Care Home: Waltham House

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What the care home does well The staff in the home are very friendly and knowledgeable about the people they look after. The manager has a good staff retention level and many have worked in the home for a number of years so people living there have continuity of care. There is a robust recruitment policy to ensure staff are safe to work with people in the home prior to their commencement of employment and are then trained and supervised to do their jobs. The home keeps accurate care plans on each individual living there and these are evaluated and kept up to date to ensure peoples current needs and expectations are being met. Where necessary the home enlists the help of other health and social care professionals for advice and help to ensure people are not being put at risk of harm. A varied programme of social activities is in place which people can access, both inside and outside the home to help them lead a fulfilled life. Since the last key inspection the home has expanded with a new building added to the original house and a new category of registration added of dementia. This building is partly used for those suffering from symptoms of dementia and the surroundings adapted to suit their specific needs. Other parts of the building have been refurbished with for example a new kitchen, dining room and conservatory. All areas were hazard free and accessible for wheelchair users, including the garden areas. The management team at the home complete regular audits on all aspects of running the home to ensure it is being run for the benefit of those living there. This is by way of surveys, talking to people, meetings, observing care practices, a newsletter and checking of all records and certificates kept in the home. What has improved since the last inspection? Since the last key inpsection the recording of activites has improved. The records now detail when an event has taken place, who has participated and the level of particiaption for example declined or played a full and active part. There were also some areas of the home that needed attention as regarding cleanliness and attention to detail of keeping the home tidy but this has now been adddressed. What the care home could do better: No requirements have been set at this inspection but we have detailed four good practice guidelines the service may which to follow. To ensure medication is stored at the right temperature the staff should keep a record of the storage room and fridge temperature where medication is stored. To further develop the choices of food on offer the owner may need to consider installing a grill in the kitchen. To ensure that staff are fully aware of what accidents and incidents are reportable to CQC it would be advisable to download our guidance on this topic from the main website for all staff to see. To help enhance the level of care within the home the management team may like to look at the guidance we have on our website which explains how a higher star rating could be achieved as this service has remained at a consistently good level for some time. Key inspection report Care homes for older people Name: Address: Waltham House Waltham House Louth Road New Waltham Grimsby North East Lincolnsh DN36 4RY     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: Theresa Bryson     Date: 1 8 1 1 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 27 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 27 Information about the care home Name of care home: Address: Waltham House Waltham House Louth Road New Waltham Grimsby North East Lincolnsh DN36 4RY 01472730020 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jane.robinson@Keme.co.uk Infinite Care Lincs Ltd care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP Dementia - Code DE The registered person may provide the following category of service only: Date of last inspection Brief description of the care home Waltham House is a large old property on the outskirts of New Waltham close to the town of Grimsby. It is set in mature gardens with car parking space to the front and side, with a new modern extension. It is registered to take people with problems of old age and dementia, (for which there is a special wing of the home adapted to their needs). The home accepts service users who are privately funded and funded by surrounding local authorities and fees are reviewed annually. Details about the home Care Homes for Older People Page 4 of 27 Over 65 0 33 33 0 Brief description of the care home in the form of a service users guide and statement of purpose is always on display in the main reception area and is sent or given to each prospective service user. Care Homes for Older People Page 5 of 27 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 inspection took place over one day in November 2009. Prior to the site visit we sent out a number of surveys to people who use the service, health and social care professionals and staff. A large number were returned all with positive comments about the home. We also looked at the service history we keep about the home to see what they had told us had been happening since the last key inspection and liaised with other departments in CQC to see what contact they had had with the service. We also asked the owner to complete an Annual Quality Assurance Assessment (AQAA), which they did and sent in to us when we asked them to. This gave us a lot of statistical information about the home and told us what they felt they had achieved in the last year and their plans for the future. During the site visit we spoke to a number of people who live there, some visitors and staff and also looked at a number of records and documents. We were able to tour the home and grounds and observe staff assisting people through out the day. We have reviewed our practice when making requirements, to improve national Care Homes for Older People Page 6 of 27 consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: No requirements have been set at this inspection but we have detailed four good practice guidelines the service may which to follow. To ensure medication is stored at the right temperature the staff should keep a record of the storage room and fridge temperature where medication is stored. To further develop the choices of food on offer the owner may need to consider installing a grill in the kitchen. To ensure that staff are fully aware of what accidents and incidents are reportable to CQC it would be advisable to download our guidance on this topic from the main website for all staff