Care Home: Rockrose

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What the care home does well Residents are helped to remain mentally and physically active and these efforts are continuing. Residents are encouraged to keep contact with their relatives and friends. The premises are suitable for the care of frail older people. The registered providers continue to keep the promises in good condition. Residents are provided with good meals and their views are taken note of and respected. What has improved since the last inspection? With advice and encouragement from Social Services, the providers are continuing to improve the quality of support for residents. They are recruiting an additional carer to reduce reliance on agency carers. With encouragement from Social Services, medication administration procedures have been improved. Care plan records have improved although these need further updating for the benefit of residents. What the care home could do better: The report contains one requirements. This relates to the need for more accurate care plans for each resident. During the CQC visit, the registered providers were advised to improve care plan records for residents. The evidence was that care plans have improved but they need to be more accurate. They should be available to staff at all times and should evidence all identified support needs. As resident`s healthcare and social care needs change, these should be more clearly identified in care plans including details of how these changing needs are to be addressed. The financial viability of the service has been a concern during the last six months of 2009. In a service registered for seven residents and which is being conducted now with a significantly reduced number of residents, the concern has been that the service is no longer financially viable. The registered providers said that they are supporting the care of residents from private savings and that residents are not at risk. At the request of the Commission, the registered providers provided some information about the financial viability of the home. Based on this information, the evidence was that the lack of sufficient income could pose a risk to residents. Key inspection report Care homes for older people Name: Address: Rockrose 10 Kingsfield Road Herne Bay Kent CT6 7EA     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: Eamonn Kelly     Date: 0 3 1 2 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 30 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 30 Information about the care home Name of care home: Address: Rockrose 10 Kingsfield Road Herne Bay Kent CT6 7EA 01227740549 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Sookdeo Sawock,Miss Uyjayantimala Aubeeluck care home 7 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: 7 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Rockrose provides support for up to 7 people. The registered providers live on the first floor of the premises. There is good access to public transport and car parking is available at the front. Residents bedrooms are single occupancy and are all ground floor rooms with en-suite facilities. Care Homes for Older People Page 4 of 30 Over 65 7 0 2 5 0 9 2 0 0 9 Brief description of the care home Residents have access to two lounge areas and to a garden that is suitable for use by frail people. Information about weekly fees and other charges is available from the registered providers and information about services and facilities is contained in the written guide to the service. Weekly fees are £308 for Local Authority funded residents and £350 for privately funded residents. Care Homes for Older People Page 5 of 30 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 inspection took place on 3rd December 2009 (11:00 am to 3:30 pm). The methodology used to produce the report includes reference to the previous AQAA (annual quality assurance assessment) submitted by the registered providers. Two members of staff and three residents were met. The AQAA outlined some of the areas that have been improved for the benefit of residents and areas of practice where further further development is planned by the providers. The profiles of three residents were assessed and the relevant care plans were seen. The inspection included a visit to all parts of the premises with the assistance of a carer. Some records used for supporting residents were checked. The outcomes of the previous inspection report (January 2009) and more recent inspection report (September 2009) were checked. Care Homes for Older People Page 6 of 30 Checks were also made of information known to the Commission about the service including how the registered providers were dealing with issues identified during Safeguarding Adults inquiries. Care Homes for Older People Page 7 of 30 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. Care Homes for Older People Page 8 of 30 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 30 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 30 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. Prospective residents and their supporters receive initial advice and guidance to help them assess the facilities and suitability of the home. Evidence: The registered providers carry out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers. The evidence was that new residents receive a contract that contains information on the rights and responsibilities of both parties. Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. They receive a written guide that contains information about services and facilities. At the start of the year, there were five residents at the home: there are now three. A resident was relocated to another residential home in the area because a Local Care Homes for Older People Page 11 of 30 Evidence: Authority believed more appropriate support could be obtained for the resident. The three residents, aged 86-94, have high suppopt needs. The Local Authority has intervened on a number of occasions over the past 6 months to ensure that the needs of the residents were being properly addressed. The registered providers have been advised during Safeguarding Adults meetings that the needs of residents were not being identified in detail and recorded fully in care plans. The purpose of this was to enable all care needs to be identified, recorded, addressed and then reviewed with the cycle then taking place again. The registered providers had difficulties at the start of this process