Care Home: The Crown Nursing Home

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• St Vincents
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• The Maypole Nursing Centre
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What the care home does well The service provides a very friendly homely environment that both the residents and their families enjoy. Individuals health care need`s are planned for, provided, and external support obtained when required. What has improved since the last inspection? There has been a programme of redecoration that has made the private and communal spaces in the home the residents use, bright, clean, and welcoming. The manager has looked at different ways encouraging relatives and friends to be involved with events and activities going on in the home. What the care home could do better: They should continue with implementing good control of infection measures to ensure that good practices are in the home. They should also ensure that information is transferred to individuals care records to assist with monitoring of their needs. There should be a more effective process included in the care planning to make sure that choices of how people like to live and their activities and interests are being met. Key inspection report Care homes for older people Name: Address: The Crown Nursing Home High Street Harwell Didcot Oxfordshire OX11 0EX     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: Ruth Lough     Date: 1 3 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: The Crown Nursing Home High Street Harwell Didcot Oxfordshire OX11 0EX 01235820010 01235834050 thecrown@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Trinity Care (Crown) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The Crown Nursing Home is a partially purpose built home located in the village of Harwell, Oxfordshire, close to local shops and amenities. The home is part of the Southern Cross group of health and social care providers. The service can accommodate up to sixteen older people who require nursing care. Care Homes for Older People Page 4 of 29 Over 65 16 0 Brief description of the care home The building has a mixture of old and new facilities and which gives a homely atmosphere to the private and communal spaces. All bedrooms have en suite toilets and wash basins. There is a lift to provide access to the first floor. Twelve of the rooms overlook the garden and some have a small balcony. The garden, which is largely paved, was designed to be easily accessible for wheelchair users. Fees range from £721.00 to £760.00 per week. People living at the home pay extra for hairdressing, podiatry, newspapers, toiletries and taxi fares. 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 was an unannounced key inspection process generated from the Good findings identified at the last assessment of the quality of the service by the commission in May 2008. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service were consulted about their opinion of what is provided. We also spoke to relatives, visitors, and staff. The findings from the homes own quality assurance survey, recently carried out in March of this year were also used. The home was subject to a Random focused inspection visit in February in response to Care Homes for Older People Page 6 of 29 concerns about the number of deaths in the home within a short timescale. The findings from the subsequent investigation, and other information obtained by the commission has formed part of this inspection process. At the time of the inspection there were nine residents living in the home. This included one person admitted on a respite stay. From this visit it was found that there are areas where they could improve as to protect the health and promote the wellbeing of the people they support. A small number of good practice recommendations were given at the time of the inspection to support this and can be found in the body of this report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 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 9 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. Individuals needs are assessed thoroughly before they are offered a place in the home. Evidence: The processs the service undertakes for the assessment of individuals needs before they are admitted to the home were reviewed. During the last inspection visit it was identified that the process is comprehensive and incorporated obtaining information from the individual concerned, their families and any health or social care professionals involved in their care. One new residents care records were looked at and they supported that this continues to be standard practice for the registered manager to carry out. They have listened to the recommendations made previously and have expanded the detail of the personal history with the support of relatives and friends of the person concerned. The home has also been able to develop their respite and short stay service to people Care Homes for Older People Page 10 of 29 Evidence: who live in the local community and from information available it was clear this has been appreciated by the small number of people who have been able to use it. Care Homes for Older People Page 11 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. The home ensures that the people in receipt of support and nursing care is planned for, and meets their needs. Evidence: Since the last key inspection in May 2008 the commission has carried out a very focused (Random) inspection visit in February of this year to the service, in response to concerns raised about the number of deaths in the home within a short period of time in January. During that visit care records and the environment were reviewed to establish if the residents concerned had receive the necessary care that they required and that there were good infection control measures in place. At the time it could be seen that there were a few improvements necessary in the care planning records to support the care actually provided but generally there was a good standard of record keeping in place. The other areas of required improvements found at this extra visit to the home will be explored in the relevant sections in this report. With reference to the improvements recommended at the inspection visit in February 2009 a sample of care planning documents were looked at again. One record was for Care Homes for Older People Page 12 of 29 Evidence: an individual who had been living in the home for approximately five months and the other had recently been admitted in March of this year. The two care plans