to see. To help enhance the level of care within the home the management team may like to look at the guidance we have on our website which explains how a higher star rating could be achieved as this service has remained at a consistently good level for some time. Care Homes for Older People Page 8 of 27 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 27 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 27 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. Written information is available about what services the home can provide and each person is holistically assessed prior to admission. Evidence: Since the last key inspection the owner of Waltham House has extended the building and added a new category of registration to enable them to take people suffering from symptoms of dementia. We looked at the new Statement of Purpose and Service Users Guide which explains to people wanting to come to the home all about the services it provides, what is included in the fees and something about the people who staff the home and how they are trained to do their jobs. This can be made available in other formats than English and the manager is exploring alternative means of presenting this information such as audio and other languages. We looked at the care plan for the last admission to the home and there was written evidence of how they had been assessed prior to admission by the manager.This Care Homes for Older People Page 11 of 27 Evidence: assessment is then used to build a fuller care programme once the staff have got to know that person a little more. People we spoke to told us how they had been comforted by how much staff knew about them when they came to the home. The home does not provide intermediate care and therefore Standard 6 is not applicable. Care Homes for Older People Page 12 of 27 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. Peoples needs are evaluated on a regular basis to ensure staff understand their current needs and expectations. Evidence: Prior to the site visit we sent out a number of surveys to people using the service, health and social care professionals and staff and had an excellent return. People told us how happy they were living in the home and said this is always such a happy place and it truly is home from home. Commenting on staff, people told us they were kind and caring and each one goes the extra mile. Relatives we spoke to on the site visit day told us they are always kept informed about their loved ones condition and staff will always make us a cup of tea and are friendly. Health and social care professionals were also complimentary about the staff saying they had a good knowledge base about each person, although they would like, sometimes, to know a bit more about them prior to a visit but once on site they received all the information they required. They also said how well staff had been trained to encompass the new part of the homes registration of dementia and how people suffering with these symptoms seemed settled in their own way. Care Homes for Older People Page 13 of 27 Evidence: We tracked through five care plans which over a period of time in this home have improved and are now more detailed then ever before. For example for one person who was having difficulty maintaining an adequate diet for their well being and health, had a nutritional assessment. This then was developed to a fuller care plan and a food chart when eating became difficult. We observed this person having a meal and staff were very encouraging trying to get them to eat and making suggestions of different foods and drinks.Advice had also been recorded when the local community dietitian had been spoken too. In another care plan seen for some one with an open head wound caused by their medical condition it was recorded how staff should dress this wound and what distraction therapy was put in place to try and keep the persons hands away from this area. Medical and nursing assistance had been recorded and also the wishes of this person as their life was drawing to a close. One member of staff we spoke to was able to explain to us the dementia mapping course they had attended and how they were now cascading this knowledge to other staff. We also looked at a care plan for some one showing symptoms of dementia. This detailed not only practical ways of ensuring the persons health and well being was being managed but also the assessments for dementia mapping. This included how the person occupied themselves and how staff interacted with them, at different times of the day. A very detailed care plan was then written to help this person through a full twenty-four hour period. To ensure staff keep the evaluation of each care plan up to date and they reflect a persons current need, we saw a general monthly audit which was completed by the manager. This was a detailed holistic over view of each persons needs. Staff also completed a monthly housekeeping and laundry audit to ensure each personal bedroom space of the person also was meeting their needs. Some people living in the home told us they like to do their bit by tidying drawers and dusting. One person told us how they cannot do so much these days but staff are happy to take suggestions of how I like my clothes laid out. Through out the day we observed staff interacting with people living in the home and assisting them with a number of personal tasks. On each occasion staff were polite and approached each situation in a calm manner. A senior member of staff showed us how medication is administered and there appeared to be safe practices in place. On looking at staff records all those administering medication had completed a suitable training course. We tracked a small sample of medication record sheets and there was written evidence to support people had received their medication as prescribed. Since the new building had been commissioned a new drug storage room had been developed. All items were now securely stored but no records were seen of temperature control to ensure they were stored correctly. The management team Care Homes for Older People Page 14 of 27 Evidence: need to look at a method of recording the room and fridge temperature. Care Homes for Older People Page 15 of 27 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. Food is prepared in a clean and safe environment and people feel able to contribute to the menu planning process. Evidence: To ensure that peoples social, cultural and religious needs and expectations are being met we looked at all records of how these are being assessed and evaluated and observed some practices and spoke to