and therefore visits by representatives of the Local Authority required assurances that the health needs of residents were being met. The Local Authority provided advice and guidance with, for example, assisting the registered providers to maintain fluid intake records and other records. Potential residents do not always visit the home prior to taking up residence as part of the admission procedure but they are invited to do so. The home previously admitted residents for respite care. The registered provider was advised earlier in the year that care plans in such circumstances should be completed fully with support needs identified and a plan of care developed. No new residents have been admitted in the meantime. There was evidence that residents relatives are confident that appropriate support is being provided to their relatives. The AQAA stated that questionaires given to relatives last year produce positive comments about how residents are supported. It also states that residents receive value for money because of the dedication of the providers, competitive fees and the fact that there is a small group of residents who receive individual attention. Mr Sawock stated that, as part of improving admission procedures and ongoing support for residents, the impact of the Mental Capacity Act has being assessed as a result of the registered providers attendance on an information seminar. Care Homes for Older People Page 12 of 30 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 lack of suitable care plans does not contribute to the health and social care support for residents is not . Evidence: The stated intention of the registered providers during previous inspections was to construct an outline profile of the prospective resident followed by a more detailed profile with the participation of the resident, family members and, in some instances, care managers. At the last CQC visit, the registered providers stated that they would obtain detailed guidance from an independent source on how to implement effective care planning. It was evident during this visit that they have not had this work undertaken through an independent source. However, the registered providers have updated each of the three residents care plans. These contained an outline of residents needs and how these are being Care Homes for Older People Page 13 of 30 Evidence: addressed. From evidence seen from the care plan records of the three remaining residents, the current updated system was contained in loose pages and was difficult to follow. Nevertheless, there was an effort to identify current needs, goals of care/support and changes in health or disoposition. The registered providers have introduced fluid intake records where this was necessary for a resident. This was in response to advice given to them by Local Authority representatives. The registered providers said they still intend to obtain independent advice on how to upgrade their care planning procedure and to keep this up-to-date. The stated intention was to have a personal file containing support plans, risk assessments, daily notes and information on contacts with healthcare services. Some work has been undertaken in updating risk assessments. Following advice from a Local Authority, the registered providers are keeping more accurate daily records of observations on residents health and disposition. They were advised to ensure that these records were updated regularly. Care plans showed that GPs visit as necessary. In connection with Adult Protection meetings over the past six months, the Local Authority obtained information suggesting that GPs were satisfied with how residents were being supported. This process has led to improvements in the way residents received support during this period of time. The Local Authority also received feedback from relatives suggesting that they were confident that their relative was receiving good support. Residents have access, according to profiles of residents discussed during the inspection, to local NHS community services. The services of district nurses are routinely obtained. This was evidenced in the case of support with wound dressings. The evidence was that the health of all three residents had improved over the past eight weeks. The medication procedure was not checked on this occasion. The registered providers explained how medications are administered and how unwanted medicines are recorded and disposed of. MAR sheets are completed at the time of administration. A Care Homes for Older People Page 14 of 30 Evidence: photograph of each resident accompanies their MAR sheet. It was said that, in the case of residents receiving respite care, a MAR sheet is completed manually to control and supervise their medication administration. No new residents have been admitted during 2009. A check of medication procedures at the premises was carried out by Social Services in January 2009 and these were found to be satisfactory. At the request of the Commission, the registered providers provided some information about the financial viability of the home. Based on this information, the evidence was that the lack of sufficient income could pose a risk to residents. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported on a day-to-day basis to remain mentally and physically active and alert. Evidence: Residents may receive visitors at any time and the service encourages this continuing contact. Residents are encouraged to be independent and to make their own minds up about how to spend their time. The registered providers described how activities are arranged such as summer barbeques, visiting musician, regular parties and gettogethers for families/residents. Arrangements were underway to help residents over the Christmas period. The evidence was that residents relatives take an active part in supporting their relative. During contact with representatives of the Local Authority as part of Safeguarding Adults procedures, it was reported that relatives stated that they believed their relative was receiving good support. The registered providers referred, as on previous occasions, to the close relationship between providers and residents/visitors because of the small number of residents. There are currently three residents and up to seven may be admitted. Care Homes for Older People Page 16 of 30 Evidence: The previous AQAA stated that questionaires returned from visitors and residents last year indicated satisfaction with how residents are helped