Care Home: Westwood Lodge

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What the care home does well The premises were clean and safe and the standard of the accommodation was good. Visitors are welcome to visit at any time, there are no visiting restrictions imposed. Most of the care staff have achieved NVQ level 2 in care. What has improved since the last inspection? There had been no significant improvements since the last inspection, What the care home could do better: Key inspection report Care homes for older people Name: Address: Westwood Lodge Brookview Helmsman Way Off Poolstock Lane Wigan Lancashire WN3 5DJ     The quality rating for this care home is:   zero star poor 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: Judith Stanley     Date: 2 6 0 5 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 30 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 30 Information about the care home Name of care home: Address: Westwood Lodge Brookview Helmsman Way Off Poolstock Lane Wigan Lancashire WN3 5DJ 01942829999 01942826357 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Meridian Healthcare Ltd Name of registered manager (if applicable) Mrs M J Mather Type of registration: Number of places registered: care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 76 Date of last inspection Brief description of the care home Westwood Lodge Care Home is a purpose built home with 3 units, which offers general nursing and personal care for up to 76 residents. The home is situated in a residential area of Wigan and is approximately 5 minutes drive from Wigan town centre and local Care Homes for Older People Page 4 of 30 Over 65 76 0 0 7 0 8 0 6 2 0 0 9 Brief description of the care home amenities. It is pleasantly situated in its own grounds and has attractive gardens with ample car parking space available at the front of the home. Accommodation for residents is provided on two levels and in the annex, The House. All rooms are single and 76 rooms have en suite facilities: two of these rooms have a shower facility. Level access to the home is provided and a passenger lift ensures access is provided to both floors. There are communal lounge/dining and quiet areas on both floors and within The House. The fees for the home are 487 pounds and 22 pence to 656 pound and 46 pence per week. Care Homes for Older People Page 5 of 30 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: zero star poor 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 included a site visit and was unannounced and was carried out over nine hours on one day. A pharmacist from the Care Quality Commission (CQC) assisted with the inspection to look a medication procedures within the home. The registered manager has been absent from the home since April 2010 and the company have asked another manager from one of their other homes to help support the deputy manager. Some weeks before our planned visit the manager was asked to complete a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This helps us to determine if the management of the home see the service they provide the same way that we do. We found that some of the information provided on the AQAA was factually incorrect. Care Homes for Older People Page 6 of 30 To help us gather further information about the home we sent surveys to residents and staff. We received completed surveys from six residents, no staff surveys were returned. Most residents indicated that they were given sufficient information about the home and services available prior to making a decision about moving in to the home. When asked if staff are available when you need them, most answered usually. One resident said, It would be better if we could have more carers then we could have a few minutes to chat. Another said, The staff are friendly and helpful. We looked around the home and spoke with residents and staff. We also spent some time looking at records that the home needs to keep such as residents care plans, activity plans, menus and staff files etc. At the end of the inspection feedback was given to the supporting manager. Care Homes for Older People Page 7 of 30 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 Care Homes for Older People Page 8 of 30 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 30 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 30 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. Peoples needs are assessed before they move into the home to ensure their care needs can be met. Evidence: We initially selected four care plans to work with. On examination of the care plans all were found to contain a pre admission assessment. This assessment is carried out to ensure the home and staff can meet the individual needs of the resident. The assessment covers areas such as personal care and physical well being, diet, sight, hearing and communication, mobility, history of falls, medication, social interests, hobbies and religious needs etc. Care Homes for Older People Page 11 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are identified in the care plans, however these are were not always being adhered to. Medication was not always handled safely and residents health and well being may be at risk from poor medication practices. Evidence: We initially selected four residents files to work with. As the inspection progressed it became apparent that other residents files would have to be checked due to some concerns found. The care plans contained a lot of information about the residents care needs, however in some cases the information was not being adhered to. For example a number of residents where on food and fluid charts to monitor what they were eating and drinking. These had not been completed correctly and there were days when it appeared that some people had had no food or fluids. When asked about supplement drinks for one resident staff were unsure of whether it was one or two drinks the resident had, although the care plan indicated one a day. In another care plan it indicated that one residents behaviour could become aggressive or Care Homes for Older People Page 12 of 30 Evidence: unpredictable. There was no management plan for staff to be aware of what triggers this change in behavior and how best to prevent it or deal with it, before having to administer medication. It was noted in the care plans that some risk assessments had been completed for the use