Care Home: Torrwood Care Centre

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What the care home does well People`s rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. People could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that people living at the home and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home, on the whole, was clean, tidy and free from unpleasant odours. People are able to bring in furniture and personal belongings to personalise their private room. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards people. One person described staff as "very good, very kind". People living at the home are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. What has improved since the last inspection? Since the last inspection staffing levels at the home have increased. This has had a positive impact on the care and support afforded to people at the home. Medication is now given at regular intervals as there are now staff available to do this. Policies and procedures have been implemented to ensure that people receive correct moving and handling techniques. Tools to enable people to make choices have been developed. In particular with regard to meals. These need to continue to be developed for example by the correct completion of the "best interest checklist". Activities and social opportunities have been developed particularly for those with dementia. What the care home could do better: Although some improvements with regard to care planning have been seen some of the care plans do not give clear guidance to staff on the needs of people living at the home. These need to continue to be developed. Staff need to ensure that they provide consistent care and support regardless of which area of the home people to live in. For example choices of drinks and use clothes protectors at mealtimes. Key inspection report Care homes for older people Name: Address: Torrwood Care Centre Gilbert Scott Road South Horrington Village Wells Somerset BA5 3BW     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: Justine Button     Date: 2 2 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: Torrwood Care Centre Gilbert Scott Road South Horrington Village Wells Somerset BA5 3BW 01749675533 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): torrwood@schealthcare.co.uk Southern Cross OpCo Limited Name of registered manager (if applicable) Margaret Ndanga Type of registration: Number of places registered: care home 82 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 82. The MD category is in place solely for one identified person with mental health needs as their primary care need, who is transferring from a care home which is closing as part of the opening of Torrwood. This category will lapse when this person ceases to be accommodated at Torrwood. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Mental disorder (Code MD) maximum of 1 place Care Homes for Older People Page 4 of 28 Over 65 0 0 82 82 1 0 Date of last inspection Brief description of the care home Torrwood is the amalgamation of two services Wookey Hole Nursing Home and Cathedral View Nursing Home. Initially all people moved into Torrwood from these services. Torrwood is a new purpose built home in South Horrington surrounded by countryside, situated 3 miles from the cathedral city of Wells. The home has been developed over three floors. The ground floor comprises of the reception area, laundry and catering departments. The ground floor also contains the managers office and staff training and rest room. The first and second floors are accessible by a lift. The first and second floors contain accommodation for people living at the home. One floor caters for people who have dementia and the other floor for people who have general nursing needs. Both of the floors contain a range of communal space including dining facilities and lounge areas. All the bedrooms meet the National minimum standards for space. All are en-suite some with shower facilities. The rooms vary in size dependant on the fees paid. In addition to the en-suite facilities each floor contains a range of accessible bathrooms and additional toilets. The home has a garden which is accessible from the floor which accommodates people who have dementia care needs. The garden is secure and accessible for those people who require the use of a wheelchair. 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: This key unannounced inspection was carried out over one day by one inspector. The Manager was available on the day of the inspection. We would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CQC Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Information is requested from each home by us on an annual basis. Information from the homes Annual Quality Assurance Assessment (AQAA) was been used throughout the inspection process. Information held in the AQAA was confirmed during the inspection visit. Records examined during Care Homes for Older People Page 6 of 28 the inspection were individuals care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, quality assurance processes and staff supervision records. We also conducted a tour of the premises. Current fee levels at the home range from £516 to £750 per week dependent on needs and the room occupied. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Although some improvements with regard to care planning have been seen some of the care plans do not give clear guidance to staff on the needs of people living at the home. These need to continue to be developed. Staff need to ensure that they provide consistent care and support regardless of which area of the home people to live in. For example choices of drinks and use clothes protectors at mealtimes. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking about using the service are provided with information and a trial period to enable them to make an informed decision about moving to the home. The home has procedures in place to ensure that people are appropriately assessed before a placement is offered. People are provided with a contract which provides them with information about the fees to be charged, services offered and a statement as to the terms and conditions of occupancy. Evidence: The home have an updated Statement of Purpose and Service User Guide.These documents provide people with information about the home and the services offered. We examined care plans for people who had recently moved to the home and we were Care Homes for Older People Page 11 of 28 Evidence: able to see evidence that people were fully assessed before a placement was offered. Care plans also contained assessments from other health care professionals. One person using the service told us that they were useing the respite facility before making a decision to move to the home on a permanent basis. They also told us that they had been provided with information about the home and the services offered. We were able to see that people had been provided with a contract which identified the fees to be charged, services offered and a statement of the terms and conditions of occupancy. The homes completed AQAA told us that people who are thinking about using the service are given the opportunity to test drive the home so that they are able to make an informed decision about moving there; Before any resident comes to Torrwood they and/or their family are shown around the home and all questions they have are answered, They are encouraged to try the home for an initial period before making their mind up. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process has improved since the last inspection. Staff now need to ensure that these are consistently developed in all areas and for all individuals living at the home. The home is meeting the peoples health care needs . Medication is on the whole well managed Evidence: Four people were case tracked during the inspection and their care plans reviewed. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The majority of the plans had been completed with the individual and or their representative. The majority contained a range of appropriate assessments and associated care plans. Some of the care plans were clear and detailed however some Care Homes for Older People Page 13 of 28 Evidence: lacked clarity and did not give clear guidance to staff on how to meet the identified needs of the individual. One person at the home had recently returned to the home after an admission to hospital. During the individuals time in hospital her condition had deteriorated and she had developed pressure ulcers (also know as bed sores). On return from hospital staff had reviewed some aspects of the care plan but not others. Staff had reviewed the pressure risk and moving and handling assessment due to the development of the pressure ulcers. This would be appropriate. It was clear in the daily records that during the admission to hospital the individuals appetite had reduced and as a result she had lost some weight. A diet high in calories and protein is required for people who have lost weight and for those who have wounds. Despite losing weight and the development of pressure ulcers the nutritional assessment and associated care plan had not been reviewed or updated. Staff had not competed regular weights on order for them to assess any continued weight loss. Despite the lack of clear assessments and care planning the staff had requested e review with the GP to discuss the individuals condition. As part of the homes quality assurance the home manager had reviewed some of the care records. The manager had identified some shortfalls in some of the care plans and assessments that she had viewed. The manager had requested that the nurses address these shortfalls. On the day of the inspection these had not been addressed. The Mental Capacity Act 2005 (MCA) makes it clear that a person must not be assumed to lack capacity or be assumed to be unable to make a decision merely by reference to a persons age, appearance or condition. As such since the last inspection a best interests checklist has been implemented for all people who have dementia. These however have not been completed well by staff. Staff have stated on the forms that the individual is unable to complete the form due to their dementia. Staff however should be discussing the care and support needs with families friends and professional others. The checklist should clearly state what and how the individual can be supported to make decisions. It was clear from the care plans seen that staff had improved their communication with other health care professionals. Staff are now seeking the help and advise of GPs, Community Nurses, dietitians and speech and language therapists. Feedback from health care professional confirmed this. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The Care Homes for Older People Page 14 of 28 Evidence: majority of the charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. It was noted during the case tracking process that staff had supported individuals to meet personal hygiene needs including oral hygiene. A number of surveys were received in addition people living at the home were spoken to during the inspection. The surveys stated that people were satisfied with the care and support provided at the home. medication procedures were viewed during the inspection. These were found to be satisfactory. Care Homes for Older People Page 15 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. Social and recreational opportunities are available. Meals and mealtimes are of a good standard Staff need to ensure that the dignity and self esteem are maintained at all times. Staff need to ensure that they consolidate and support people in making choices. Evidence: Since the last inspection the provision of social and recreational opportunities has been developed. The AQAA stated that A Breakfast club has been introduced and runs three days per week on the Dementia floor. This is to help maintain independence and help socialising with others. A Social Bar has been set up and runs one afternoon per week. This encourages social skills, possible reminiscences and is open to service users and relatives. A Reminiscence room is in operation. Service users can go into the room at any time. The room is also used for reminiscence sessions. Rummage boxes are present in lounges and are filled with various items such as hats, scarves, handbags, jewelery. All service users can access when desired. The mobile library now comes to Torrwood every 3 weeks giving the opportunity to service users to leave the building and select their own books. We have strengthened the key worker system to Care Homes for Older People Page 16 of 28 Evidence: encourage more focus on the individual care of the service, including the physical, social and emotional care. These improvements were confirmed during the inspection visit. During the inspection we viewed the lunch time meal. Everyone we spoke with said the food was very good or excellent. This was confirmed in the surveys received. The food served on the day of the inspection looked and smelt appealing with a range of vegetable available. A choice of meal was evident. A four week rolling menu has been developed including a cooked breakfast and a hot option in the evening. It was noted during the inspection that there appears to be some differences between the meals served in both areas of the home. In the dementia care area it was noted that all people living at the home were wearing food protectors. Whilst it is appreciated that this may be required for some people the use of this equipment for all did have add a rather institutional feel to the meal. Staff need to consider how this impacts on peoples dignity and self esteem. Any soiled clothing could be changed following the meal. It was noted that in the area providing nursing care choices were given with regard to drinks. In the area providing dementia care no choices of drinks were given. The home has developed pictures of all meals in order to support people to make choices. This is excellent and should be commended. The choice of meals is made the day before so some people with memory loss may not recall what they had ordered or what the choices were. Staff could confirm the choices by showing two plates of food on the day of the meal. Snacks and drinks were seen to be available to all people throughout the day. 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 an appropriate complaints procedure in place and people feel confident in raising concerns. Procedures are in place to reduce the risk of harm or abuse to the people using the service. Evidence: The home have produced a complaints procedure which is clearly displayed in the reception area of the home. Copies of the policy are also contained within the resident handbook which is made available to each person using the service. During this inspection people told us that they would feel confident in raising concerns if they had any. No concerns were raised with us during this inspection. The home maintains appropriate records relating to all concerns received. We were able to see evidence that concerns had been appropriately investigated in line with the homes procedures. The Commission have not received any concerns since the last inspection. Staff spoken with demonstrated a good awareness of the whistle blowing procedures the protection of vulnerable adults procedures. Staff also stated that they would not hesitate in raising concerns should they arise. Staff have received training in the protection of vulnerable adults and in the deprivation of liberties. Care Homes for Older People Page 18 of 28 Evidence: The home have a range of policies in place to reduce the risk of the harm or abuse to the people using the service. 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. The home is clean, tidy fit for purpose and provides a good level of accommodation. Evidence: Torrwood is a purpose built newly opened care home. All bedrooms have en-suite facilities some with toilet and wash hand basin. Others have en-suite shower facilities. The bedrooms vary in size dependant of the fees paid however all meet the national minimum size. In addition to the en-suite facilities there are a range of accessible bathrooms, shower rooms and toilets throughout the home. Each bedroom has been fitted with an adjustable bed and the home has a range of up to date hoists and equipment. The home is fitted with a nurse call bell system in all areas. We sampled a few bedrooms and it was evident that people are encouraged to personalise their private space. The home has a range of communal living spaces including lounges, dining rooms. Corridors are wide and well lit. There is a good range of signage particularly in the area that supports people with dementia. Ancillary services such as kitchens and laundry are all found on the lower ground floor. As these are new they are clean, tidy and well equipped. The fixtures and fittings at the home are of a good standard. Care Homes for Older People Page 20 of 28 Evidence: At the last inspection some people told us that the home felt hotel like. Since the last inspection the home has developed and is now beginning to feel more homely. The manager told us that she hopes that these developments will continue over the next few months. This will include the development of the garden in the spring. Since the last inspection TVs have been provided in all bedrooms. The home takes appropriate steps to reduce the risk of the spread of infection. Liquid soap and paper hand towels are appropriately sited throughout the home. Staff have access to a good supply of protective clothing. All people in both the surveys received and spoken to during the inspection stated that they were happy with the level of cleanliness of the home. 