Care Home: Roseworth Lodge Nursing Home

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What the care home does well There is a friendly, welcoming atmosphere and everyone said that the staff are caring and helpful. Typical comments made by service users included: "The carers are excellent." "The staff always listen to me and act on what I say." "The home always makes sure I get the medical care I need." "I kept my doctor when I came here and did not have to change medical practices." "Mandy, the events coordinator works really hard to arrange a variety of activities and social events." "The home always arranges activities that I can take part in if I want." There is good information provided to prospective service users so that they can make informed choices about whether to stay at the home. Arrangements for health and personal care are increasingly personcentred, respecting the unique individuality of each service user. The service protects people who use it from abuse, via careful staff recruitment checks and training in safeguarding adults. People said they could approach staff and management about any concerns or complaints and would receive a helpful response. The home is well maintained and comfortable with many communal rooms to choose from, including a smoking room. All bedrooms are singles with en suite toilets and wash hand basins. The home is generally well staffed and managed following recent improvements, although further work is needed to consolidate progress. What has improved since the last inspection? There has been on-going redecoration and refurbishment, including a new bathroom, hairdressing salon and provision of a large digital, flat screen television. Self-closers have been fitted to bedroom doors and improved fire doors have been installed in corridors. A more person-centred approach has been taken recently to the delivery of health and personal care. The key worker and named nurse system is being reintroduced and 3 senior care staff have been appointed from within the staff team. Clinical governance meetings have been introduced to share and review practice issues, with the intention of improving care outcomes for service users. Menus have been improved in consultation with people who use the service and the main meal of the day is now served in the late afternoon. Quality assurance systems have improved with regular consultations with service users and their representatives, including meetings, surveys and audits. What the care home could do better: The service needs to develop the senior care assistant role and establish the key worker and named nurse roles. The home is working towards these objectives. It also needs to ensure good and appropriate staffing levels at all times, including weekends. The home is trying to recruit suitable, permanent nursing and care staff so that it does not have to rely on agency staff. Staff supervision and appraisal needs to be developed as the frequency of one to one supervision sessions has fallen. The home would benefit from stable management arrangements (although current, interim arrangements are good) because there have been a succession of changes over the past 6 months which have been unsettling. The home`s focus on `person-centred care` needs to become embedded and fully established as the service`s approach to consistently good outcomes for service users. Key inspection report Care homes for older people Name: Address: Roseworth Lodge Nursing Home Redhill Road Roseworth Stockton-on-Tees TS19 9BY     The quality rating for this care home is:   two star good 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: Stephen Ellis     Date: 1 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 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 27 Information about the care home Name of care home: Address: Roseworth Lodge Nursing Home Redhill Road Roseworth Stockton-on-Tees TS19 9BY 01642606497 01642617878 roseworth.lodge@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Julia Christine Foster Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Five adults aged 50 years are able to be accommodated in the home. The home is able to provide one place to a named resident under the age of 65 in the category for Mental Disorder (MD), should this person no longer require the service, CSCI must be notified. Date of last inspection Brief description of the care home Roseworth Lodge is registered to provide nursing and personal care to forty-eight older people. The home is two-storeys and purpose-built, providing single bedroom accommodation, each with its own en suite toilet and wash hand basin. The bedrooms are a minimum of 10 sq.m. There is a passenger lift giving access to the upper floor. On the ground floor, there are two lounges (one of which is for people who use the service and wish to smoke) plus the homes main dining room. There are four other Care Homes for Older People Page 4 of 27 Over 65 48 0 0 48 Brief description of the care home lounges and a small dining room on the first floor. The home is close to local shops and amenities, with a car park at the front of the home. For current fees, enquirers should contact the home directly. Care Homes for Older People Page 5 of 27 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was carried out on 30/07/2008. The present key inspection took place over one day on 19/04/2010. It was informed by the homes Annual Quality Assurance Assessment completed on 18/03/2010, which is the homes self assessment of its performance to date. Written surveys were received from 6 people who use the service and 4 staff. During the inspection, discussions were held with 7 service users, 2 relatives and 6 staff. Comments were also received from the acting regional manager and a visiting manager from a local care home. The inspection involved an examination of a sample of records and documents, including 4 plans of care, plus a tour of the building, sampling rooms and facilities. Care Homes for Older People Page 6 of 27 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 Care Homes for Older People Page 7 of 27 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 27 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 27 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. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: The homes statement of purpose and service users guide are well written and informative. They are available in a variety of formats to aid accessibility. There is also a comprehensive home brochure that is very useful. A copy of the last inspection report is made available to enquirers. Further information with regard to the registered provider can be found on the Company website, along with specific information about Roseworth Lodge. People who use the service and relatives said that they felt they had enough information about the home to make an informed choice about admission and whether to stay long-term. Trial visits and short breaks for respite are encouraged to help people get to know the service. Full assessments of peoples needs are completed prior to admission and in the first few days following admission, with a basic care plan being completed before admission, which is then Care Homes for Older People Page 10 of 27 Evidence: developed quickly following admission. Four plans of care were examined and these confirmed that full assessments of need were carried out in the manner described. The home has been trying hard recently to ensure that full assessments and accompanying care plans are always completed in a timely way, because it was recognised that improvements were needed following some slippage around the end of 2009. Intermediate care is not provided. Care Homes for Older People Page 11 of 27 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Four service users plans of care were examined. These were comprehensive, detailed and up to date. They were well organised and subject to review and evaluation, in keeping with peoples assessed clinical and care needs. Improvements have been made recently with care planning and evaluation, trying to ensure that a comprehensive and timely, person-centred approach is always taken. This means that each person using the service is treated as an individual whose personal needs, wishes, feelings and aspirations are reflected in the plan of care, thereby guiding staff to act in ways that will promote respect, dignity and personal fulfilment. The home uses a comprehensive Care and Health Assessment Profile for each service user. Service users plans of care were found to include a photograph of the person using the service, dependency ratings, skin integrity risk assessments, moving and handling risk assessments and guidance, nutritional and oral assessments, pain chart where appropriate, continence/catheter assesments where appropriate, falls and general risk Care Homes for Older People Page 12 of 27 Evidence: assessments, weight charts, wound document photo consent where appropriate, bedrail risk assessments where appropriate, admission property lists, care plan documents for each assessed need, progress sheets, key worker diary and family communications record, multi-discipliniary communications record, specimen record where appropriate, social activities record, miscellaneous records and social services care plans, plus the Care and Health Assessment Profiles. Peoples health care needs were well documented and reviewed. People who use the service were positive and complimentary in their comments about health and personal care. They also felt their privacy and dignity were respected and promoted. Typical comments received included The carers are excellent. The staff always listen to me and act on what I say. The home always makes sure I get the medical care I need. I kept my doctor when I came here and did not have to change medical practices. A selection of medicine records were examined and checks were made of the arrangements in the medical treatment room for storing medicines. These confirmed that there are good arrangements for the safe ordering, storage, administration and disposal of medicines, using the monitored dosage system. Medicine records were well completed, including hand-written entries on medicine administration records (MAR sheets) where there were 2 signatures confirming the accuracy of the information. Weekly medicine audits are being carried out to ensure good standards continue. There was a recent problem when antibiotics were delivered to the home but were not commenced until 6 days later due to poor communication. However, this is the exception rather than the rule and a PCT Pharmacy Audit completed on 24th march 2010 awarded the home 82 , which is a very respectable score. All medication is administered by registered nursing staff at present, but there are plans to train up senior care staff to take responsibility for administering medicines for service users in receipt of residential care rather than nursing care. This is a welcome development that will help promote good care practice throughout the staff team and free up nursing staff for other nursing duties apart from medication. Care Homes for Older People Page 13 of 27 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. People who use this service are able to make choices about their lifestyle, and are supported to develop their life skills. Social, educational, cultural and recreational activities meet peoples expectations. Evidence: The home has a full time activities coordinator who arranges a full programme of social and recreational activities. Positive comments were received from people who use the service and/or relatives about this programme, including, typically, Mandy, the events coordinator works really hard to arrange a variety of activities and social events. These include art and crafts, motivation sessions, visiting entertainers and speakers about a variety of subjects, exercise sessions, bingo, shopping trips, occasional outings, reminiscence, one to one sessions, plus pie and peas suppers to which friends and family are invited. People said they were free not to participate in any event if they did not wish to. They also confirmed that religious services are made available by visiting clergy, either at the home or at one of the local Churches. People confirmed that they could spend their time as they wished and could wear the clothes they liked. Typical comments included The home always arranges activities that I can take part in if I want. People also said they liked the meals at the home and there was usually a good choice of menu or alternative