Care Home: Ryland View

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What the care home does well The home has good systems in place to make sure that each person has their needs assessed in full before they move into the home. People are given the opportunity to discuss their needs throughout this process. The home does provide people with the opportunity to take part in activities of their choice. People told us "I like to sing, I like this best". The home has a responsive complaints system in place. This means that people can be confident the home will listen and take action to address their concerns. People told us "I would always speak to the nurse in charge" and "I know who to speak to I needed to make a complaint. I wouldn`t hesitate the manager and the staff always try to sort things out for us". The physical environment is well maintained and offers a pleasant place for people to live. There are sufficient staff on duty to meet the needs of the people living in the home. People told us "the staff are very good and I don`t have to wait too long for them to come and help me". What has improved since the last inspection? The home was issued with a Statutory Requirement Notice following our last inspection because they had failed to make proper provision for the safe keeping and administration of people`s medication. We have visited the home in August 2009 to make sure the home has complied with the requirements in this notice. We found there had been a significant improvement and people were receiving their medication as the doctor had prescribed it. The home had also looked at the way in which they audited medication and had made improvements to that. This means that there are better systems in place and the risk of people running out of medication as we saw previously, is now very minimal. We also found the home has improved upon the care planning. People`s needs were being appropriately planned and documented. There was also a clear audit trail so that we could see what care had been given and whether it had been effective. The home has continued to improve upon the environment by redecorating and refurbishing the units. We have seen an increase in the amount of equipment such as profiling beds and pressure relieving equipment. This will provide added comfort for people. What the care home could do better: We have made one requirement for all staff to have training in the Mental Capacity Act 2005 and the deprivation of liberty safeguards. This will help staff understand their role and responsibility in supporting people who may not have the capacity to consent to their care and/or treatment. Key inspection report Care homes for older people Name: Address: Ryland View Arnhem Way Great Bridge West Midlands DY4 7HR     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: Mandy Beck     Date: 2 1 1 0 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 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) 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 27 Information about the care home Name of care home: Address: Ryland View Arnhem Way Great Bridge West Midlands DY4 7HR 01215201577 01215570859 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.bupa.com BUPA Care Homes (CFHCare) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 140 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 140 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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) 54 Dementia (DE) 60 Physical Disability (26) Date of last inspection Brief description of the care home Ryland View is a large nursing home owned by BUPA, with ample car parking in the grounds. It is located near to Tipton and is accessible by car and public transport. Each unit has its own garden area. Care can be provided for up to 140 people in five separate, purpose built and spacious bungalows, called Bloomfield, Haines, Manby, Care Homes for Older People Page 4 of 27 2 9 0 5 2 0 0 9 60 0 26 Over 65 0 54 0 Brief description of the care home Palethorpe and Heronville. Bloomfield can have up to 24 people, who are 58 years old and above, 10 of whom may require palliative nursing care. Haines can have up to 30 frail older people needing nursing care. Manby and Heronville can each have up to 30 older people who have dementia. All bedrooms are single occupancy and there are 4 en suite bedrooms on Bloomfield. There are toilet and bathroom facilities near to bedrooms on other units. Each unit has a large communal lounge, dining room and small quiet lounge. Bloomfield and Palethorpe have an additional lounge. Bloomfield has a large meeting room also used for teaching sessions. Each unit has a small kitchenette, which can be used to make drinks and snacks. There are aids and adaptations such as grab rails, assisted baths and hoists available on each unit. The administration offices, central laundry and kitchen are situated in a separate block. The current range of fees charged by the home are between £470 and £1130. For information about whats not included in these fees people are asked to 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: This was an unannounced inspection of the home, they were given no prior notice that we were going. The inspection was completed in one day by two inspectors and the commissions specialist pharmacist inspector. We looked at all the information that we have received, or asked for, since the home was last inspected in May 2009. This included the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical about the service. Information we have about how the service has managed any complaints Care Homes for Older People Page 6 of 27 What the service has told us about things that have happened in the home, these are called notifications and are legal requirement. We have also used the information given to us by the home in their improvement plan following the inspection in May 2009. We have also used the information from any other visits we have made to the home since the last inspection and also the results of any enforcement action we have taken with the home. We also used a Short Observational Framework for Inspection (SOFI) during this inspection. SOFI is designed to give us an opportunity to record our observations during the inspection of care homes where people have dementia. SOFI offers first hand experience of sitting alongside people who use the service for a couple of hours in a communal space within the care home. It gives an insight into their general well being during this time, and also into the staff interaction with