that were reviewed showed that time had been taken to ensure that they were written well and were generally informative for staff. The majority of the health care needs of individuals are identified, planned for and actions implemented to meet them. From examining the sampled records it could be seen that staff ensure that any external health care is obtained and records noted of any consultation or treatment undertaken. They have implemented a number of monitoring tools for pressure area care and skin integrity and there are processes in place for observing any specialist monitoring for health needs, such as diabetes. The individuals care and nursing dependency is also reviewed regularly. The care records we sampled for both the people in receipt of support had gaps in the monitoring of their weight, but these were in the main because the nursing staff had not transferred them from a general record for the home. For one individual this was particularly important as there had been a considerable loss in weight over the last few months possibly through episodes of ill health and it was not clearly identified in the care planning that this was being monitored closely. This concern was passed back to the manager and the senior member of the organisation who was present during the home during the inspection visit. Overall the records for care planning have improved since the last inspection process. Staff are writing clearly and concisely about the outcomes for individuals who they support. Those residents and relatives spoken to during the day confirmed that they thought that their needs were being met. Comments from the homes most recent survey carried out included to the question of what they do well; Care and comfort. General looking after. Keeping in touch with the family. The medication administration practices were only briefly reviewed during this inspection process as this was partially assessed during the visit to the home in February. A recommendation was made to the manager at the time of that inspection to improve in the future any recording of any immunisations given to some of the Care Homes for Older People Page 13 of 29 Evidence: residents as to ensure that there is clear information about what they had been in receipt of. The home has the necessary policies and procedures in place for safe medication administration practices. The also have secure facilities for the safe keeping of medications in the home, including lockable spaces in individuals own rooms should the able to manage their own medications. Medication retraining for the registered nurses was undertaken in December 2008. At the last key inspection(May 2008), it was identified that there is very little recorded in great detail in individuals care planning for choices of how they wished to be cared for at the end of their lives. The recent random inspection identified that care had been taken by staff with the relatives of those with deteriorating health, to be included and consulted about the care of the person they support at the end of their lives. The manager was able to provide information that they continue to look at improving the process of obtaining this very specific information and are also looking at if they can offer to the local community a very focused service to people who wish to remain either in the home or the community they live in at the end of their life instead of being admitted to hospital. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are given the opportunity to exercise choice over their lives and be able to maintain some of their interests. Meals and menu planning appear to meet the needs and personal choices of the people they support. Evidence: The homes practices for supporting the people they care for with social contact, activities, and interests were reviewed. No previous concerns had been raised in the last inspection process or subsequent visit to the home that residents were not obtaining sufficient assistance to meet their needs or wishes. However, a recommendation was made at the time to develop the written information about personal choices. During this inspection visit the programme of events, the individual planning to meet personal choices, and the processes to ensure that what is provided meet the needs of people were reviewed. Some of the residents who were able to comment about what is provided did give some information about their experiences. Also relatives who were present during the day were able to give some insight to what is on offer in the home. Generally the opinion was that there was a mixed programme of events that suited Care Homes for Older People Page 15 of 29 Evidence: some but not all of the residents in the home. One resident who particularly enjoyed communicating with others and involvement with practical activities felt at times that there was a limited opportunity to do this, especially with the needs of the other residents in the home. The manager provided information in the Annual Quality Assurance Assessment about the activities provided to residents living in the home. They include games, mind games, events for friends and families, film afternoons, outside entertainers. Also information was given that there are plans for carers to get more involved in social activities of the residents including being encouraged to sit and talk to residents or read to them when time permits. They also stated they are planning to set up a Friends of The Crown group who could offer voluntary support for trips and other events. From what could be seen there is a very good relationship between staff and relatives as they expressed during the day of the inspection the pleasure that they and their relatives enjoyed at being encouraged to participate in the events and activities. Residents and relatives stated that they had had a marvelous day out to a local garden centre the previous week. The home was having a party in the afternoon of the inspection visit that had been planned to celebrate the managers birthday and unknown to some of the staff, for her to present them their certificates of qualification for their recently attained NVQs. Its was very evident that this event was being enjoyed by all the residents, staff and visitors. From discussion with the manager, staff and others there is a continual effort to support residents to obtain contact with the community they live in. For some this is quite relevant as they have lived in the local community for the majority of their lives. Regular activities include the local church visiting the home take a service for those who wish to participate. The records