some people living in the home and staff. The recording of events which have taken place are now written in each persons personal care plan and social needs assessment. We also saw detailed activities records kept by the activities coordinator. These recorded the date an activity occurred, how the person participated or declined. We spoke to staff involved in ensuring people have a fulfilled life and they explained how they are commencing developing life stories and how they were going to adapt these for people with dementia. This ensures staff are aware of peoples current needs and how to plan meaning full activities for the future. The records showed a good variety of events had taken place, including group events such as reminiscence therapy, games and quizzes, entertainers and outings. One to one sessions included reading and shopping trips. A library service is also provided. One person told us how they like the visit of the Pat-A-Dog scheme, as I used to Care Homes for Older People Page 16 of 27 Evidence: own one but couldnt have it here now I get to love them without the worry. Another person liked visits out to a local social club. The home also produces a regular newsletter which we saw and this has a variety of topics, including peoples birthdays and poems. Around the home were posters of forth coming events and details to remind people of the day and time of the week. Since our last key inspection visit a new kitchen and storage area and dining area had been built. Staff spoken to said how pleased they were with this development and how the had been consulted about their working area. We saw on the day that food was being prepared in a clean and safe environment and that all written records were being kept up to date to ensure safe practices always took place. All equipment was in working order and some was new, for example the trolley for serving food. The one item, which staff felt was needed, was a grill to ensure food can be presented in a different format at times.There had been an increase in staff since the last inspection which ensures care staff are not taken away from their roles and all meals can be provided by suitably trained kitchen staff. The weekly menus continue and we saw other records now kept by kitchen staff of peoples likes and dislikes. Staff also told us they are informed in advance when a new admission is due. People living in the home told us that the cook always comes to ask them what they have liked or disliked on the menu and felt they were contributing to the planning process. Other comments by people included we get such a good choice and what I like is the basic home cooking, nothing fancy. Others commented on the good portion sizes and how well food was presented. We observed a lunchtime meal which was being served in the new dining room, which was clean, bright and spacious. Staff were seen assisting those who needed it and encouraging those less able to maintain a balanced diet. Care Homes for Older People Page 17 of 27 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. Robust systems are in place to ensure people are protected from abuse and are free from harm. Evidence: When the service sent us their Annual Quality Assurance Assessment (AQAA) it stated the home had not received any complaints in the last year. On the site visit day we looked at their complaints log and found this statement to be true. No concerns had been raised to CQC since our last visit. We spoke to several people living in the home who told us they had every confidence in the manager and staff dealing with any concerns they may raise. Health and social care staff also told us any small concerns they had raised about practical issues of care had been readily addressed by staff for the well being of each individual. Staff files showed that their training was up to date for knowing how to recognise abusive situations and could detail the process to us when we asked during our site visit. In the last year they had also accessed training for staff on the topics of the Mental Capacity Act and Deprivation of Liberty. This, staff said, has helped them understand better the need to ensure people, especially with symptoms of dementia, have their rights protected. The policies for protecting vulnerable adults and ensuring complaints are dealt with swiftly were checked and there was written evidence these had been reviewed. Care Homes for Older People Page 18 of 27 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. People are living in a safe, comfortable and secure environment. Evidence: Since the last key inspection the home has been visited by inspectors from the CQC Registration Team who checked and toured the newly built parts of the building and allowed the home to open these facilities and to have a further category of registration of dementia. During the site visit for this key inspection we also toured the whole home. In the dementia wing a lot of thought had gone into helping people who suffer from symptoms of dementia to recognise where they live. With memory shelves outside their doors which family members had adorned with photographs and ornaments people would hopefully recognise. Each door had been painted a different colour, had a number, door knocker and letter box. This unit accommodates ten people. Other parts of the rest of the home had been upgraded including the dining room, some bedrooms and the conservatory area. The staff had created a music room which had a CD player and a piano but no TV to encourage people to have quiet reflective times. People living in the home told us that they were pleased the new build had been completed as it had been quite noisy, but that they had been informed at all stages of the development of what was happening. For those whose areas had been upgraded they felt they had been consulted enough about their own environment. Care Homes for Older People Page 19 of 27 Evidence: There were a lot of examples of how people had been able to personlise their own rooms, which people told us was a comfort to them. The local Environmental Health Officer had visited the week previous to our site visit and given the home the highest star rating - 5 stars - for the cleanliness and lack of risks in the kitchen area. The garden area has also been newly developed with a new summer house, new car parking area and further development of the enclosed garden and main garden. All areas are accessible for wheelchair users and were hazard free at the time of our visit. We looked at all the safety certificates for the building and equipment in use in the home and found them to be valid and up