of bed rails, falls, pressure care etc. However we were told by some residents that they deal with there own medication such as inhalers and creams. There were no risk assessments available in the care plans relating to this. There was evidence to show that the home contacted outside agencies. For example, the Speech and Language Team (SALT) and the residents doctor. It was apparent from checking of some residents records that their advice was not always being followed. During the inspection the specialist pharmacist inspector looked at how well medication was handled. This was because we had previous concerns that medicines were not been given properly. We spoke with three nurses who had the responsibility for medication administration on the day of the inspection, the deputy manager and the supporting manager who was helping to run the home in the absence of the registered manager. The two units, in the main building, had special rooms in which to store medication and in the house medication was kept in lockable cabinets in residents bedrooms. Storage of medication was mainly safe and secure. However we found that some controlled drugs, powerful medication which by law must be stored in special cabinets, were kept in the ordinary cupboards. Creams and ointments were stored in residents rooms on the two units in the main building; these creams were not locked away. We also found that no checks had been made to make sure that it was safe to do so. It is important that these checks are made to ensure that residents health is not put at risk. During the inspection we observed that some medication was left unattended on an open trolley during the medication rounds. All types of prescribed medication must be locked away safely in the correct type of cabinets so that they are not at risk of being mishandled. The standard of record keeping was poor. Records about controlled drugs were poor and confusing. They showed that some unwanted controlled drugs had been destroyed when they had not been. These records also showed that some controlled drugs were unaccounted for or had gone missing. It is essential that accurate records are made about these very powerful drugs to ensure that they are not mishandled. Care Homes for Older People Page 13 of 30 Evidence: The records about other prescribed medicines were also poor. Medication such as Warfarin and pain relief could not be accounted for. During the inspection we watched one nurse sign for medication before it was given to the residents. This is very poor practice as medication must not be signed for as given until the resident has actually taken the medication. We also found that nurses signed for medication, such as creams and inhalers, which they had not personally administered. Some medication was given to residents but had not been signed for. Sometimes it was not possible to tell if medication had been given as prescribed or if it could be accounted for because the nurses had failed to record the quantity of medication received for residents when it arrived in the home. Nurses did not always record good quality information when doses of medication were not given as prescribed. One resident was prescribed two types of laxatives, sometimes nurses recorded that one laxative had been omitted because of loose bowels but the other laxative had been given. All records about medicines must be clear and accurate so they can show that residents are being given their medicines properly all medication can be accounted for. Records about creams overall were very poor. There was no information recorded to tell staff where to apply creams or how often. We also found that there was not enough information recorded about how to give as required medication or medication prescribed as a variable dose. This information is needed to enable staff to give medicines to people safely and consistently. There was a similar lack of information available for care staff about how to use a prescribed thickening powder to thicken drinks for people who had swallowing problems. We also noted that there were no records made to show that staff thickened fluids for residents who were prescribed this treatment. Thickeners are prescribed to help residents with swallowing problems. One resident told us that she thickened her own drinks; however the nurse said staff did this. The information and records were confusing and conflicting and did not serve to protect the residents health. Most medication was given to people as prescribed. However, some residents could not have their prescribed medicines or dressings because there were none available in the home for them. We looked at a sample of records and medication for fourteen people in the main building and found that five of them had run out of one or more their medicines for periods of up to twenty one days. One resident we spoke to was very concerned about a dressing running out on a regular basis and it appeared to be causing some distress. The resident added that their dressing was sometimes used for other residents. One of the nurses spoken with confirmed this as being correct. We found that sometimes nurses failed to confirm the prescribers directions when the Care Homes for Older People Page 14 of 30 Evidence: medicine is prescribed as directed; as a result one resident was given double the recommended dose of their medication. Sometimes nurses simply failed to follow the prescribed directions carefully. One resident was prescribed a laxative twice a day; however it was only ever given once daily. Nurses told us this resident needed it twice a daily as the resident often became constipated. If residents so not have their medication as prescribed their health could be at significant risk of harm. Some residents chose to look after some of their medication, there was no information recorded that they could do that safely. It is important the regular checks are made to make sure that residents continue to look after their own medication safely. We found some Homely Remedies were kept in the home. These are everyday medicines that can be bought over the counter for simple ailments. We found a quantity of Paracetamol in the cupboard which was being used as a homely remedy for both residents and staff. The Paracetamol had not been bought by the home but had been taken form a residents prescribed supply. It is not allowed to use medication which had been