Care Home: St Leonards

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What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. Care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. There is a motivated and established staff team that consists of nursing and care staff who respond to service users in a respectful and appropriate manner. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Communication between people who use the service and staff was observed to be positive and open. The home ensures that people using the service are provided with a choice of wholesome and appealing meals in pleasing surroundings. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. Health and Safety procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? The home now ensure that all staff have a P0VA first check before they start work and an enhanced criminal record bureau clearance (CRB) is obtained. The home has made sure that the home`s generic complaints policy and procedures are supplemented with details of the specific local contacts. The home has made sure that generic safeguarding procedures within the new management system are supplemented with details of the specific local contacts. What the care home could do better: The home has made sure that service users plans include guidelines for the administration of all `when required/when needed` medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. Staff must provide support and monitoring as detailed in the care plans, for anyindividual who requires extra support with feeding. The home must ensure that two references are obtained for all staff before they commence employment at the home. All staff must be are up to date with mandatory training. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Leonards 86 Wendover Road Aylesbury Buckinghamshire HP21 9NJ     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: Barbara Mulligan     Date: 1 1 0 5 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 29 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 29 Information about the care home Name of care home: Address: St Leonards 86 Wendover Road Aylesbury Buckinghamshire HP21 9NJ 01296337765 01296339529 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Colley Care Limited (Trading as B & M Care) Name of registered manager (if applicable) Mrs Teresa Warren Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 45. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories only: Old age not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home St. Leonards is a purpose built care home providing personal care and accommodation for 45 older people. It is divided into two units. One unit caters for older people requiring general support, the other for older people with dementia. It is owned by B & M Care, which is a private care organisation. The home is located on Care Homes for Older People Page 4 of 29 care home 45 Over 65 0 45 45 0 Brief description of the care home the outskirts of Aylesbury, close to shops, pubs, a post office and other amenities. Public transport is easily accessible. The home was registered on the 19th April 2000 and consists of two floors. All bedrooms are single with en suite (WC and hand basin) facilities. Three rooms have an en-suite shower. There is a passenger lift. The home has a secure garden to the rear that is accessible to service users. Fees range from £600 to £750 per week. Additional charges are made for hairdressing, chiropody, newspapers and toiletries. Care Homes for Older People Page 5 of 29 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 unannounced key inspection was conducted over the course of one day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with some people who use the service, examination of some of the homes required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and Care Homes for Older People Page 6 of 29 diversity. The inspection officer was Barbara Mulligan and the manager for the home is Teresa Warren who was in attendance throughout the visit. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: The home has made sure that service users plans include guidelines for the administration of all when required/when needed medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. Staff must provide support and monitoring as detailed in the care plans, for any Care Homes for Older People Page 8 of 29 individual who requires extra support with feeding. The home must ensure that two references are obtained for all staff before they commence employment at the home. All staff must be are up to date with mandatory training. 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 29 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 29 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. Service users needs are assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. Evidence: Four completed needs assessments were examined, including those most newly admitted to the home. This assessment forms the basis of the care planning process. Files for people new to the service had a fully completed needs assessment and this shows that all areas and conditions of people using the service are assessed prior to offering them a place in the home. This information is readily available to staff who are expected to refer to the documentation to meet service users care needs. One person using the service said they has visited the home with their family before Care Homes for Older People Page 11 of 29 Evidence: they had moved in. It is noted that the service users have been asked their preferred name which is indicated throughout any further documentation seen, this is noted as good practice. