Care Home: Redruth Nursing Home

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What the care home does well People who use the service and relatives spoken with were full of praise for the manager and staff and were happy with the care and support that they were receiving. They were confident that if they had any concerns, they would be listened to and acted on. Visiting arrangements are flexible and visitors were seen to come and go throughout the day. People confirmed that staff are welcoming and supportive of friends and families. There is an experienced staff team and staffing levels were good which helped to ensure that people were getting care and support as and when they needed it. What has improved since the last inspection? A statement of purpose and a service user guide have been developed since the last inspection, providing people with information about the services provided. A complaints procedure is included within these documents. There had been a general improvement in the management of medication and systems were more robust, though we did find what appeared to be an isolated incident where there was no clear audit trail. Some staff have received safeguarding of vulnerable adults training and more was scheduled for the end of July 2009. Improvements to the premises are being made as part of an ongoing redecoration and refurbishment programme. We did not identify any odours indicating that this problem has been resolved since the last inspection. Work had taken place to limit the water temperature to a safe level. What the care home could do better: The service user guide needs to include details of the fees in order that people are able to understand the costs involved and reasons why there may be differences in fees charged. The admission process needs to ensure there is clarity about a persons primary care needs to ensure that they are within the category of registration. While we found that people were receiving a good standard of care, the care plans need to be more personalised and consider individual preferences and needs, in relation to lifestyle, daily routines and care needs. This will help to guide staff in providing more individualised care and enhance people`s daily lives. There is a need for further re-decoration and refurbishment, which the Registered Provider is aware of. Improvements are needed in staff recruitment and staff training to ensure that people are safeguarded and staff have the knowledge and skills to meet their needs safely.An application for registration needs to be submitted for the manager to comply with legislation. Key inspection report Care homes for older people Name: Address: Redruth Care Ltd trading as Redruth Nursing Home Weedon Road Upton Northampton Northants NN5 4RR     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: Kathy Jones     Date: 1 6 0 7 2 0 0 9 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 28 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Redruth Care Ltd trading as Redruth Nursing Home Weedon Road Upton Northampton Northants NN5 4RR 01604585584 01604587001 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Redruth Care Ltd care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category of service only: Care home with Nursiong - Code N to service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Old age, not falling under any other category - Code OP Date of last inspection Brief description of the care home Redruth Nursing Home is situated on the A45 some 2 miles from the centre of Northampton and 3 miles from junction 16 of the M1. Redruth is a large Victorian house standing in approximately 2 acres of grounds and gardens. The home has 37 beds registered but has transferred the use of two double rooms to single en-suite accommodation so would not have more than 35 people using the service. Lounges and dining rooms overlook the gardens. The home offers Nursing care to Older People, some who may be terminally ill and require palliative care. Care Homes for Older People Page 4 of 28 Over 65 37 0 Brief description of the care home Redruth has been under the current ownership since February 2008. At the time of this inspection fees for people who are privatley funded were £650 per week. For people who are entitled to funding through the local authority, or who receive funding for nursing care, a top up fee to bring the amount up to £600 per week may be required. It is advisable to contact the service for up to date information. Care Homes for Older People Page 5 of 28 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: Standards identified as key standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for people using the service. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, inspection visits to the service, collating information received in surveys received from relatives, people who use the service and staff and drawing together all of the evidence gathered. We received completed surveys from four people who use the service and two staff. Three of the people who use the service had received help from a relative who in some cases added their own comments. This information was taken into account as part of the inspection planning and helped to form our judgments. The pre-inspection planning was carried out over the period of half a day and involved Care Homes for Older People Page 6 of 28 reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection (this is called a key inspection) took place in July 2008. Information from this inspection was taken into account as part of the planning. This inspection involved an unannounced visit to the service. An inspector from the registration team had made an appointment for the same day to assess an application to vary the conditions of registration. The findings of both inspectors have been incorporated into this inspection. The inspection was carried out by using a method of inspection called case tracking. This involves selecting samples of peoples records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. The management of peoples medication was checked through reviewing prescribed medication for a sample of people and a sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of peoples general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was given to the Acting Manager throughout the inspection and some feedback was given to the Registered Provider at the end of the inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide needs to