meal so that they could have what Care Homes for Older People Page 14 of 27 Evidence: they liked, including a full cooked breakfast if that is what they preferred. The main meal of the day now takes place in the late afternoon, with a lighter meal at lunchtime, by popular demand. Snacks and drinks are readily available throughout the day and nutritional assessments are carried out routinely so that peoples dietary needs are well met. Most people dine in a pleasant, relaxed dining room on the ground floor but can eat elsewhere, such as their bedrooms, if desired. The kitchen has recently been awarded 5 stars (maximum award) by the local environmental health authority for food hygiene, which is commendable. Further improvements to meals are proposed, involving the input of a chef from another service within the Group, and the homes catering staff welcome this opportunity to develop their service. People who use the service can receive visitors at any reasonable time and the home engages with the local community, encouraging social contact. Peoples social histories are reflected in the initial assessment of needs process, but the home plans to develop life story books for each person, involving individual key workers from the staff group. This project is to be commended as it will help to ensure that each person is known and treated as a unique individual, thereby promoting greater understanding and personal fulfilment. Care Homes for Older People Page 15 of 27 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. People who use the service are able to express their concerns. They have access to a robust, effective complaints procedure and are protected from abuse. Evidence: The home has a clear complaints procedure which is displayed in the main reception area and is also available in the service users guide. Additional information about how to contact the Local Authority and CQC is also given. People who use the service and their relatives said that they knew how to make a complaint and who to speak to if they were unhappy about anything. The home regards complaints as an opportunity to put things right and to improve service in the future. The home will respond promptly to complaints and will provide full feedback to the complainant about the homes findings and any action to be taken. The home is trying to ensure that each person who uses the service has an assigned key worker who will be particularly approachable and helpful about any concern or complaint the individual might have. The home is trying to ensure that it always responds positively and constructively to any complaint, in line with its person-centred approach to the delivery of care. The service has robust policies and procedures for safeguarding adults. It has recently held training sessions for staff to raise and refresh awareness of good practice with regard to protecting service users from abuse or neglect. The home has demonstrated good practice in notifying CQC and the Local Authority responsible for coordinating the investigation of any allegation of abuse or neglect. The home has plans for further staff training in safeguarding adults. It also plans to provide greater support and Care Homes for Older People Page 16 of 27 Evidence: guidance to staff about safeguarding and whistle-blowing (reporting concerns about poor practice) by developing this aspect of the role of its 3 senior care staff, who have been recently appointed. Care Homes for Older People Page 17 of 27 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 physical design and layout of the building enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: People who use the service were pleased with the facilities and cleanliness of the home. All bedrooms are singles with en suite toilets and wash hand basins. Pressure relieving mattresses and special seating arrangements were evident for those people who would benefit from them. There is a dedicated smoking room on the ground floor. A tour of the building revealed the home to be clean and well maintained throughout. There was however an unpleasant odour in one unoccupied room and the home will address that. Key staff have completed infection control training and action has been taken by the home to ensure that liquid soap, paper towels and hand-cleansing gels are readily available throughout the home to minimise the risk of infection. The home has a full time maintenance officer who ensures that all safety checks, servicing and repairs are carried out promptly. Records are maintained of these actions and form part of the audit process carried out routinely by the home. These include water temperatures, fire alarm checks, fire drills, minutes of health and safety meetings, five year electrical test certificate, Gas Landlords certificate, passenger lift certificate, LOLER certificate for each hoist and Chlorination certificate. Some of these services are carried out by specialist agencies. The maintenance officer confirmed that he is Care Homes for Older People Page 18 of 27 Evidence: regularly involved in refurbishment and redecoration work. The home has fitted a new apollo bath on the first floor, installed a hair dressing salon on the first floor and a large flat screen digital television in the main downstairs lounge. Self-closers have been fitted to all residents rooms and new fire doors have been installed in corridors. The lounges, dining room, corridors and foyer have all been recently refurbished. The home is looking to provide an outdoor seating area for people to enjoy in the summer. Care Homes for Older People Page 19 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: At the time of the inspection, there were 30 people using the service, of whom 22 people were in receipt of residential/personal care. Staffing levels and deployment are generally appropriate for the assessed needs of service users most of the time. However, at weekends there can be a shortfall and there have been concerns and complaints raised by relatives about this issue. The staff roster showed that there are usually 5 or 6 care staff on duty during the morning and early afternoon (8 am to 2 pm), followed by 4 care staff typically on duty during the late shift (2 pm to 8 pm). In addition, there is always a registered nurse on duty for the 8 people