Care Home: St Andrews

What the care home does well People are provided with good information about the home and they are invited to look around before they move in. This helps people with their decision making when looking for a service. The home makes sure that it can meet peoples` needs before they move in by receiving important information from professional people from health and social care services who have carried out an assessment of need. There are good arrangements in the home for meeting service users` health care needs. Service users are supported to see their GP`s, dentists, chiropodists, etc. There are good procedures in place for making sure people receive their medication at the right time and in the right way. There are plenty of activities available for people to take part in and relatives can visit the home any time they wish. The meals are good with plenty of home baking and choices available. There is a good complaints procedure and everyone said they were confident in talking to staff if they were unhappy. The home is clean and comfortable and everyone has their own bedroom. Staff training is good and includes the different needs of people who live in the home. This means that staff have the right knowledge and skills. Surveys are used to find out what people think about the service. This information is then used to improve the home. Service users said when asked what the home does well: "the food", "standard of care", "looking after me", "activities", "kept clean" and "attends to all my needs". Staff said when asked what they thought the home does well: "gives excellent care for all needs", "care of residents", "everything"and "St Andrews runs well in all aspects of care and with a good understanding of the people who live here". What has improved since the last inspection? This was the home`s first inspection following change in ownership in 2009. What the care home could do better: When we carried out the inspection we made a small number of requirements and recommendations about what the service could do better. For example about making care plans more person centred in relation to service users` preferred daily routines, how they like to dress and the individual way they like to be supported, the meal time arrangements and making sure service users are treated with dignity at all times. Reporting incidents was another area we felt the service could improve upon as well as adaptations to the environment for people with dementia. Since we did this inspection we met with the manager at St Andrews. It was evident that she has taken immediate steps to address all of the above issues, which is commendable. Key inspection report Care homes for older people Name: Address: St Andrews Church Bank Stanley Co Durham DH9 0DU     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: Nicola Shaw     Date: 2 7 0 1 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 28 Information about the care home Name of care home: Address: St Andrews Church Bank Stanley Co Durham DH9 0DU Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) St Andrews Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is : 45 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 category: Old Age, not falling within any other category - Code OP Dementia - Code DE Physical disability Code PD Past or present alcohol dependence - Code A Date of last inspection 10 20 0 20 Over 65 0 0 45 0 Care Homes for Older People Page 4 of 28 Brief description of the care home This care home with nursing is very well established and close to all local amenities, being situated near to the town centre of Stanley. Its ownership transferred to a new company in 2009. All bedrooms are singles and well equipped, although most do not have en-suite facilities. There are a number of lounges and bathrooms throughout the home. People with dementia are accommodated on the first floor of the home, but there is flexibility so that service users can move about the home as they wish, with support as required. There are adequate parking facilities and a well maintained garden. The weekly fees range from 390 pounds to 603 pounds. 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: Before the visit we looked at, information we have received since the last inspection, how the service has dealt with any complaints and concerns, any changes to how the home is run, the providers view of how well they care for people and the views of people who use the service, their relatives and staff. An unannounced visit was made on 27th January 2010. During the visit we, talked to people who use the service, relatives, staff and the acting manager. We looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We also looked around parts of the building to make sure it was clean, safe and comfortable. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: When we carried out the inspection we made a small number of requirements and recommendations about what the service could do better. For example about making care plans more person centred in relation to service users preferred daily routines, how they like to dress and the individual way they like to be supported, the meal time arrangements and making sure service users are treated with dignity at all times. Reporting incidents was another area we felt the service could improve upon as well as adaptations to the environment for people with dementia. Care Homes for Older People Page 7 of 28 Since we did this inspection we met with the manager at St Andrews. It was evident that she has taken immediate steps to address all of the above issues, which is commendable. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 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 9 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. Good information is available to help prospective service users make an informed choice about where to live. The admissions process ensures that people are adequately assessed prior to care being offered. This means that service users are offered the right type of care at the home. Evidence: There is a Statement of Purpose and Service User Guide. These contain up-to date information about the homes manager and responsible individual. They also contain useful information, for example, about the type of activities and meals available and arrangements for respecting the privacy and dignity of individuals. The Statement of Purpose is available in different formats, for example with pictures, to help to make the information easy to understand. Care Homes for Older People Page 10 of 28 Evidence: Five out of eight service users who completed a survey said that they had been given enough information about St Andrews to help them decide that it was the right place for them to live, before they moved in. For prospective service users, funded by the local authority, the manager obtains a copy of the needs assessment and care plan from the care manager so that she can decide whether St Andrews is able to meet their needs. For potential service users who are not funded by the local authority a nurse will carry out an assessment of need. The home also provides service users with the opportunity of visiting the home, have a meal or and/or move in on a trial basis. We spoke to the homes administrator who confirmed that the new provider is in the process of developing new contracts for service users. Care Homes for Older People Page 11 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. There is good information in the care plans about the health and personal care needs of the service users. They are beginning to be written in a way that will ensure that everyone receives care and support in a way that they prefer. Staff care practices generally preserve the dignity and privacy of the people who live here. Medication administration procedures protect the service users. Evidence: There is a generic risk assessment which is used to identify any risks in relation to the service users health care needs. From this care plans are developed. Care plans cover a range of aspects of the service users health and personal care needs. However, standardised care plans are used for each area of need identified and are not person centred. This means they do not provide information about each Care Homes for Older People Page 12 of 28 Evidence: individuals daily routine or information about how they prefer their personal care needs to be delivered. For example, those care plans we looked at in relation to rest and sleep did not provide information about the time the individual likes to go to bed or what their preferred night time routine is. Similarly, those we looked at for eating and drinking provided generic guidance to staff, for example plate guard may be of advantage and to sit in dining room for all meals and do not describe the support each individual actually does need. Nor do they promote choice with the generic statement to sit in dining room for all meals. In one persons daily notes staff had recorded on a regular basis that this person had become agitated, particularly after mealtimes. However there were no guidelines in place in the care plan, identifying possible triggers to this persons anxiety and what staff should do to help alleviate this persons stress at such times. In one care plan the guidance available to staff was no longer current and needs to be reviewed. For example, it said in the care plan, in relation to pressure sore prevention, encourage X to carry out positional changes when sitting in the chair, and X should be sat upright at mealtimes preferably in the dining room. This person is now receiving 24 hour care in their room and is totally dependent upon staff for all aspects of their personal and health care needs. After this inspection we met with the manager. She has worked hard to improve the service users care plans since our visit. We looked at three she has been working on. Service users, where able, have been involved in up-dating them. They contained detailed person centred information about the service users personal and health care needs. The manager is also introducing advanced care planning. This involves finding out about service users care needs whilst they are able to make decisions for themselves. This is good practice as it helps to make sure they receive the care they need in the way that they want should they ever loose the ability to make decisions. Service users weights are monitored each month. Service users have access to all NHS facilities. There are regular visits from GPs and other health professionals, including community psychiatric nurses, chiropody services and the speech and language therapy team. Service users said they get the Doctor for you if you need one. And seven out of eight service users who completed a survey said that the home always makes sure they get the medical care they need. Medication is stored in a locked, secure room. The medication trolleys were clean and well organised. Care Homes for Older People Page 13 of 28 Evidence: Staff monitor the temperature of the medication room and the medication fridge to make sure that medicines are stored correctly. However, the temperature of the medication fridge had regularly been recorded as being approximately 12 degrees centigrade. The acting manager confirmed that the fridge had been broken for some time. Some prescribed medication was being stored in it. The acting manager took immediate action and contacted the pharmacist for advice in relation to whether these medicines must be kept in a fridge. At this time none did, however, the acting manager agreed to develop a policy and procedure about where to store any medication a service user may need which must be stored in a fridge, whilst they are awaiting delivery of a new one. Senior staff order the medication from the prescriptions to ensure that service users are provided with the correct medication. There were no gaps on the Medication Administration Records, (MAR), we looked at which demonstrates that service users are receiving their prescribed medication. There is a small stock of controlled drugs. These are stored securely and an accurate record kept of the administration of these. There is no brought forward figure recorded on new MAR sheets for as and when required medication which is not dispensed in a monitored dosage system. This makes it difficult to carry out a stock check of this medication. Although staff referred to the service users by their preferred name and it was clear there was a good rapport between the staff and service users, staff were not always aware that their approach was not respectful. For example, they did not always knock on the service users door before entering their bedroom. Also, when assisting people with lunch, this was carried out in a task orientated way with little engagement with the service users. Since the inspection the manager told us that additional training has been provided to staff about privacy and dignity. 