Care Home: Silver Lodge

What the care home does well The home has a warm and friendly atmosphere and staff work hard to ensure they can maintain good standards of care. The manager has a wealth of experience and her staff group has worked at the home for a good length of time. She operates an open door policy which encourages people and their relatives to engage with staff. The home was good at gathering information about the person to develop assessments and comprehensive care plans to confirm outcomes for individuals. Reviews of care and risk assessments were good and relatives said they feel involved in their relatives care and they were confident that any changes to their relatives care would be communicated to them. The home has developed a good range of activities and people were engaged throughout the inspection. The development of notice boards ensures people were informed of future events. Mealtimes were well managed and staff offered support and assistance to people appropriately. Staff was trained to a good standard and they have a good record of maintaining the required levels of NVQ qualified staff. The home has robust recruitment and selection procedures to ensure the right staff was employed to keep people safe. What has improved since the last inspection? Since the last inspection the staff have improved the information in the care plans to ensure it is up to date and reflects the care needs of people who use the service. Risk assessments have improved and staff ensure that the plans were regularly reviewed. Medication procedures have improved to ensure the records are an accurate reflection on the medication received, stored and administered to people. Staff have attended training to ensure they have the required skills and competencies to administer medication safely. They have improved parts of the environment by replacing the flooring in the small dining area, and aprons have been purchased to protect peoples clothing while they were eating their meals. New systems have been introduced to better manage peoples money. A new computer system ensures accurate records were kept and larger amounts of money had been banked appropriately. What the care home could do better: The home could improve the way they follow safeguarding procedures as agencies were not informed in a timely manner. The environment could be improved to ensure people can safely access the grounds, as areas were overgrown with weeds and the slope leading from the conservatory was extremley steep and would not be easily accessed by people without staff supervision. The bathing facilities must be fit for purpose and in sufficient numbers so people can choose to have a bath close to where their bedroom is located. The registered providers must continue to refurbish the home including bedrooms furniture and soft furnishings around the home. The kitchen refurbishment has not taken place and this was required at the last inspection of the home, it is unacceptable and must be completed within the timescales of this report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Silver Lodge 12 Housley Lane Sheffield South Yorkshire S35 2UD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Valerie Hoyle     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Silver Lodge 12 Housley Lane Sheffield South Yorkshire S35 2UD 01142468177 01142578383 silverlodge@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross BC OpCo Ltd care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Dementia - Code DE, maximum number of places 32 Mental Disorder, excluding learning disability or dementia, Code MD - maximum number of places 32 Date of last inspection Brief description of the care home Silver Lodge is a Care Home providing personal care for elderly people with dementia. The home is a large detached house set in its own grounds; it is built on two levels, consisting of the original building and extensions including a conservatory. The home is situated on a quiet road in Chapeltown near to the shops, library and local Care Homes for Older People Page 4 of 28 Over 65 32 0 0 32 Brief description of the care home amenities. The home is spacious and allows service users to wander around communal areas of the home freely, with a selection of quiet or popular seating areas for the service users to visit alone or with family and friends. The home does not provide nursing care. The manager confirmed that the range of monthly fees on 21st April 2009 were 368.00 pounds - 463 pounds and 15 pence per week. Additional charges included hairdressing and private chiropody. Copies of the last inspection report dated 22nd April 2008 are displayed in the entrance to the home. Further details about this service can be obtained by contacting the manager. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. This inspection of the service took place over 7 hours starting at 09:30 finishing at 16:30; this included a partial inspection of the home. Five people who use the service, and four staff were spoken to during the visit. Their views were included throughout the report. Four relatives were spoken to during the inspection to assess their views on the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that People who use the service are not being put at significant risk of Care Homes for Older People Page 6 of 28 harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Occupancy at this home follows current trends, with 27 of the 32 beds occupied on the day of the inspection. Four peoples care plans were looked at. Policies relating to medication, complaints, protection of vulnerable adults and handling of peoples money were looked at. Three staff recruitment and training records were looked at to assess how people were protected. Procedures and risk assessments relating to health and safety were looked at and discussed with the manager. The registered manager is Jayne Vickers; she has worked at the home for a considerable length of time and was appointed as manager four and a half years ago. She has obtained the Registered Managers Award and continues her professional development by attending training as required