include details of the fees in order that people are able to understand the costs involved and reasons why there may be differences in fees charged. The admission process needs to ensure there is clarity about a persons primary care needs to ensure that they are within the category of registration. While we found that people were receiving a good standard of care, the care plans need to be more personalised and consider individual preferences and needs, in relation to lifestyle, daily routines and care needs. This will help to guide staff in providing more individualised care and enhance peoples daily lives. There is a need for further re-decoration and refurbishment, which the Registered Provider is aware of. Improvements are needed in staff recruitment and staff training to ensure that people are safeguarded and staff have the knowledge and skills to meet their needs safely. Care Homes for Older People Page 8 of 28 An application for registration needs to be submitted for the manager to comply with legislation. 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 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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. There is an assessment and admission process which helps to establish whether peoples needs can be met. Evidence: A statement of purpose and service user guide have been developed since the last inspection. These documents provide people with information about the service and what is provided, helping to inform their decision about using the service. People are also encouraged to visit to help them to decide if it is the right place for them. People spoken with confirmed that they had received enough information to help with this decision. At the last inspection, we raised the need to include details of the fees in the service user guide. This information has not yet been included. This information is important in helping people to make informed decisions about their care. Care Homes for Older People Page 11 of 28 Evidence: Redruth is a care home registered to provide nursing care to older people. This information is included in the statement of purpose, though it would benefit from being clearer that peoples primary needs must be that of an older person. An assessment of peoples needs is carried out prior to admission to ascertain if their needs can be met. We looked at the information that had been gathered for someone who had been accepted at short notice. We found that basic information had been gathered which was sufficient to make a decision about whether the persons needs could be met. Information gathered as part of the pre-admission assessment helps to inform more detailed assessments and to form the basis for a care plan which guides staff in meeting the persons needs. An application to vary the conditions of registration was being assessed during this inspection visit. During discussion with the acting manager and registered provider, expectations in relation to being able to evidence that the needs of people admitted, fall within the category of registration and statement of purpose were explained. Additional clarity and rigour in the pre-admission assessment process, will help to ensure that peoples needs and expectations will be met. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are happy with and receiving a good standard of care which could be enhanced by more individualised and detailed care planning. Evidence: We received positive comments from people using the service and their relatives about the care provided. Comments included Every aspect of her care is impeccable, The staff care for my needs. We found that people had care plans in place which were based on the information gathered prior to admission. These care plans provided staff with information about peoples individual physical limitations, indicating areas where people needed support. Some of the information in the care plans was detailed and individual, for example good clear guidance was in place for someone who required assistance with feeding. The majority of the care plans seen were standardised, and contained general statements, rather than being reflective of the individual and their choices and preferences. For example, for someone, who had a plan which stated may be restless at night, the actions included prescribed drugs put to bed at appropriate time There Care Homes for Older People Page 13 of 28 Evidence: was no information about the persons preferred time for going to bed, type of drugs prescribed or when they were to be given for optimum effect. We looked at the records for someone who staff had told us had pressure ulcers that had now healed. The records showed that advice had been sought from the tissue viability nurse about treatment. Records relating to pressure area and wound care were fragmented making it difficult to track changes to the skin condition and treatment. This makes it more difficult for staff to identify and act on any deterioration. Records show that advice is sought appropriately from relevant health professionals, which include the General Practitioner, Tissue Viability Nurse and Speech and Language Therapist. We asked people to tell us what they thought the home does well. A staff member responded The home is particularly good at providing the highest quality of care for palliative care residents and their families. This was supported through discussion with someone using the service and their relative. We looked at a care plan for someone who had been admitted for palliative care. We have given advice about the need to develop all care plans for people approaching the end of their life to include information about any religious or cultural needs and any particular wishes. A requirement was made at the last inspection that recording of medication received and administered must be robust enough to allow for reconciliation at anytime. We found that there had been a general improvement in the way this was managed, in that there was now a system in place to record medications when received and administered and this was in the main adhered to. Advice was given to the manager of the need to carry out regular audits to help ensure that medication is managed safely. Medication was safely stored and we found no discrepancies in a sample check of controlled drugs against the records. Care Homes for Older People Page 14 of 28 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. Most people were satisfied with their