the people who use the service. We also looked at the care of eight people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes ability to meet peoples needs. Care Homes for Older People Page 7 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 8 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 9 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 10 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 are given all of the information they will need in order to make a choice about living in this home. They can feel confident their needs will be assessed in full prior to admission. Evidence: The home has both a Statement of Purpose and Service User Guide that give people all of the information they will need to know about the service the home provides. It includes the range of fees people are expected to pay and the additional extras that will not be included in the weekly fee. Before people agree to move into the home the manager will spend time with them completing an assessment of their needs. This is done to make sure the home is able to meet peoples needs and that it will be the right place for them. We looked at the needs assessments of eight people during this inspection and found that each one had been completed and provided a sound basis for staff to be able to plan care for Care Homes for Older People Page 11 of 27 Evidence: people. People choosing to live here are given ample opportunity to sample the service before they agree to move in. We were told that people are encouraged to spend time in the home on trial visits. One person told us I had been to several places but chose this one. The home does not provide intermediate care facilities at this time. Care Homes for Older People Page 12 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. People living in this home have the assistance they need in order to meet their personal and healthcare needs. Medication practices are good and mean that people have their medication as prescribed. Evidence: People living at the actions required by care plan. The care found to reflect the home have a care plan, which outlines most of their needs and the staff to meet their needs. Each person case tracked had their own planning documentation was being reviewed regularly and was care being provided to people living in the home. There was also a range of risk assessments that highlighted potential risks and the action required to minimise them. All the risk assessments we saw had been regularly updated and amended to show the changing needs of people living in the home. Pressure area care management had improved so people were protected from developing pressure sores. Skin integrity assessments had been reviewed on a regular basis and reflected changes in the persons condition. Pressure relieving equipment Care Homes for Older People Page 13 of 27 Evidence: was available and was based on the persons individual needs. Wound care plans had enough information to guide staff in meeting needs. We did speak to staff about peoples needs in relation to pressure area care. They told us that it was apparent that certain people living in the home were not leaving their beds because the home could not supply them with appropriate seating during the day. This was discussed with the manager at the time of the inspection, she told us that this has been recognised as an issue and the home had ordered six new chairs that would address this problem. Once these chairs have been received people will no longer have to spend all day in their bedrooms should they choose not to. Staff were able to demonstrate through records and by talking to us that they would and were acting in a proactive manner to meet peoples needs. For example peoples weight was monitored regularly and this is linked to the nutritional care plans. Staff were able to tell us what care they were giving in relation to meeting nutritional needs and this matched the care planning records. Food diaries and fluid charts were in place for people who are deemed at nutritional risk, these had been completed and demonstrated monitoring was taking place. A care plan for a person with behaviour that challenges was reviewed and this contained good information. Staff also informed us that they had received training in behaviour that challenged and felt supported. A large number of beds had been replaced with profiling beds which are more appropriate for meeting the health needs of people living in the home. These profiling beds have bedrails built into them and are available for use. This ensures that the bedrail matches the bed although they do not have to be used. Following our last inspection of the home in May 2009, a Statutory Requirement Notice (SRN) was issued. This means that we had very serious concerns the home was not making sure they were storing and administering medication safely. We visited the home again in August 2009 to make sure that the requirements of the SRN had been met. We found the home had made many improvements and the requirement had been addressed. The pharmacist inspector visited the home on 21st October 2009 to check the management and control of medicines within the service.The pharmacist inspector visited three out of the five units. We found that there had been an overall sustained improvement in the management of medication in the units. We saw that medication was stored securely, which means that medication is safe and Care Homes for Older People Page 14 of 27 Evidence: therefore the people who live in the service are protected from harm We looked at the medication administration records and overall found that they were well documented with a signature for administration or a reason was recorded if medication was not given. The Manager informed us that regular checks are also made on the records to ensure that they are correct and up to date. We spoke to the Quality Consultant who had just completed a medication quality check on Manby Unit. This means that there are arrangements in place to ensure that medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. We found that other medication records were generally up to date. For example, we saw current records for the receipt and disposal of medication. The date of opening of boxes and bottles of medicines were usually recorded and balances of medication were carried forward from old records to new records.We saw a nurse recording the receipt of medication onto the medication records on Haines Unit. We saw a nurse documenting the disposal of unwanted medication on Heronville Unit. These records helped