to remain physically and mentally active. Each resident has his/her own bedroom which contains their own possessions and encouragement is provided to increase the levels of personalisation. The registered providers demonstrated a good understanding of each residents disabilities and support needs. A range of newspapers and magazines was available. There are two lounge areas. TV and DVDs are available in communal areas as well as in individual bedrooms. Staff assist residents on a one-to-one basis, helping them to walk about the premises, provision of books and newspapers, talking to them, providing music and helping them visit the garden. All facilities are on the ground floor which benefits residents. A member of staff said that arrangements are made for access to church services; the registered providers said that residents wishes are being met as part of improving equality and diversity awareness. During the inspection, there was a positive atmosphere and the registered provider and carer were working actively with residents when they were not engaged in household activities. The carer, previously a hairdresser, was carrying out hairdressing for residents. Nutritional assessments are carried out and recorded in care plans. The registered providers keep written information about residents food intake following advice received from a Local Authority. The evidence was that all three residents have improved over the past eight weeks. A resident whose main diet comprised Ensure drinks for a long period of time was seen to eat a full meal. The leg ulcers of another resident has shown improvement and the resident is under the supervision of a district nurse. A residents continence difficulties are being addressed and the evidence was that the residets condition has improved. The lunchtime meal was observed during the inspection. Residents referred to choices of meals, to the way meals are served and to how they enjoy the occasion with fully laid tables including linen tablecloths and serviettes. Residents were seen to receive a substantial meal of chicken casserole, mixed vegetables, cauliflower, swede and Care Homes for Older People Page 17 of 30 Evidence: carrots followed by dessert. A resident with eating difficulties ate a full dinner of liquidised potato and vegetables followed by dessert. The resident also receives Ensure drinks at mid-morning, afternoon and late evening. The registered providers said that the evening meal contains a heated component that residents may choose. Care Homes for Older People Page 18 of 30 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. Residents are protected from abuse. Their views and those of relatives are listened to and acted upon. The possible lack of financial viability could pose a risk to vulnerable people. Evidence: According to the registered providers and evidence from Safeguarding Adults meetings, relatives are closely involved in aspects of the service. A copy of the complaints procedure is made available in the service users guide. According to records seen during the CQC visit, both registered providers and the carer at the service have received training in matters associated with POVA. Mr Sawock said they know how to report notifiable incidents to Social Services. A copy of the Local Authority Safeguarding Adults policy was available at the premises. During 2009, the registered providers attended a number of Social Services safeguarding meetings in respect of concerns about residents welfare and health. As a result of concerns at that time, a Local Authority found alternative accommodation for a resident. This was to enable the high dependency needs of the resident to be met more appropriately. The previous annual quality assurance assessment (AQAA) stated that members of Care Homes for Older People Page 19 of 30 Evidence: staff are aware of the necessary procedures relating to protection of residents. At the request of the Commission, the registered providers provided some information about the financial viability of the home. Based on this information, the evidence was that the lack of sufficient income could pose a risk to residents. The registered providers have recruited a new member of staff. It was confirmed during this inspection that existing and new staff have completed application forms, references have been obtained and CRB checks have been carried out. At the previous CQC visit, the registered providers undertook obtain a full review and upodate of their method of maintaining care plans but this work has not been followed through. A recurring theme during recent Safeguarding Adults meetings was that the registered providers had difficulty in maintaining care plan records that indicated ongoing review of residents health. The concern was that, without such recorded reviews, the health of residents was likely to deteriorate. The evidence during this visit was that the registered providers have adopted some of the advice for improving this aspect of provision of residential support. They have improved care plans to some degree for each resident and have introduced fluid intake charts. It was evident during this visit that the health of residents had demonstrably improved. Care Homes for Older People Page 20 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for use by frail older people. Residents live in a comfortable and well maintained environment and benefit from the ongoing improvement programme of redecoration and routine maintenance. Evidence: The previous AQAA contained declarations relating to safety checks and associated safety certificates being in place and up-to-date. This included confirmation that PAT (portable appliance tests) are carried out. Radiators are covered for the safety of residents. Hot water outlets accessible to residents are temperature controlled and were manually checked, according to the registered provider, each week for safety reasons. There is a good level of attention given to maintaining all areas of the premises. One bedroom has recently been renovated. Medication and MAR sheets are kept in a locked cupboard in the office. There is a separate laundry room. Communal areas and all bedrooms were visited during this visit. Lounges, dining area and bedrooms were decorated and furnished to a good standard. All parts of the premises at the time of the visit were clean, odour free and in a good state of repair. Residents met said they like their bedrooms. Care Homes for Older People Page 21 of 30 Evidence: All bedrooms are single occupancy and have an en-suite facility (toilet and washbasin). The premises have a communal bathroom and staff WC. It was evident that the premises were safe and comfortable. Indoor and outdoor facilities are suitable for residents. Bedrooms were well furnished. Care Homes for Older People Page 22 of 30 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. The registered providers, agency carers and employed staff provide good support for residents. Evidence: There has been considerable reliance reliance on agency carers while additional carers are being sought. The registered providers are recruiting a new member of staff who is currently an agency worker. Information from a staff file showed that an application form was completed, two written references were being taken up and a CRB check was being made. The registered providers live at the premises and undertake the majority of day time and night time support for residents. There are now only three residents at the home. The previous AQAA contained details of the barriers to improvement and some of these were discussed during several inspections during 2009. They include the challenge of coping with low weekly fees and low bed occupancy. The concerns about the financial viability of the service are not alleviated by the difficulties experienced by the registered providers, for example, not being able to deliver a good training programme for staff during the coming year. Care Homes for Older People Page 23 of 30 Evidence: Both registered providers are former NHS nurses and the registered manager has achieved the registered managers award. According to the training records seen, the providers and carer have attended short courses in first aid, moving and handling, infection control, medication administration, food safety, fire safety and health and safety. Care Homes for Older People Page 24 of 30 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. Residents live in a care home where their interests are generally promoted. Residents do not have the benefit of the use of care plans that show their changing needs and how suitable support is provided. Evidence: Both registered providers are former NHS nurses. The registered manager has completed the registered managers award. The stated objective of the service is to help residents to remain independent when their physical and mental capabilities are declining. Where residents are judged to be no longer able to conduct their legal or financial matters, the registered providers help to assist them to obtain independent representation or the responsibilty is referred to a family member or advocate. A declaration was made in the previous AQAA that all relevant safety checks for the Care Homes for Older People Page 25 of 30 Evidence: premises and associated records are maintained by the registered provider. The examples discussed during the inspection were portable appliance tests, fire alarms and equipment, gas appliance tests and call bells. At the beginning of 2009, Social Services were continuing to encourage and assist the service to implement care plan records required under current contracting arrangements. Following their inspection in January 2009, Social Services provided further advice on how support plans and recorded risk assessments should be maintained. The providers, at that stage, said they were taking steps to update each support plan in accordance with this advice. As the year progressed, Social Services concerns arose about the support some residents were receiving. These led to Adult Protection meetings where advice was given to the registered providers on aspects of the support that would be expected to be received by residents and which would be expected to be evidenced in care plans for each resident. The evidence was that the registered providers were unable during the year to implement suitable care plans that proved that care needs were being identified, that these needs were being addressed and that reviews of care were being carried out and recorded. Subsequently, a Local Authority found alternative accommodation for a resident because it was deemed necessary for more appropriate support to be identified. Two additional CQC visits were made during this time. At a previous CQC visit, the registered providers said that they would replace the care planning system. It was confirmed during this inspection that this work had not been carried out. The care plans for each resident had, however, been updated by the registered providers and it was clear that the health of each resident had improved. From evidence seen during this visit, resident support is in place. The evidence was that residents health had improved. Please refer to information about this earlier in the report. The premises was warm, well lit, comfortable and well maintained. Care Homes for Older People Page 26 of 30 Evidence: The evidence was that esidents receive good healthcare support from GPs and district nurses. The meals provided were good as evidenced during the visit. Relatives, according to reports ontained from Social Services, remain satisfied that their relative is being supported properly. The financial viability of the service has been a concern during the last six months of 2009. In a service registered for seven residents and which is being conducted now with a significantly reduced number of residents, the concern has been that the service is no longer financially viable. The registered providers said that they are supporting the care of residents from private savings and that residents are not at risk. At the request of the Commission, the registered providers provided some information about the financial viability of the home. Based on this information, the evidence was that the lack of sufficient income could pose a risk to residents. Care Homes for Older People Page 27 of 30 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 28 of 30 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 17 The service must maintain up to date care plan records in respect of each resident. The previous report required that suitable care plans be maintained. Care plans have improved but they must be more accurate and up to date. 03/02/2010 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 Care Homes for Older People Page 29 of 30 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. 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. 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