daily lives, though more individualised planning may increase the choice and control for some individuals and improve their quality of life. Evidence: The needs and interest of people using the service are quite varied, as is their ability to express their view about their daily lives and preferred activities. Care plans were very generalised and did not identify peoples preferred lifestyles or interests. It is important that this information is gathered and used to plan and provide the support that people want and need. People told us that staff respect their wishes to stay in their own room, rather than having to spend time in the shared lounges and that staff will serve meals in their room if they wish. Others seemed to enjoy the company of others. There was a relaxed atmosphere in the lounges with staff engaging and interacting positively with people. Comments received in surveys confirmed that activities are provided and records show that activities include some musical entertainment. Three sessions had taken place or Care Homes for Older People Page 15 of 28 Evidence: had been arranged over the months of June and July. A summer fete was planned for the end of July. Other records showed reading, listening to the radio and hand massage. One person commented that The home could improve on the extent and content of daily activities and entertainment for residents. Since the activities lady retired several months ago there hasnt been any regular, sustained activities to occupy and stimulate the residents. Visiting arrangements are flexible and visitors confirmed that staff made them feel welcome and were supportive of relatives encouraging people to visit. People told us that they were happy with the meals provided and were always offerred something that suited them. One person told us that their appetite and tastes changed as a result of treatment they were receiving and that staff were very flexible and accomodating in arranging meals. The lunch time meal on the day of inspection was well presented and people were given the assistance that they needed with their meal. Care Homes for Older People Page 16 of 28 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 is a complaint procedure which people are aware of and staff are aware of their responsibilities in relation to safeguarding vulnerable adult procedures. Evidence: There is a complaint procedure within the service user guide which has been developed since the last inspection. A sample of people who use the service have told us that they are able to speak to someone informally if they are not happy and know how to make a complaint. A record of complaints and the actions taken to address these is kept. Advice has been sought from other professionals where there have been differing views about someones care and where appropriate referrals have been made to Northamptonshire County Council through safeguarding vulnerable adults procedures. Staff spoken with were clear about their responsibilities and what to do if they suspect a colleague of poor practice. Safeguarding vulnerable adults training had been booked for the end of the month for some of the staff team. More training was to be provided for others. A few staff have received training on Deprivation of Liberty Safeguards. The manager acknowledged the need for further training on this and the implications of the Mental Capacity Act that serves to protect people who may not have the capacity to make Care Homes for Older People Page 17 of 28 Evidence: decisions that will directly affect them. Care Homes for Older People Page 18 of 28 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 improvements to the premises are providing people with a comfortable and pleasant place to live. Evidence: Redruth is set within its own grounds. There are lawned areas with borders and mature plants and a patio to the right of the home with paths leading to the front. Most people need some degree of support or supervision to access the grounds safely. For example, paths consist of a mixture of patio style slabs and crazy paving. Some sections of the paths are uneven and may present a trip hazard. There is also quite a steep drop to a lawned area at the front of the building, just beyond a flower and rockery border. There is ramped access to the front of the building and in the reception hall way there are portable ramps to assist wheelchair users to access the premises. The home has a complex layout with various staircases and floors on different levels. The corridors are well lit and are fitted with hand rails. The communal areas are large, light and airy and homely. Residents were comfortably seated in the lounges and were encouraged to choose where they spent their time. There are separate lounge areas offering a choice of environments. The lounges are used to enhance activity social and recreational opportunities and doors from the lounges enable people to access outside Care Homes for Older People Page 19 of 28 Evidence: spaces easily. We had made a requirement at the last inspection about the need for people to have the opportunity to lock bedroom and bathroom doors if they wish. Some of the bathroom and toilet doors had privacy hooks fitted following the inspection, however there were no locks in place on all of the rooms. This is important to enable people to have privacy and retain their dignity. Information was found on care files to say that people had been asked if they wanted locks on their bedroom doors. Some of the bathrooms and toilets have limited space for maneuverer for people who use wheelchairs and require the use of movement and handling equipment. Staff confirmed that the current owner is making improvements to the premises and that there is an ongoing re-decoration and refurbishment programme. Positive comments were received about cleanliness and a relative told us that no matter what time of day they visit the home is always clean. No unpleasant odours were noted. Hand sanitising gel was available and in a prominent position in the entrance hall. During a tour of the premises some issues to be addressed were identified and raised with the with the Acting Manager, such as bins without liners and a bathroom that didnt have any soap for hand washing. The annual quality assurance self assessment identified that none of the staff had received training in infection control. Staff training is considered to be important in helping to reduce the risk of infection in the care home