in regard to planning and providing individual support for people to continue with their interests and activities was only included in the initial assessment process. The organisation does have a focus on providing a holistic person centered documented care plan but this could not be seen in those sampled. Neither could there be seen an outline of the preferred daily routines individuals may have which would assist staff to achieve meeting their personal choices of how they wish to live for the people concerned. Care Homes for Older People Page 16 of 29 Evidence: These areas of recommendation for improvement were passed back to the manager during the day of the inspection. However, it was quite clear from speaking to residents and relatives that personal choices, routines and support with activities were generally obtained. The provision of meals and some of the menu planning were reviewed to see if personal choices are listened to and any dietary needs of the individual are being met. From discussion with staff and a review of some of the records it was evident that personal choices and any specific nutritional needs are identified and passed to the cook to plan and provide meals for individuals. The usual process is that any needs are identified during the initial assessment needs and noted in part of the individuals care plan. Through discussion with the cook responsible for taking the lead with the provision of meals in the home it was apparent that there was very little documentary evidence kept of personal choices in the kitchen or the planned alternatives on offer. Neither does the meal and menu planning appear to be developed through using the organisations own nutritional menu planning process, Nutmeg, which is in place to ensure that meals are balanced and do not compromise the dietary intake of those who do not require a specialist diet. Residents, staff, and relatives did provide good evidence that personal choices were listened to and acted upon and that the cook did find alternatives to the meals should people wish to have a change to the planned meal. There was also good evidence that residents were able to obtain extra snacks at different times to the regular mealtimes. Relatives and visitors are also encouraged to join at meal times should they wish and often some come in to assist staff providing support to the person they care for, with their main meal of the day. A further recommendation was given for the records held in the kitchen to be improved to ensure they are clear and concise and give the necessary information of how the staff are meeting the individuals choices, wishes and nutritional needs or the person concerned. During the day a sample of the main meal was taken, which was a mixture of home cooked mince or chicken and potatoes and pre-prepared mixed vegetables. The sweet was a Chocolate Gateaux. All the residents observed appeared to enjoy their meal. 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 people who use the service can be confident that their concerns or complaints are listened to and acted upon. They can also be reassured that there are the necessary systems in place to protect them from possible abuse or harm. Evidence: The residents and relatives we spoke to confirmed that they knew who to speak to should they have any concerns and that in their opinion they were listened to and staff were very quick to rectify anything identified. The complaints process is given in the Statement of Purpose and Service User Guide, plus is on display in the hallway of the home. The manager provided information in the Annual Quality Assurance Assessment that there had been one complaint made to the service since the last inspection process. From information available the concern was acted upon swiftly and appropriately and action taken where needed to rectify the concern. The commission has not been in receipt of any concerns or complaints about the service since the last inspection process, although as previously stated did respond to information received about the high level of deaths in the early part of this year. Through the investigation and some correspondence sent to the commission from relatives, they expressed that they had no concerns about the service and felt that Care Homes for Older People Page 18 of 29 Evidence: they acted appropriately to meet the needs of their relatives living in the home. The home has the necessary policies and procedures in regard to Safeguarding residents from possible abuse or harm. The topic has been revisited by all staff in the last year within the training programme and it was evident that staff responded well and acted accordingly when the service was investigated under the local safeguarding procedures in February. Care Homes for Older People Page 19 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 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 maintained well and meets the needs of the people who currently live there. The manager and staff continue to improve the management and practices in the home to ensure that they can offer better protection from the spread of infection. Evidence: During the last inspection process there were some concerns identified about the en suite facilities and spaces, furniture and fittings in two of the rooms used for shared accommodation. As previously identified the size and facilities for these en suites remain impractical for use for those with limited mobility. However, these rooms are not currently in use and the manager outlined that they intended reviewing the services they can offer in the home in line with their facilities. The recent changes in the number of the residents living in the home have enabled the manager to invest in time to redecorate and refurbish in parts the majority of the bedrooms in the home. From reviewing the redecorated rooms they now appear much cleaner, brighter and welcoming. Generally the home continues to have problems with the lack of storage space for equipment such as wheel chairs, commodes and hoists. Care should be put in place to ensure that en suites, corridors and bathrooms are not used as storage space for these or personal equipment as these can effect minimizing the control of infection. It Care Homes for Older People Page 20 of 29 Evidence: could be seen that staff had placed wheel chairs in a downstairs en suite as it was in close proximity to the communal areas, that and storing similar items in the communal shower room on the ground floor could not be seen as good practice. The manager and staff in the home have acknowledged the deficits in their management of