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. There were copies of the care management assessments and hospital discharge letters in the care files. The home does not admit service users for intermediate care. Care Homes for Older People Page 12 of 29 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 who use the service are well cared for and this is supported by good record keeping, risk assessments and support from other health care professionals in the community. Medication procedures within the home are clear but guidance needs to be recorded in care plans about as needed medicines. The manner in which personal care is delivered ensures that service users are treated with respect and dignity and their right to privacy is upheld. Evidence: Four care plans were examined during this inspection, including those most newly admitted to the home. These provide adequate information about the person using the service and how staff are to meet their identified needs. Care needs are identified with an action plan setting out guidelines detailing how staff will meet those needs. However, some of the the action plans lacked detail. For example, one action plan to assist a service user with personal care is recorded as needs assistance with personal care, showering and also grooming and dressing and another entry reads assistance Care Homes for Older People Page 13 of 29 Evidence: from one carer in all aspects of personal care. These are very vague statements and do not provide specific details for staff to follow to ensure the service users needs are being met correctly. One resident had returned to the home from hospital on the day of the inspection and there was a short term care pan in place because her needs had changed. Again this lacked detail and it is strongly recommended that care plans set out in detail the action that will be taken by care workers to meet the assessed needs of service users. The staff spoken to are knowledgeable about service users care needs and preferences.There is evidence that care plans are reviewed monthly and updated when appropriate. Daily notes are detailed and informative and record the personal care received and activities that the individual has undertaken through out the day. Additional support is accessed through the local GP surgery, where service users can access physiotherapists, occupational therapists and speech therapists. The home receives district nurse support and they are available for advice regarding continence support and pressure area care, and can assist in the provision of pressure relieving equipment. The home provides regular exercises classes and this was taking place on the day of the site visit. Staff provide support to individuals needing to attend outpatient and other appointments. The manager stated that eye screening has not been undertaken regularly and has arranged for a domiciliary optical service to attend the home on an annual basis. The nutritional needs of service users are identified at the assessment stage and their weight is monitored on a regular basis. Referrals to the dietitian are made via the individuals GP. There is a domiciliary dental service that visits the home on a needs only basis and service users can visit the local dentist. Risk assessments are in place covering areas such as falls, moving and handling and nutrition. These show evidence of regular review. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the four people whose care was being case tracked as part of this inspection and at the MAR charts for the rest of the people using this service. At the time of the inspection there were no service users who were able to selfadminister their medication. The home uses a monitored dosage system (MDS) and medicines are stored in two mobile, lockable trolleys. All medicines are administered by staff who have received accredited training in the safe administration of medicines and who have then been deemed competent. Staff training records demonstrate this to be the case. The medication is safely stored and there are facilities for the storage of controlled medication. The MAR charts for all people using this service show no omissions and tell us that Care Homes for Older People Page 14 of 29 Evidence: people are receiving their medicines as they were prescribed by their doctors. The MAR charts showed that there were numerous hand written entries on them. These should be signed and dated and it is strongly recommended as good practice that when it is necessary to handwrite on a medication administration record chart in the home, the member of staff writing the chart signs and dates the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. There are no written guidelines for many as required (PRN) medicines and this is often left up to individual care staffs discretion to administer. A requirement is issued for the home to implement a system to be put in place that ensures service users plans include guidelines for the administration of all when required/when needed medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. The inspector observed staff assisting people who use the service in a kindly and respectfull manner. Staff are obviously aware of the importance of privacy and dignity and were seen to always knock on doors before entering and always addressing the individual by their preferred term of address. The homes induction programme includes training regarding privacy and dignity. The Statement of Purpose and Service Users Guide include information about maintaining the privacy of service users. Residents of the home can have a key to their rooms if they wish to use this facility and it is felt to be safe. Care Homes for Older People Page 15 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a range of activities available to residents who are encouraged and supported to follow their own interests, remain in contact with their families and friends and are supported to use local community facilities ensuring people do not become socially isolated. The presentation and standard of food is good and meets the nutritional needs of people who use the service, however support for people who need extra support with feeding needs to be improved to ensure they are not put at risk of malnutrition. Evidence: Care plans show individual routines of daily living and include bathing, rising and retiring times. As part of the admission process, the home or relative