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 at the home are now adequate. Additional developments in staff training are required although the majority of staff have reiceved mandatory training. Staff recruitment procedures are good and ensure the safety of people living at the home. Evidence: At the last inspection it was reported that the care and support provided at the home was compromised due to reduced staffing levels. Since the last inspection staffing levels have been increased. Staffing levels no longer seem to have a negative impact on the care and support provided. In the surveys received no person stated that staffing was an issue. When asked are staff available when you need them everyone stated always or usually. At the last inspection it was reported that Torrwood is registered to provide Dementia care in this area however only one of the qualified nurses is a Registered Mental Nurse (RMN). The manager stated she was aware of this and was actively trying to recruit additional RMNS. This remained the case at this inspection. Two staff recruitment files were viewed during the inspection and there was evidence Care Homes for Older People Page 22 of 28 Evidence: that the home was following robust recruitment procedures which also included appropriate checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA) The staff training matrix was viewed. This showed that the home employs 34 care assistants. Of these 13 have an NVQ. An additional six staff have applied to commence this qualification. The training matrix showed that the majority of staff have all received all necessary training. The training statistics showed that between 80 and 91 of staff had received mandatory training. Where the statistics were low training had been arranged. 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. The home currently has a manager registered with us. The home is run with the service users best interests safeguarded by policy, practice and procedures. Evidence: The home manager is Margaret Ndanga. Ms Ndanga joined Southern Cross in July 2008 and was initially responsible for the two homes that moved into Torrwood. Ms Ndanga has numerous years experience working in the field of care home management and is a registered nurse. In addition she has a bachelors degree in Care Home management and a masters degree in Community health. Ms Ndanga lives in the grounds of the home and is available to staff and people living at the home for the majority of time. As such she has been seen to work long and sometimes excessive hours. Ms Ndanga must ensure that she manages to have some time off to ensure that she has a good work life balance. This will ensure that she is Care Homes for Older People Page 24 of 28 Evidence: able to fulfil her role to the best of her ability when she is at work. Ms Ndanga has been instrumental in making the improvements from the previous homes. Staff stated to us that they found her very approachable One staff member stated that she felt that staff now worked as a team and that this was due to the home now having robust leadership. The home has systems in place to monitor the quality of the services and care offered. Copies of the homes internal quality audits were seen. Regular meetings are held for relatives, carers and staff where views are encouraged. All people spoken to during the inspection stated that they would feel happy to raise any concerns with the management. All stated that they thought their views would be listened to. All staff have recieved recent supervision. As part of the homes quality assurance programme and as required in the Care Homes Regulations, monthly visits are made by a company representative with written reports completed. Reports were examined during this inspection. We were informed that the home does not act as appointee for any people living there but manages small amounts of spending money for people. We looked at the records relating to this and found them to be well maintained. Details of transactions and balances are maintained in computerised format on an individual basis. Statements are forwarded to individuals relatives or representatives as appropriate, on a monthly basis. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 It is required that care plans 05/09/2009 are completed consistently so that they all provide clear guidance to staff of the care needs of individuals living at the home. All the care plans should be completed in person centred way clearly detailing the likes, dislikes of the individual and how they would like their care to be delivered. 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 14 The manager should support staff to complete the best interest checklists. This will enable staff to enable people to make choices and desicions. Staff should ensure that the use of clothes protectors does not effect peoples dignity and self esteem. 2 15 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. 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. 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