to ensure there was a clear audit trail of medication. We found that counts and checks made on medication were accurate, which showed that people who live in the service were being given medication as prescribed by a medical practitioner. We found detailed information relating to medication available in the care plans for individual people living in the service. This information included any changes made by a medical practitioner. The written information was clear, up to date and ensured that staff could access the information at any time. Care Homes for Older People Page 15 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 are supported by the home to take part in some activities. People are now satisfied with the meals on offer after arrangements were made to improve them. Evidence: There are five activities co-ordinators working at the home. This means there is one for each of the units. We visited Haines, Heronville and Manby during this inspection and saw on each of these units activity taking place. They ranged from general knowledge quizzes to karaoke. People were clearly enjoying themselves during this time. We spoke to staff who told us Each person is different, one person you can tell by eyes if he likes the things we do. Another staff member said love it every day, everyone is so individual, not a text book person out there. The home has tried to improve the amount and variety of activity on offer for people. On all of the units we saw that activities are planned, that there is variety and choice for people, even for those people who spend alot of time in their own rooms and can be at risk of social isolation. One person said I like to sing, I like this best. Recent events have included the Halloween disco, a visit to the Grand Theatre and trips to the pub. Care Homes for Older People Page 16 of 27 Evidence: The home has an open visiting policy and people are encouraged to have visitors when they want them. People can also choose whether to see people in the privacy of their own rooms or in any of the communal areas within each of the units. We looked at peoples bedrooms as part of our case tracking process and found them to be personalised by the people occupying them, appropriately furnished and pleasant places for people to stay. We also took the time to talk to people about the food on offer. We did this because during our last inspection in May 2009 people made comments about the poor quality of the food and the limited choice on offer. We were told at that time the home was in the process of reviewing this so that meals were more appealing and tasteful for people to enjoy. It was pleasing to see during this visit, that this has been completed and not one of the people we spoke to said that the food was of poor quality. We were told its very nice and there is a choice if you dont like whats on the menu. We tasted some of the food on offer and found that there had been a vast improvement. We observed during mealtimes that people were assisted by staff in a manner that was sensitive and appropriate to peoples needs. Choices were offered to people and meals were shown to people on the dementia care units so that making a decision about what meal they wanted was easier and less stressful for them. We also observed mealtimes to be relaxing and unhurried for people during this inspection. This is an improvement and means people have the time and assistance they need in order to finish their meals. Care Homes for Older People Page 17 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 using this service should feel confident their views would be listened to and acted upon. Staff have the knowledge and skills to keep people free from harm and abuse Evidence: The home has a complaints policy that is available to all people. A copy of the complaints policy is in the service user guide and in each persons bedroom. Since the last inspection in May 2009 there have been three complaints recorded. The manager told us that she is always there to talk through any concerns that people have and will always act upon them. We have not been made aware of any concerns about the home. Those people we spoke to told us I would always speak to the nurse in charge and I know who to speak to I needed to make a complaint. I wouldnt hesitate the manager and the staff always try to sort things out for us. The home has policies in place for dealing with allegations of abuse and keeping people safe from harm. We call this safeguarding vulnerable adults. We spoke to staff about this. All of the staff we spoke to were able to tell us what different types of abuse there were and how they would recognise the signs of abuse. Generally most of the staff knew who to refer to if an allegation was made to them or they had witnessed an act of abuse. The manager of the home understands what is expected of her in relation to reporting of incidents and allegations to the safeguarding team. Care Homes for Older People Page 18 of 27 Evidence: We also spoke to staff about their understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguards. None of the staff we spoke to knew what this meant. The home has told us there is training to be arranged for staff. This will need to happen so that all staff can be aware of their role and responsibility in supporting those people who may not have the capacity to make decisions about their own care and treatment. We looked at recruitment practices and found the home is taking steps to prevent unsuitable people from working with vulnerable adults. This includes required checks against the Protection of Vulnerable Adults list (PoVA) and a Criminal Records Bureau disclosure (CRB). Care Homes for Older People Page 19 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 home is well maintained and offers a comfortable place for people to live. Evidence: We visited the home in May 2009 and found that all of the units were generally well maintained. We did identify some areas for improvement. The home has told us the wheelchair access from the garden into Palethorpe unit has been improved so that people no longer struggle to do this. The home has also told us they have purchased new profiling beds for peoples added comfort and new pressure relieving equipment. Each of the units is pleasantly decorated. Some of the units have been decorated so that they provoke memories for people with dementia. We also noted the inclusion of a three piece suite on one unit which people took particular pleasure in sitting on. They appeared to be very relaxed and comfortable. Each unit has