older People 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 that staff are given the necessary instruction to be able to meet their needs. 3 9 13 The Registered Person 28/08/2010 should make the arrangements to ensure that service users receive their prescribed medications which are administered by suitably trained and skilled staff. You should make sure that the people you support receive the medication and treatment they are prescribed. Your staff should be trained with the appropriate level of skill to do this task safely and effectively. 4 27 18 The registered person should ensure that at all times suitable qualified, competent, and experience persons working in the care home to meet the health and welfare needs of the people living in the home. You should make sure that there are enough trained and skilled people employed to meet the needs of the people living in the home. 28/08/2010 Care Homes for Older People Page 27 of 29 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 5 29 19 The registered person 28/08/2010 should ensure that they do not employ a person to work at the care home unless they have obtained and hold the supporting evidence that they are fit do so. You should ensure that the people you employ to work in the care home have been employed through a robust recruitment process, provided with the necessary training and are present in the home in sufficient number to meet the needs of the vulnerable people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 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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