environment. A link nurse for infection control has been allocated to look at ensuring that good practice guidelines are followed. Care Homes for Older People Page 20 of 28 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 is a good staff team who were providing people with appropriate support and assistance, however improvements to the recruitment process are needed to provide better safeguards for people who use the service. Evidence: People were complimentary about the level of care and support that they receive from staff and a relative told us that Staff cannot be more helpful, this must be one of the best homes in the county. Staff told us that they felt that there were sufficient staff on duty at any one time to meet peoples needs. We observed staff to be available when people needed assistance and that they were responsive to their needs. Staff confirmed that their employer had carried out criminal record bureau checks and taken up references before they started work and that they received training to help them meet the needs of people using the service. We looked at staff files for two people recruited since the last inspection and found that documents to confirm that necessary checks had been made and information obtained in respect of one of the people. In the second case, the documents showed that more than two months had passed before a check was made against the Care Homes for Older People Page 21 of 28 Evidence: protection of vulnerable adults register and three months before the criminal record bureau clearance was received. References could not be found for this person either. The annual quality assurance self assessment (AQAA) identifies that twenty of the thirty two care workers employed have achieved a National Vocational Qualification in care. This is important in helping staff to gain the knowledge and skills to meet peoples needs. Review of the AQAA and the staff training matrix identified that there are areas where further training is needed. Some examples were, basic first aid, infection control, nutrition and the management of medication. Care Homes for Older People Page 22 of 28 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. Although people have confidence in the Acting Manager, Redruth continues to operate without a registered manager who would have legal responsibilities for the management of the service and quality of care provided. Evidence: Standard 31 relates specifically to the registered manager and their experience and qualifications. At the time of the inspection there was no registered manager in post. Management arrangements are considered to be a key factor in helping to ensure that people receive appropriate care. At the time of this inspection the Acting Manager had been in post for fifteen months and to date an application for registration has not been received. The Acting Manager and the Registered Provider said they werent aware that it is an offence under the Care Standards Act 2000 to manage a care home without registration. They confirmed that they would arrange for an application for registration to be submitted. Care Homes for Older People Page 23 of 28 Evidence: As the current Acting Manager is not a registered nurse, she is supported in any clinical decisions by a clinical lead who is a registered nurse. Positive comments were received from staff, people who use the service and relatives about the Acting Managers commitment to Redruth and the people who live there. A relative stated The Manager Suzanne is very devoted to the home. Staff confirmed that the Registered Provider visits the home regularly and that he listens to views of staff, people who use the service and relatives. The also commented that he was making changes and improvements to the building. The last residents meeting was in April 2009, however people spoken with felt they were able to raise any issues as and when they arose. Questionnaires have recently been sent out to staff, people who use the service, visitors and visiting professionals as part of the quality assurance process. The findings of the inspection indicate that some internal audits would be beneficial, in helping to ensure that legislation is complied with and the quality of care maintained. Small amounts of money are held where required to assist people in paying for services such as hairdressing. A sample check confirmed that the balance of money held corresponded with the records. We noted that hairdressing receipts contained the date when the money was received, but did not give the dates that the hairdressing had been carried out. Advice was given for these to be more specific which enables this to be audited more easily. The staffing section of this report identifies the need to ensure that all staff have received up to date training in safe working practices. We observed staff to use a lifting device (hoist) where people were unable to mobilise independently. In one instance we observed someone transported in a hoist to the toilet, increasing the risk of an accident, rather than them being transferred to a wheelchair. Care Homes for Older People Page 24 of 28 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 25 of 28 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 1 5 The service user guide must include details of the fees, and a statement as to whether the fee would be different if paid in whole or part by the service user. This is to help people make informed choices about the cost of their care. 27/11/2009 2 3 14 Sufficient information must be gathered prior to admission to ensure that people admitted fall within the category of registration and the statement of purpose. This is to help ensure that peoples needs are met. 27/11/2009 3 7 15 Care plans must reflect individual needs and preferences. 14/12/2009 Care Homes for Older People Page 26 of 28 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 To help ensure that the care and support people receive takes account of their needs and preferences. 4 29 19 Prior to staff being employed 10/11/2009 information and documents specified in schedule 2 of the Care Homes Regulations 2001 must have been obtained. This is to help safeguard people who use the service. 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 38 Staff practice in relation to movement and handling should be monitored to ensure safe practices are consistently followed. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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