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. Service users enjoy a variety of activities, and are able to maintain family and other contacts if they want to. This ensures service users have opportunities to lead a fulfilling lifestyle and do not become socially isolated. Service users health and welfare is promoted by the provision of a varied menu. Evidence: There is a designated activities co-ordinator, who works 30 hours per week. The activities available to service users include crafts, reminiscing, games such as play your cards right, pie and peas suppers, gentle exercises, as well as trips out for picnics, fish and chips or for a meal. There are photographs on display in the home of the activities service users have taken part in. We talked to the activities co-ordinator who keeps a diary of events and who has taken part. He told us there is also a mobile shop. And the home has its own transport. There is church service held in the home every fortnight. Care Homes for Older People Page 15 of 28 Evidence: Staff told us about one service user, who has dementia, and likes to help staff with domestic tasks, an activity which they encourage them to take part in. This is good practice in dementia care. Four out of eight service users who completed surveys said that there were always activities they can take part in if they want to, two people said usually and two people said sometimes. However, there is very little information in the care plans about the service users social history. We talked to the activities co-ordinator about this who agreed it would be beneficial to find out about the service users past lives, interests and hobbies. This will help with the development of the activities programme. The manager, in her review of the care plans, has started to introduce these. Relatives said that they can visit the home any time and are always made to feel welcome by staff. Relatives are also encouraged to take part in the care of their family member if they want to, for example, helping them with their meal. We spent time with people on the first floor of the home whilst lunch was served. There were two dining tables in the lounge/dining room, which seat eight people. On this day a remaining seven people sat in the lounge/dining room with a small table in front of them. Whilst salt and pepper were available on the dining tables this was only offered by staff to one service user who was not sitting at a dining table. There were no table clothes on the tables. Those service users who needed support were offered this by staff, but this was at times carried out in a task orientated way with little engagement with the service users. There were only two care staff available to serve the meal and then assist those people who needed support. At least three service users needed assistance. This meant that one service user had to wait for their meal. The manager has since confirmed that she has ordered new dining room furniture and reviewed the meal time arrangements, including how the meal is presented, to ensure service users are treated in a dignified way. There is a picture menu available to help service users choose what they would like to eat. There is lots of home baked cooking on the menu and everyone we spoke to was very complimentary about the food. Comments from service users included: Care Homes for Older People Page 16 of 28 Evidence: they provide good meals and the foods Ok. A relative said: the quality of food is OK. Five service users who completed surveys said that they always liked the meals, two said usually and one said sometimes. Care Homes for Older People Page 17 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. The home has a good complaints procedure so people know that their views will be listened to and acted upon. Steps have recently been taken by the manager to ensure that all potential safeguarding incidents are reported which assists in helping service users be protected from abuse. Evidence: The home has a complaints procedure. This is on display in the home and in the Service User Guide. There has been one complaint in the last year. We looked at the complaints record, which showed that this had been thoroughly investigated by the manager. All eight service users who completed a survey said that they could speak to someone informally if they were not happy. Five service users said in surveys that they knew how to make a complaint. A relative we spoke to said I wouldnt hesitate to complain, but I have no cause to complain. There have been no safeguarding referrals made in the last year. However, when we looked in one service users daily notes an incident had been recorded where they had been physically aggressive towards another service user. This had not been reported to the local authority through the safeguarding procedures. We had also not been Care Homes for Older People Page 18 of 28 Evidence: notified of this incident, which is a legal requirement. We spoke to the manager about this after the inspection who has now reviewed and up-dated the homes incident reporting policy. All staff have now been provided with a copy of this to make sure all potential safeguarding incidents are reported properly. Twenty one staff need training about safeguarding adults. This has been arranged to take place later this year. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a clean, homely and well maintained place to live. And improvements are beginning to be made to the environment to help people with dementia find their way. Evidence: When we visited the home was clean and tidy. Seven out of eight service users said in surveys that the home was always clean and fresh. People with dementia live in this home. However, the environment had not been adapted to help meet their needs. For example, although name plates were on bedroom doors these were placed quite high on the door and may be quite difficult for some people to see. There were no other cues, such as a photograph or memory boxes containing items familiar to that person to help people to find their rooms. Grab rails were also a similar colour to the walls and may be quite difficult for some people to see. We met with the manager after this inspection who has started to make positive changes to the environment. This has included purchasing signs for bedroom doors, such as the name of the person and a picture of their former occupation, to help them find their bedroom. In addition corridors are to be named to give clues to people to help them find their way around the home. We looked at a small number of bedrooms. These were personailsed with photographs Care Homes for Older People Page 20 of 28 Evidence: and ornaments reflecting the individuals interests and tastes. A number of bedrooms have recently been re-decorated. New assisted baths are currently being fitted. The grounds are neat and tidy and can be easily used by visitors and service users in the warmer weather. The laundry was clean and well organised. Thirty staff have completed training in infection control. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels and staff training is satisfactory and includes specialist training in order to meet the diverse needs of the service users. This helps to ensure staff can effectively meet the care needs of people who live here. Staff recruitment procedures generally protect the service users. Evidence: On duty when we visited was the acting manager who was also the nurse in charge on the ground floor, and a senior carer and one care worker on each floor. There was also a full time administrator. There are currently 28 people living in the home and therefore these staffing levels are considered sufficient. However, as previously mentioned there needs to be a review of the staffing levels at mealtimes on the first floor of the home. Four service users who responded to surveys said that there were always staff available when they needed them and four said usually. Two staff who completed surveys said that there were usually enough staff on duty and two staff said sometimes. There has been a low turnover of staff, which is good for continuity of care. Care Homes for Older People Page 22 of 28 Evidence: All of the service users spoke positively about the staff and there was clearly a good rapport between the service users and staff. Service users said: the staff are all very nice and friendly. A visitor said : the staff are the kind of people you can talk to. We talked to the administrator who is arranging future training for staff. She has identified where there are gaps in staff training and has developed a training programme to address this. Staff we spoke to said that as well as the NVQ level 2 and 3 qualifications in care they had completed training about dementia and palliative care. And all four of the staff who completed surveys said that they had been provided with training relevant to their work which helps them to meet the needs of the service users. Staff files showed that the companys recruitment procedures are followed. This includes obtaining two written references and an Enhanced Criminal Records Bureau check to ensure that the prospective staff member is suitable. However, in one staff file we looked at there was no reference from the persons most recent employer, which is not good practice. The manager told us after the inspection that this issue had been immediately addressed. New staff staff complete an in-house induction when they start working in the home, which meets the Skills for Care requirements. Care Homes for Older People Page 23 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. Good management systems generally ensure the health, safety and welfare of service users. There is a good quality assurance system in place. It is based on the views of service users, where they are able to communicate their wishes, so that they know their rights and views will be listened to. Evidence: The registered manager is a First Level Nurse who has seventeen years experience of working as a nurse and seven years experience of managing a care home. She has been absent from work for a short time but will be returning in February 2010. In the meantime the deputy manager has been overseeing the management of the home. All sections of the Annual Quality Assurance Assessment were completed and the information gave a reasonable picture of the current situation within the home. The evidence to support the comments made were adequate but there were areas where Care Homes for Older People Page 24 of 28 Evidence: more supporting evidence would be useful to illustrate what the home has done in the last year. For example: in relation to the staffing outcome group when asked what had improved in the lst 12 months all we were told was staff had had additional training, with no further information about what this training consisted off. There are no regular service user/relative meetings, although it is stated in the Statement of Purpose that there are regular meetings with service users and families. However, the home operates an open door policy and obtains the views of service users and their relatives in this way. Surveys are also sent out to service users and relatives every six months and questionnaires sent to staff. The new registered provider has started to carry out monthly visits of the home to make sure standards of care are maintained. Service user monetary transactions are recorded appropriately. The home carries out internal maintenance checks and has contractors to service equipment. There are regular checks of fire fighting equipment, alarms and emergency lighting. Records showed that fire drills are carried out regularly. Staff are provided with training in health and safety issues such as moving and handling, first aid and food hygiene. There is a stair gate across the top of the stairwell in the residential unit. This is kept locked. We were told that this had been there for a number of years but there was no written evidence that advice had been sought from the Fire Service about this. The manager has since confirmed that a representative from an independent fire risk assessment company has made recommendations about this which will be acted upon. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 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 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 9 There should be a brought forward figure recorded on the Medication Administration Record for loose medicines to assist with the auditing process. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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