the control of infection seen during the focused inspection visit in February. They have also listened to the guidance given by the Health Protection Agency when they visited the home. They have ensured that antiseptic hand rub is left in prominent places, and put action in place to fit mechanical sluices on both the ground and first floor. The date for completion for the mechanical sluices had not been obtained at the time of this inspection visit. They were also advised to look at if they could improve the hand washing facilities in the laundry area and ensure that they comply with recommended practices. Currently the staff have to use the same sink used for residents clothing. Throughout the home the home appeared to be kept clean, tidy and fresh smelling. This was confirmed by the comments made by residents and relatives during the day and in the homes quality assurance survey carried out in March. From speaking to residents, relatives and staff, some considerable effort had been made to improve the courtyard garden. The photographs taken last summer by the manager showed that that although small the garden had been a very pleasant area for residents to enjoy and observe from the overlooking bedrooms. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number, qualifications, and knowledge of staff working in the home currently meet the needs of the people they support. Evidence: The recruitment, employment and supervision records for staff employed in the home were reviewed to see if there are robust practices in place that protect the people who use the service. From information given a two week sample of the duty rotas, it could be seen that the core members of staff are supported by a regular team of bank staff in order to maintain sufficient levels of support to the residents. The manager has not recruited any new staff to the team, apart from one member who has recently left for personal reasons, since the last inspection process. The nursing and care staff are always assisted every day with a cook and domestic on duty which relieves them from the respective duties to concentrate on providing care to the people in the home. As previously stated in this report the manager was able to provide information that of the seven care workers employed, five have achieved an NVQ 2 in care, four in the Care Homes for Older People Page 22 of 29 Evidence: recent weeks. The manager provided information about the training programme given to staff to support them in their roles. The majority of the training for safe working practices had been carried out, mostly lead by the registered manager who is attained the necessary training and qualification to do so. The only area that is recommended to improve is training in nutrition for the members of staff employed to provide meals. Care Homes for Older People Page 23 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 service is run in the best interests of the people living there, and is managed effectively by a knowledgeable manager and provider. Evidence: Comments provided in the homes own survey included, I feel the house is a very comforting and welcoming place. Also, May is a fantastic manager that is why the home is run so well. Overall the home is run well and in the best interests of the people living there. From speaking to residents, relatives and staff the manager appears valued by them, and has striven to improve what the service provides to the people they support. She has also continued to look at improving her personal knowledge and skills to enhance her role and management abilities. This has been through attending relevant training through the provider and has a planned revisit to improve her ability to provide training to staff. Care Homes for Older People Page 24 of 29 Evidence: The recent episode of the high number of deaths in a short period of time from a respiratory infection in the home did show that the processes for reporting these concerns to the commission were weak. This was addressed by the manager and the organisation after a requirement was made during the random inspection in February. The manager appears to have met their responsibility to notify the commission swiftly of any adverse event that effects the well being of the people they support as the commission is now receiving this information promptly. The manager was able to provide information about the improvements made to the formal processes to consult with residents, relatives and others about the service. This has been through the manager encouraging the development of relatives to be involved in events and activities, providing a regular managers surgery every week and six monthly surveys. The results and information from the last survey carried out in March of this year being used for this inspection process. She has also continued providing a regular news letter to residents and has left copies in the front entrance for visitors to view. The organisation has a routine programme of provider monitoring visits in compliance to Regulation 26 of the Care Standards Act 2000. They have recently reviewed some of the documentation and format for this to ensure that they look at outcomes for the people using the service with better effect. The home has robust procedures and monitoring processes for any monies kept for safe keeping on any residents behalf. The records for this were not reviewed in depth during this inspection process as the organisation includes this in their regular quality monitoring processes. A sample of the records and information for safe working practices were reviewed to see if residents and others are protected by what is in place. During the last inspection process a previous concern about a fire exit being partially blocked which was rectified immediately. There were no concerns of this nature during this inspection visit. From the records available there is a regular programme of maintenance for the equipment, lift and water systems. The fire service did an audit of the fire safety practices and procedures in place in the home in November of last year. The manager was advised to amend the instructions Care Homes for Older People Page 25 of 29 Evidence: on display for the fire procedure and to practice with staff an evacuation of the home during the night. Both these recommendations could be seen to have been carried out quickly following the receipt of the report from the fire brigade. Care Homes for Older People Page 26 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 27 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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