to date. These are presented in a book format so the management team can keep themselves aware of when each needs renewing. Care Homes for Older People Page 20 of 27 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. A robust recruitment system is in place to ensure staff are safe to work with people in the home and are then trained to do their jobs. Evidence: As the home has taken on a different category of registration and increased its occupancy levels the rotas of staff for all departments has now increased. Staff told us they felt thought had gone into where the best places would be to deploy staff. People living in the home told us staff came very promptly when they required assistance. We tracked four staff personal files and there was sufficient evidence to support that adequate safety checks had been made on them prior to their commencement of employment to ensure they were safe to work with people living in the home. As the home had a new category of registration, that of dementia, care had been taken by the management team to ensure suitable training had been provided for all staff to enable them to meet the needs of these people. Staff told us that they had also received training in other topics such as nutrition, how to audit care plans, recognising depression and maintaining their NVQ awards. Most had now gained level 2 in these awards and some level 3 or were working towards obtaining this. staff said training topics are varied and training has helped me alter the way I look after people. Each staff member has a training book which details training received and is used to up date the management team in ensuring that all mandatory training has been completed. Care Homes for Older People Page 21 of 27 Evidence: In the last year the home has also gained the Investors in People Award which is valid for three years. This shows how well the assessors have seen training being a large part of how staff are developed in the home. Care Homes for Older People Page 22 of 27 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. Peoples views are sought, who live in the home, to ensure it is being run for their benefit and auditing systems are in place to ensure it is a safe place to live and work. Evidence: The owner of this home is very fortunate in that the same management team have been together for a number of years, as have most of the staff, which has resulted in a good continuity of care practices being developed. The management team have kept, according to their training records, themselves up to date with the latest practices for looking after people, for which the home is registered. We also saw copies of the Regulation 26 site visit reports completed by the owner, which are very detailed, and which have been sent to us in the past. This is no longer required, but they do need to stay in the home and be available for us to see when we next visit. The Company has a simple quality auditing tool in place which involves a combination of meetings, surveys and auditing of various documents, records and processes by the owner and management team. Records seen at the site visit included minutes of meetings with people living in the home, visiting health professionals, relatives and Care Homes for Older People Page 23 of 27 Evidence: staff. People living in the home told us they felt able to contribute to their daily lives by voicing suggestions on topics as diverse as how to iron a particular dress, to choosing flowers for the hanging baskets, to the colour to paint their bed room. The management team also look at the processes in place to ensure the home is a safe place to live with regular auditing of the fire safety processes, care planning evaluations and accident records, for example. In the accident records we found details, for example, of when an accident had occurred, what was done at the time to assess and protect this person and any changes to that persons care plan. Each accident is then audited by a senior member of staff and if practices need to change this is recorded and a record kept on how this is cascaded to all staff. Some staff were not totally up to date in their knowledge base, when questioned, about what is notifiable to CQC. This guidance should be down loaded from the CQC website to ensure all staff are aware of our requirements. We also tracked three peoples personal allowance records and found them to be correct. We could see that the records were examined and that the Owner of the home also checks these records and records this on the Regulation 26 site reports. The residents fund records are now in a much more legible format and detailed what had been received and what had been used. We also saw the receipts for these transactions. This ensures there is no fraudulent use of funds by staff members. Due to the increase in staff numbers we looked at the supervision records of staff to ensure they were being maintained and staff were fit and safe to work with people living in this home. A new system is now in place which enables the supervisor of each staff member to challenge them with policies in place, their knowledge base about people living there and what training they have undertaken. The records we saw at the site visit showed a combination of discussion times with staff and observations in the work place. The Owner and management team at the home have been able to maintain a continued good standard of care to the people who live there, over a long period of time and would benefit from looking at the Key Lines of Regulatory Activity (KLORA) from the CQC website to see where more improvements could be made to gain them a further star rating. Care Homes for Older People Page 24 of 27 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 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 To ensure medication is stored at the correct temperature a method should be found to ensure the storage room and drug fridge temperatures are recorded. The Provider should consider providing a grill for kitchen staff use to vary the way food is prepared for people living in the home. As some staff appeared unaware of what accidents and incidents need referring to CQC the management team should ensure the latest guidance from CQC is available for staff to read. The Owner and management team may benefit from downloading the Key Lines of Regulatory Activity (KLORA) from the CQC website to see where they could possibly improve their practice more. 2 15 3 31 4 31 Care Homes for Older People Page 26 of 27 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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