using the service who require continuous nursing care. At night there is one registered nurse and 3 care staff. These staffing levels are generally appropriate, with the exception of weekend cover when the typical number of care staff on duty during the day is only 4. The homes management is aware of this issue and is trying to improve cover at weekends. It has been having discussions with staff and is trying to implement full, weekly cover. It has also had to rely heavily on agency nursing staff due to a shortage of permanent nursing personnel. It is trying to ensure that there is continuity of nursing care by deploying the same agency nurses each time wherever possible. The Care Homes for Older People Page 20 of 27 Evidence: homes management has recently appointed 3 senior care assistants, whose jobs will include providing support and guidance to other care staff, as well as responsibilities for the safe handling and administration of medicines to people in receipt of residential/personal care. The home is trying to recruit more permanent staff as well as bank staff, so that it will not be so reliant on agency staff in the future. The home has a full time activities coordinator, a full time administrator, a full time maintenance officer, plus catering and domestic staff in sufficient numbers for the needs of the service. There is also a gardener. Management is reintroducing the key worker role and named nurse role so that each service user is paired with a member of the care team who will have a special relationship with the individual service user. This is regarded as being good practice, designed to help ensure the delivery of person centred care. Approximately half of the care staff members have achieved National Vocational Qualifications (NVQ) in care at level 2 or above. A staff training programme is in operation based on assessments of training needs, ensuring that all mandatory training and refreshers are completed. For example, senior care staff will be starting safe handling of medicines training in the near future, in preparation for their new role. The home has a good policy with regard to staff recruitment, based on equal opportunities and ensuring the protection of service users. Staff files are being audited and checked for compliance with the registered providers policies and legal requirements. Care Homes for Older People Page 21 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems led by a competent management team. Evidence: The home has a registered, qualified manager who is currently on sick leave. In her absence, management input has been provided effectively by peripetetic managers supplied from within the Company, plus a visiting manager from a local care home and weekly support from the Companys regional management team. The deputy manager has been on maternity leave and is not expected back until later in the year. An acting deputy, who is a registered nurse from within the staff team at the home, has been appointed. Comments received from staff were positive and complimentary about recent improvements in the organisation and management arrangements. They valued the person centred approach being taken and felt supported by management. Staff morale was stronger. People who use the service and relatives also expressed confidence in the recent direction of the service. People said they could talk to staff and management about any issues of concern, and they would be taken seriously and Care Homes for Older People Page 22 of 27 Evidence: efforts would be made to help. There are regular meetings with service users and relatives and these are minuted. There is an open door policy and management welcome comments and feedback from service users and their representatives. The home conducts annual written surveys of service users. Regular quality assurance audits are carried out by management and there is close monitoring of matters where there has been a high risk assessment, via remedial action plans. For example, care plans, medicines procedures and particularly vulnerable service users have all been focused upon recently. The home has regular health and safety meetings, plus staff meetings (normally every 3 months) and these are minuted. There are also clinical governance meetings that were introduced into the home last year, which are designed to share and review practice issues, to help improve practice within the service locally and throughout the Company. There are robust procedures for looking after service users personal monies, including individual accounts, computer records and double signatures for each transaction, plus receipts. These are subject to regular auditing by management and central office personnel. The homes administrator takes a lead role in these matters and ensures that service users have ready access to their money and records. Staff confirmed that they had had appropriate training in health and safety matters and safe working practices. Procedural guidance was provided along with written risk assessments where appropriate. Necessary equipment was provided and accidents were recorded as required. Management and staff both said that staff supervision and appraisal had fallen behind over the past year, but efforts are being made to remedy this by the introduction of senior care assistants taking on supervisory responsibilities. The home needs to ensure that each member of care staff has one to one supervision six times per year, including an annual appraisal. Care Homes for Older People Page 23 of 27 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 24 of 27 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 27 18 The registered person must 14/06/2010 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. There have been occasions when there have been staffing shortages and the service has had difficulty meeting its legal obligations. 2 36 18 Care staff members must 16/06/2010 have regular supervision, which is expected to be six, one to one sessions each per year, including an annual appraisal. Staff must be appropriately supervised, as specified in the regulations. Care Homes for Older People Page 25 of 27 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 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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