complete a life history of the individual, to give staff information about previous leisure pursuits, hobbies and other interests. Relatives and friends are welcome at any time and a visiting relative spoken to on the day was able to confirm this. The home employs two activity organisers and there is a variety of activities provided such as poetry appreciation, bingo, coffee mornings and quiz nights. A member of staff has undergone training & has successfully qualified as a Leader of Armchair exercises. Care Homes for Older People Page 16 of 29 Evidence: She now organises exercise classes for service users and these take place at least weekly. There are notice boards that display the weeks activities and any up and coming events. On the day of the visit several people went out to a local museum. Regular trips are arranged out to garden centres, the pub, personal shopping and the home has its own transport to facilitate this. Service users are able to receive visitors in the privacy of their own rooms, and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. Involvement by local community groups includes the local church and regular visits by the hairdressers, mobile library and various visiting entertainers. The inspector was able to join service users for a lunch time meal. The dining area was attractive with tables laid with attractive tablecloths and napkins and a small plant. The lunch served was attractively presented and tasty. The meal for the day was written on a notice board for all to see. During the meal it was noted that one person was asleep through most of the meal. A staff member sat beside them to assist with feeding. She gave them one spoonful of food, got up to undertake other tasks and never came back to assist. Another serve user on the same table tried to assist this individual with feeding whilst trying to eat their own meal. At the end of the lunchtime meal this persons plate was removed even though most of the meal remained on her plate. The care plan for this person was examined which states, food must be cut up for them This did not happen during this meal. Another entry in the care plan says, requires assistance with feeding and drinking. The support provided to this person during the lunchtime meal was poor and not in line with the guidance in their care plan which could potentially put t his individual at risk of malnutrition and dehydration. Weight monitoring was looked at for this person and that shows they have steadily lost weight since February. A nutritional assessment was completed for this service user in April. This was not completed using current information and gives a false picture of this individuals nutritional needs and support needed with meals. A requirement is issued for improvement in this area. Comments made about the food by people using this service include, the food is lovely, its good home cooking and they try really hard with the food, there is always a choice if you want. Care Homes for Older People Page 17 of 29 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 is able to effectively manage complaints and safeguard service users ensuring people who use this service are listened to and kept safe from harm and abuse. Evidence: There is a complaints policy and procedure, which clearly describes the way in which complaints should be handled and the deadlines that are set for response. The complaints procedure is accessible to service users and their representatives. A record of all complaints is maintained, and the complaints log was viewed during this inspection. The home has received two complaints in the last year. These are well recorded and responded to within stated timescales. A summary of the complaints procedure is included in the Statement of Purpose and Service Users Guide. No complaints or concerns have been received by the Care Quality Commission. Procedures are in place for the protection of vulnerable adults and staff have access to a whistle blowing policy. The home has a copy of the local authority Safeguarding policy. Training records demonstrate that staff have undertaken training in adult protection. There have been no safeguarding issues about this service. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is excellent, providing people who use the service with an attractive and homely place to live. Evidence: The home is purpose built and is located just off the main road between Aylesbury and Wendover, about one mile from Aylesbury town centre. The layout of the home is on two floors and is divided into two units. A twenty two bedded unit for elderly frail people and a twenty three bedded unit for people with dementia. All areas of the home are accessible by wheelchair. All bedrooms are single occupancy with en suite facilities such as, toilet and wash hand basin. The fixtures and fittings are of a high quality, well maintained and adapted to meet the diverse needs of individuals. Service users are able to personalise their rooms and can use their own furniture if they wish. The internal decoration of the home is in good repair and well maintained. There are many personal touches around the home such as flowers, pictures, books and mirrors. There are accessible toilets available for service users throughout the home and Care Homes for Older People Page 19 of 29 Evidence: several are close to the lounges and dining area. There is a system in place to address day-to-day maintenance issues, so that the safety of service users and staff is safeguarded. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a staff team who are sufficient in numbers to support the residents with personal care. The home needs to improve its recruitment procedures and staff mandatory training to ensure the safety and protection of residents in the home. Evidence: The homes staff rota demonstrates that there are adequate numbers and skill mix of staff on on duty at all times. The manager confirmed that there were additional staff on duty at busy times of the day. The manager is supernumerary on the roster, allowing for flexibility during peak and holiday periods. The home employs bank staff to cover additional shifts so that the homes staff ratio is maintained. The care team are also supported by full time housekeeping laundry and catering teams. Service users spoken to on the day of the visit said that staff are very kind and always helpful and the staff are lovely. They will always do that bit more then they need to. The AQAA tells us that there are twenty seven care staff employed by the home and fifteen of these have obtained a National Vocational Qualification level 2 or above. Care Homes for Older People Page 21 of 29 Evidence: The recruitment files for four staff were examined, including those new to the service. Three of the files examined contained the necessary documentation as detailed in schedule 2. However, in one file looked at there was only one reference available and a requirement has been issued for improvement in this area. Following the previous inspection a requirement was issued for all staff to have a POVA first check before they start work and an enhanced criminal record bureau clearance (CRB) must be obtained. The four files examined all contained POVA first checks and Criminal Records Bureau checks. All staff complete an induction programme that covers the common induction standards for social care and this was seen in the four files examined. Training records show that staff need to update their mandatory training. The manager has already identified this as an area that needs improvement and there was evidence of staff booked to attend some future training courses. It is a requirement of the report that all staff complete mandatory training. There is specialist training available for staff, and an example of this is oral health, managing challenging behaviour and dementia care. Care Homes for Older People Page 22 of 29 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 by a stable management team and service users are protected by safe working practices ensuring the health and safety of people using the service. Evidence: There is a new manager in post who has been employed since 17th December 2008. She is currently applying to register with the Care Quality Commission. Previous experience includes working as an acting manager in a care home for older people for eight months and prior to that she worked in a Domiciliary Care setting within a retirement village. The manager has completed the Registered Managers Award and is currently undertaking a National Vocational Qualification l5 in leadership and management and an accreditted Leadership in person centre care in dementia. The organisation & home has a clear and accountable management structure and the manager is supported by a senior manager. The inspector noted good teamwork in progress and all the staff spoken to had a good working knowledge of the individual Care Homes for Older People Page 23 of 29 Evidence: residents and their care needs. The organisations management system includes a quality assurance module which includes a satisfaction survey. These have been sent out and a summary of the results have been collated and an action plan drawn up to address any improvements needed. Regular service users and family meetings are held. There are confirmed plans for these to be independently chaired by Age Concern. Senior managers from the organisation also undertake regular monitoring visits. Reports of these visits are kept at the home and are open to scrutiny. Service users are encouraged to look after their own financial affairs where at all possible. If this is not practicable then families will undertake this role. There are secure facilities available for the safe-keeping of money and valuables and record and receipts are kept of possessions left for safe keeping. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment that is reviewed annually and is dated 17/12/2008. Service reports are in place for PAT testing and electrical installation. There is a Gas service certificate dated 10/10/2008 and Legionella dated 13/04/2005. Care Homes for Older People Page 24 of 29 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 29 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 9 13 The registered person is required to ensure that the home implements a system to be put in place that ensures service users plans include guidelines for the administration of all when required/when needed medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. To ensure people who use the service are protected by the homes policies and procedures for dealing with medicines. 30/06/2009 2 15 16 The registered person is 30/06/2009 required to ensure that staff provide support and monitoring as detailed in the care plans for any individual who requires extra support with feeding. Care Homes for Older People Page 26 of 29 To ensure the nutritional needs of the service user are met and the risk of malutrition is reduced. 3 19 19 The registered person is required to ensure that two references are obtained for all staff before they commence employment at the home. To ensure the homes recruitment procedures ensure the safety and protection of residents in the home. 4 19 18 The registered person is required to ensure that all staff are up to date with mandatory training. To ensure that people who use the service benefit from staff who are competent to do their job. 30/08/2009 30/06/2009 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 7 It is strongly recommended that care plans set out in detail the action that will be taken by care workers to meet the assessed needs of service users. It is strongly recommended as good practice that when it is necessary to handwrite on a medication administration record chart in the home, the member of staff writing the chart signs and dates the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. Page 27 of 29 2 9 Care Homes for Older People Care Homes for Older People Page 28 of 29 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. 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