by the organisation. The AQAA was sent to the home in February 2009, this was returned to us on time, which demonstrates responsiveness and cooperation. An Annual Quality Assurance Assessment is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. The inspector would like to thank everyone who agreed to be interviewed as part of the inspection process, and the friendliness of staff. What the care home does well: What has improved since the last inspection? What they could do better: The home could improve the way they follow safeguarding procedures as agencies were not informed in a timely manner. The environment could be improved to ensure people can safely access the grounds, as areas were overgrown with weeds and the slope leading from the conservatory was extremley steep and would not be easily accessed by people without staff supervision. The bathing facilities must be fit for purpose and in sufficient numbers so people can choose to have a bath close to where their bedroom is located. The registered providers must continue to refurbish the home including bedrooms furniture and soft furnishings around the home. The kitchen refurbishment has not taken place and this was required at the last inspection of the home, it is unacceptable and must be completed within the timescales of this report. Care Homes for Older People Page 8 of 28 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive information about the home and their needs were assessed before they move into the home. Evidence: All new people receive a full comprehensive needs assessment before admission. This was carried out by the manager or other senior staff who have the required skills and competencies. The service was highly efficient in obtaining a summary of any assessment undertaken by the placing authority, and insists on receiving a copy of the care plan before admission. Staff confirmed that information contained in the assessment was essential to understand what they needed to do to ensure peoples needs were met. Three assessments were looked at and they focused on achieving positive outcomes for people who use the service. Before agreeing admission the manager and staff carefully considers the needs assessment for each individual prospective person and Care Homes for Older People Page 11 of 28 Evidence: the capacity of the home to meet their needs. People were given the opportunity to spend time in the home, before making final decisions about where to live, although most would move directly from other care settings due to their limited capacity. The same process was followed when admitting people for emergency or short stay. A short stay assessment was looked at and it was comprehensive, enabling staff to provide the care they needed. Relatives said they had visited a number of homes before selecting Silver Lodge as the best home to meet their parents care needs Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with sufficient information to meet the needs of people who use the service. Arrangements for dealing with the health issues were met with support from health professionals. Medication procedures were well managed ensuring the safe administration of medicines to people. Evidence: The three care plans seen reflected individual needs and had comprehensive information about the personal history, individual choices and preferences of people at the home. Records were maintained on a daily basis detailing their changing needs and the care provided. Any risks associated with providing care were also recorded, such as the risk of falling or the development of pressure sores. Relatives said they had been consulted regarding the care of their parent, and they were confident that any changes to their care would be discussed with them. Relatives said the staff were very good and they knew their relative was receiving the best possible care. Records looked at and discussion with staff confirmed peoples healthcare needs were met. The manager said they had good relationships with the district nursing staff, who Care Homes for Older People Page 13 of 28 Evidence: provide support to staff. Assessments to ensure the nutritional needs were looked at and they were comprehensive and included action to ensure peoples dietary needs were met. An audit of medications stocks and records were looked at and were found to be correct, ensuring the health and welfare of people who use the service. Senior staff had responsibility for administering medication and they had attended accredited training to ensure medicines were safely given to people who use the service. The local pharmacist was contracted to undertake periodic checks to ensure the stock levels were maintained and procedures followed. Medication was stored securely in the office and there was a seperate, locked room for storing medication which also housed a locked fridge and a controlled drugs cabinet. Throughout the inspection staff were seen interacting with people who use the service in a kind manner, they spent time talking to people and were observed knocking on bedroom doors before entering. All people were referred to by their first name and this was agreed in the care plans looked at. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were encouraged to make choices and exercise control over their lives. Mealtimes were well organised and staff offered discreet support where needed. Evidence: There was a warm, friendly and relaxed atmosphere on entering the home and a sense of wellbeing throughout the home. Activities were arranged that were suitable to stimulate people with dementia. There was a member of staff who had responsibility for organising activities. The activities took place in the conservatory where people participating in board games. The coordinator said outside entertainers visited the home, including an organist and hairdresser. She said she hoped to arrange more outings outside the home, using the organisations mini bus. Notice boards and posters were displayed to advertise forthcoming events. There was a calm atmosphere throughout the visit with some people spending time in their bedrooms, whilst others spent time