a garden that people can access. Efforts have been made to make sure that each garden is pleasant and offers a stimulating place for people to be. The home does have good systems in place for the management of infection control and peoples laundry. Staff told us that they have access to gloves and aprons and other protective equipment to keep the risk of cross infection to a minimum. Care Homes for Older People Page 20 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. There are sufficent numbers of staff on duty to meet the needs of the people living in the home. New staff are recruited safely and training is given to all staff to keep them updated. Evidence: We saw throughout the inspection there were sufficient staff on duty in order to meet peoples needs. The manager told us that staffing levels will be reviewed as and when peoples needs change. We spoke to staff they told us yes, there are enough of us on duty, sometimes it would be better if the nurses helped us but they have paperwork to do. People living in the home told us the staff are very good and no, I dont have to wait too long for them to help me. There was an induction training programme available and this meets the standards of the Social Skills Council. Carers and nurses undertake a three day induction programme where they are supernumerary for a minimum of one day when the commence employment and they gradually work through a training booklet over a 12 week period. New nurses also undergo a medication competence test during their induction to ensure they are safe to administer medication. The training matrix demonstrated staff had undergone training recently in fire, safeguarding vulnerable adults and more dementia care training. A number of staff Care Homes for Older People Page 21 of 27 Evidence: have received training in manual handling as part of an ongoing rolling programme. The training matrix given to use did not evidence specialist training such as diabetes and end of life care. Staff informed us they had attended such training. The AQAA supplied to us stated 41 of care staff had completed National Vocational Qualification (NVQ) level 2 or above in care. The AQAA also stated they hope to improve on the number of people with this qualification. The NVQ level 2 in care demonstrates a certain level of skill and competence has been achieved by staff working at the home. We looked at the recruitment processes in place and found them to be satisfactory. we looked at the staff recruitment files of four new workers since our last inspection. All of the files contained the required information. The home has also made sure that required safety checks against the Protection of vulnerable adults list (PoVA) and a Criminal Records Bureau disclosure (CRB) has been carried out. This will help prevent unsuitable people working with vulnerable adults. Care Homes for Older People Page 22 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 home is being well managed and improvements made mean the home is being run in the best interests of the people living there. Evidence: The home has had a change in management since the last key inspection. The new manager has worked well with existing staff to improve the standards of health care, medication administration and overall performance of the home. We saw improvements in all areas during this inspection. We spoke to staff about the manager and asked if they felt supported by her. They told us give her her due she is very good and supports us all, she is very approachable and I feel she listens to what we have to say, like its important. The home has introduced more quality monitoring systems to make sure that people have their medication as it has been prescribed. They have also introduced more robust care plan evaluations, this means that shortfalls in documentation are being Care Homes for Older People Page 23 of 27 Evidence: identified and addressed. Improved record keeping gives the home a clearer picture of peoples health care needs and the effectiveness of the care they have been given. We have also evidenced that all of the requirements we made as a result of the last inspection have been met, along with the requirements of the Statutory Requirement Notice. In addition to the new quality monitoring audits the home also seeks the views of the people who live there and act upon their views. We looked in dept at the quality monitoring system during our last inspection in May 2009 and found shortfalls in the quality of the catering provision that the home has addressed. We have seen improvements in the menu and choice and also the quality of the food on offer for people to enjoy. We have identified in the complaints and protections action of this report that staff were not aware of the Mental Capacity Act 2005 and the deprivation of liberty safeguards or their responsibilities under this legislation. We have said that all staff will need to have training in this legislation so they they are aware of their roles and responsibilities under the Mental Capacity Act 2005. The organisation has told us that they are in the process of rolling out this training to all of its staff and training will take place at Ryland View as part of this programme. At the last two key inspections management of peoples money met the standard. The system has not altered since the previous inspection. Money is held in a bank account which has sub accounts for each individual persons money. The home audits these accounts and the administrator is not aware of when these will take place. Individual finances were not looked at this inspection. The home has good systems in place for the promotion of peoples health and safety. Equipment is regularly serviced and replaced where appropriate. Staff have ongoing health and safety training. The training matrix shows us that the home keeps on top of this and staff are currently up to date. Care Homes for Older People Page 24 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 25 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 18 13 The home must make sure that staff have training and understand the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This is so people will be protected. 29/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The home needs to provide appropriate seating for people so that they do not have to spend excessive amounts of time in their beds and/or bedrooms. This will reduce the risk of social isolation for people. 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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