in the lounges and conservatory. A partial inspection of the building found many good examples of how people were able to bring in personal items for their room to help them feel at home. Bedroom doors had been painted in bright colours to help people orientate to their room. Care Homes for Older People Page 15 of 28 Evidence: Visiting relatives said they were always made to feel welcome and staff were very caring. They also said they were confident in staffs ability to provide the care needed for their relative. The cook gave good examples of the menus provided and said alternatives were always available. The menus indicate the nutritional value of the meals and it was the cooks responsibility to ensure the meals were balanced and nutritional, while taking into account the likes of people who use the service. Mealtimes were well managed by staff who had a good understanding of peoples dietary needs. The cook said assessments had been completed to ensure people received additional supplements where needed. Staff were seen giving assistance in an unobtrusive way. People said they enjoyed their meal of pork steak and fresh vegetables. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service could access the complaints procedure and the manager ensures any concerns were recorded and investigated appropriatley. Adult safeguarding procedures were in place, although they had not been followed, which may put people at risk from harm. Evidence: The was a complaints procedure that was available to people who use the service and their visitors. The procedures was also referred to in the Service Users Guide, identifying the stages to follow. This includes the timescales to respond to complaints. The address and telephone number of the Care Quality Commission needs to be included in the procedure. Complaints records were looked at, they show that one complaint had been recorded since the last inspection at the home. The complaint was discussed with the manager. Relatives said they were confident that the manager would deal with any concerns they may have. There was a comprehensive Adult Safeguarding and whistleblowing policies and staff were aware of the procedures. The manager said she would investigate fully any allegations of abuse and work to the procedures. However, records confirmed that a recent incident had not been reported as required by the safeguarding adults procedures. The incident was discussed with the manager and the operations manager. The manager did not have a copy of the local authorities safeguarding adults procedures, although she was able to obtain a copy before the inspection was Care Homes for Older People Page 17 of 28 Evidence: completed. The manager holds discussions with staff to talk over issues on how to recognise different forms of abuse. Staff said they had received training on safeguarding adults. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were serious concerns about the environment as areas were unsafe and not fit for purpose. Evidence: A partial inspection of the building was undertaken. This included looking at the outstanding requirements made at the last inspection in April 2008. It is unacceptable to find that the requirements made by CSCI and Environmental Health Department regarding the kitchen had not been completed. The kitchen equipment was in poor condition and although it had been deep cleaned the problem had not been resolved. The dishwasher was out of order, although the manager said they were awaiting a new one. A representative of Southern Cross Healthcare told the inspector that plans had been developed for a new kitchen although she could not give any indication when the work would commence. The sluice identified at the last inspection had not been completed although work had commenced. There was only one bathroom in use which was situated on the ground floor. The bath was in poor repair, as some of the enamel had been damaged. It should be replaced or repaired to make it a better environment for people to bathe. The organisation must ensure that other bathing facilities must be made fit for purpose, as it is unacceptable that people were not able to bathe close to where their bedroom is situated. One facility is an inadequate provision for the 27 people who use Care Homes for Older People Page 19 of 28 Evidence: the service. A number of bedrooms were looked at. The furnishings in most rooms were poor, with ill fitting drawers and wardrobes which were not secured to the wall. These pose significant risk to people who use the service. The water pressure in a number of bedrooms was poor. Some of the rooms had very little water coming from the hot water taps, making it virtually impossible to wash adequately. The person responsible for maintaining the building was aware of the problem, although the problem had not been resolved. This makes the issue of the lack of bathing facilities even more urgent to ensure people can receive appropriate care and prevent the spread of infection. The door handle was missing from one bedroom which means the person using the room would not be able to close their door, without finding themselves locked in the room. The decor in most of the rooms looked at was poor and the soft furnishings did not match with the decor. There was extensive grounds around the home, although most of the paved areas were overgrown making it difficult for people to access the gardens without assistance. The organisation should consider contracting with a company to keep the garden safe and well maintained. The access to the garden from the conservatory was via a steep slope making it extremely difficult for people to access independently. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the skills and competencies to fulfill their roles within the home, a stable staff group ensures continuity of care by staff that knows the people who use the service. Recruitment policies were robust ensuring the safety and protection of people who live at the home. Evidence: Training records looked at show the staff have the required skills and competencies to deliver a good service. Discussion with the manager and staff confirmed that there was a stable staff group who had worked at the home for a good period of time. Staff said they enjoyed working at the home, and felt supported by the manager. The Partnership for Older Peoples project provides valuable support to the home, through training and advice that helps staff to develop new skills, which helps them do their job better. The manager was able to confirm training was organised as needed and the training plan was used to identify gaps in peoples knowledge. The manager said training had been organised in areas of Mental Capacity and the Deprivation of liberty, although it had been postponed to a later date. A number of staff had completed courses to enable them to cascade training to care staff, which means training can be delivered quickly and effectively when issues arise. There was a comprehensive induction and probationary package, which was service specific. It meets Skills for Care standards. One induction programme for a new Care Homes for Older People Page 21 of 28 Evidence: member of staff was looked at and had been fully completed. The manager confirms permanent employment when satisfied that competence and progress had been shown to be satisfactory against their standards. Staff rotas and observation during this visit showed there were sufficient staff to meet the needs of people who live at the home. However staffing levels during the afternoon should be kept under review as mealtimes and evening routines may affect the way people can be supported. Relatives said there was mostly enough staff and they were very good at their job. Staff had the required skills to meet the needs of people, and they are commended for meeting the requirement of 50 NVQ Level two qualified staff. The AQAA told us that 13 of the 20 permanent members of staff have achieved the award in care. A further 6 members of staff were working towards NVQ Level 2 award in care. There were robust recruitment and selection procedures that ensure people who use the service are safe and protected. A number of staff recruitment files were looked at, and there was evidence that all required employment checks had been undertaken, prior to commencing work at the home. Evidence confirmed all staff had a Criminal Record Bureau check. All files looked at had two references. The manager should check the date on all existing CRB checks as good practise suggests that a new CRB should be carried out every three years, to ensure the information had not changed. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 managed, the procedures ensures the health and safety and welfare of people using the service. Evidence: The registered manager has a wealth of experience and knowledge and was able to demonstrate her ability to manage the home. She has achieved the required management and care qualifications and continues to attend training as required by the organisation. She operates an open door policy to ensure she was accessible to staff and people that use the service. Relatives and staff spoke highly of the manager and said she was efficient and very caring. Staff and group meetings ensured that staff were informed about training opportunities and the day to day running of the home. They were also encouraged to be involved in decision making. There was evidence that the home actively seeks the views of people who use the Care Homes for Older People Page 23 of 28 Evidence: service. There was a satisfaction survey and they also have meetings to enable people to discuss problems and give their views on how they want the home to be run. Representatives of the organisation visit the home monthly and undertakes a quality audit (Regulation 26). Reports were available for inspection. People who use the service were able to manage their own finances, although most prefer the manager to assist with dealing with their personal monies, due to their limited capacity. Records were looked at and they were an accurate reflection of the accounts held on peoples behalf. Systems to ensure money held at the home was kept to the minimum had been introduced, since the last inspection of the home to ensure they act in the best interests of people. Accident reports were analysed by the manager to ensure risk assessments were developed where needed. Maintenance and service records were looked at and were up to date and current to the service provided. The manager displays the required Health an Safety policies, procedures and notices. Fire procedures were in place and service records were looked at and were current, ensuring the safety of people. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23 All parts of the care home must be kept clean and reasonably decorated. The home must after consultation with the environmental health authority make arrangements for maintaining satisfactory standards of hygiene. Therefore all the recommendations made by the environmental health on the 22nd of Feb 2008 must be complied with. 03/08/2009 2 26 16 06/07/2009 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The ground must be maintained to make them safe for people to use. This includes pathways and patio areas and the slope from the conservatory into the garden 29/06/2009 2 21 23 Sufficient bathing facilities must be available and fit for purpose. To ensure people can bath close to where their bedroom is and they should have a choice of shower of bath. 31/07/2009 3 25 23 The water pressure and hot 29/06/2009 water system must be fit for purpose in all areas of the building. To enable people to follow good hygiene practices Care Homes for Older People Page 26 of 28 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 2 3 18 21 24 Safegurading procedures must be followed to ensure the health, welfare and safety of people who use the service. The bath on the ground floor should be replaced or recovered as some of the enamel was in poor repair. Refurbishment of peoples bedrooms must continue which includes the replacement of worn carpets and furniture which is not fit for purpose. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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