prescribed, labelled and supplied for one resident to treat other people and the supporting manager was told that that this practice must be stopped immediately. Nurses told us that they had all been trained on the correct use of some specific equipment for example syringe drivers to administer pain relief. Some information given to CQC, by the home, stated that nurses had received medication training; however nurses told us they had not received any formal medication training since coming to work at the home. One of the nurses said she had been at the home for three years and had received no up to date training. Because of the poor and outdated practice it is very important that staff are given up to date training to help them manage medication safely. Information on the returned AQAA told us that , The Care Centre works with the company medication policy which ensures that medication is given in a safe manner by competent staff you have all had relevant training to a high standard. This was clearly not the case. We asked if regular checks were made to make sure that the managers could tell if medication was being handled safely. The supporting manager said the last company audit check, had been done about six months ago. On the day of our inspection an audit of the medication had been scheduled to take place. Staff ensured that the privacy of residents was maintained. However some dignity issues need to be addressed especially for some residents who were seen eating their meals in bed. Some looked uncomfortable and would have benefited from being Care Homes for Older People Page 15 of 30 Evidence: propped up more and some had no clothes protection and were struggling to stop food from spilling on their clothes. It is appreciated that some residents may not want to wear a tabard, but may consider the use of a large napkin instead. Care Homes for Older People Page 16 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of provision of social activities that means people do not have opportunities to participate in stimulating and meaningful activities of their choice. Evidence: We asked about the range of activities provided. Information on the returned AQAA told us that residents have access to leisure activities and that the home employs two activities coordinators. The activity programme did not offer a good range of activities for residents, many of who are confined to bed. A programme for May was submitted and included board games, of which several people would not be able to join in, a baking day, again of which several people are to poorly to join in with or are in bed and a fish tank day. This were residents sit and watch staff clean out the fish tank. On the day of our visit the activity was coffee shop and book swap over in The House, it was asked how were the poorly residents and bed fast residents could be included in this activity. We discussed the activities programme with the supporting manager who agreed these were not suitable. The supporting manager confirmed that she would be taking over the planning of activities and making sure these were suitable. Information on the returned AQAA told us that, We employ two activities coordinators who provides flexible group and one to one activities with the consideration of individual choices and preferences. We saw no evidence to show that Care Homes for Older People Page 17 of 30 Evidence: this was happening and there was no planned activities on the units during our visit. it was noted three out of the five returned surveys that there was room for improvement with the the activities provided. Visitors to the home are made welcome by the staff. There are no restrictions as to when people can visit. Residents can meet with their visitors in the communal areas or in the privacy of their own rooms. There are some residents at the home that can make their own choices and decisions with regard to choice of meal and drinks etc. Others have to rely on staff to assist them in decision making. We asked about the menus and the choice available. One resident on a returned survey said, The menu seems to be the same, there is no variety. Also there is a lack of space in the kitchen for patients own food. Another said, They could make sure that the meals are nicely presented for example no cracked or chipped plates and dishes. There could be more fresh fruit available. On the day of our visit the main lunch time meal was sausage, chipped or creamed potatoes with baked beans or gravy. From our observations there appreared to be quite a lot food being wasted. There were a number of people eating meals in their own rooms. For some people this was not an option, but for others they could or should be encouraged to eat in the dining room. This would create a more social time for residents and staff would be able to assist them more easily. It looked for some residents that it was to much effort to eat and that they were struggling to cut up their food. Some residents who were in bed looked uncomfortable and others were finding it difficult trying not to spill their food. The supporting manager confirmed that she had looked at the menus and had started making changes to them. It was also mentioned about changes to the tea time and supper menus. Care Homes for Older People Page 18 of 30 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. Policies and procedures were in place, which help to ensure that people living at the home are protected from injury or harm. Evidence: A complaints system is in place should anyone one feel the need to complain. There had been nine complaints made to the manager within the last year. Information on the AQAA did not tell us if all nine had been responded to within the recommended twenty eight day timescale. Four of the complaints had been upheld and at the time of our visit one was still outstanding. There had been two safeguarding referrals and investigations within the year. This had been suitably dealt with by the management of the home and by the appropriate agencies. It was confirmed that all staff have undertaken mandatory training in the protection of vunerable adults. Care Homes for Older People Page 19 of 30 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. Westwood Lodge provides a safe and comfortable home that is well maintained and decorated and furnished to a good standard. Evidence: From a tour of the premises, it was evident that the home is maintained to a high standard both internally and externally. Several of the residents bedrooms were looked at. These were seen to clean and tidy, and residents had personalised their own rooms with their own possessions brought with them from home. All bedrooms were nicely decorated and furnished. The bathrooms were clean and domestic in character. There was some evidence of communal toiletries for example block soap. The outside of the home is well maintained and the grounds were neat and tidy. To reduce the risk of cross infection staff were seen wearing different protective clothing when carrying out different tasks. The laundry is sited away from food preparation areas and food storage areas and does not intrude on the residents. Care Homes for Older People Page 20 of 30 Evidence: In the main the home was clean and tidy, however a slight malodour was detected on Lake View. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for the recruitment of staff were thorough to ensure suitable staff are employed to safeguard people who use the service. Evidence: On the day of the inspection there were sufficient numbers of staff on duty. On some returned surveys comments have been made regarding staffing levels. One said, If there were some more carers then we could have a few minutes for a chat. A few years ago the carers always seemed to have time to talk to us but these days they always seem rushed off their feet. Another said, The home has a constant turn over of staff and some are very good and some or not. One comment made was that, The care staff and attention from care assistants and nursing staff are nursing staff are excellent. Of the staff group, 95 of staff have completed NVQ level 2 in care. All staff are supported to complete an NVQ suitable to their role, this includes all auxiliary staff. Mandatory training such as moving and handling and protection of vulnerable adults is ongoing. However training for nurses in medication, administration and recording was way overdue. Care Homes for Older People Page 22 of 30 Evidence: A full copy of each members of staffs employment is kept at the home in a secure location. We looked at some staff files and these were complete and up to date. Files contained an application form, two written references, Criminal Records Bureau check and other forms of identification. Care Homes for Older People Page 23 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management systems does not ensure the efficient running of the home. Evidence: The homes registered manager has been absent from the home since April 2010. Within the last month the company have brought in a manager from another home to support the deputy manager. The supporting manager has already made changes in some areas, for example changes to the menus and introduced more variety and is now overseeing the range of activities. The supporting manager was not aware of the poor practices we found in medication systems but was given full feedback by the CQC pharmacist inspector. The supporting manager assured us that she would start to deal with the medication problems immediately. The AQAA, which is a legal document was completed by the registered manager. Some of the information recorded on the AQAA was found to be factually incorrect. For example, The Care Centre works within the companys medication policy which ensures medication is given in a safe manner by competent staff who have had all Care Homes for Older People Page 24 of 30 Evidence: relevant training to a high standard. Staff spoken with confirmed that they had not had up to date training with one nurse stating she had not received any training in the last three years. Also, the home has a monthly plan in place for the activities, this is given to all residents so that they may choose the activities they wish to participate. It was noted that from the programme several of the activities would not be suitable for a number of resident as they are confined to bed. Information on the AQAA told us that the home has the necessary policies and procedures. However it fails to tell us when this were last reviewed as requested. Some quality assurance systems were in place for example, satisfaction questionnaires, resident and staff meetings. The home has monthly visits from senior management who compiles a written report on their findings. The AQAA tells us that regular audits on care plans and medication are carried out. However information in the care plans was not being followed with regard to food and fluid charts and risk assessments. The last medication audit was completed several months ago. Some of the residents living at Westwood Lodge had handed over small amounts of money for safe keeping. Money was seen to be individually stored and on checking the balance sheets no discrepancies were noted. Information on the AQAA indicated that some of the maintenance of equipment used within the home had been serviced or tested. It was noted that the no date was give for the testing of the premises electrical circuits, the emergency lighting and the heating system. The testing of portable appliances was overdue this was last done in October 2009 and the gas appliances was September 2009. Any accidents, injuries and incidents which may occur at the home were suitably recorded and the CQC notified as required. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must only be given to the resident for whom it has been prescribed, labeled and supplied. To protect residents health and well being. 16/06/2010 2 9 13 All records about medication 16/06/2010 receipt, administration and disposal must be clear and accurate. To show that medication is given as prescribed and can be accounted for. 3 9 13 If medication is not given as prescribed the reason for the omission or variation must be clearly recorded. To protect residents health and well being. 16/06/2010 Care Homes for Older People Page 27 of 30 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 4 9 13 All medication must be given 16/06/2010 to residents in exact accordance with prescribed directions. To protect residents health and well being. 5 9 13 Risk assessments must be done when residents choose to look after some or all of their own medication. To protect residents health and well being. 16/07/2010 6 9 13 Clear and accurate 16/07/2010 information must be recorded to inform staff how to give when required medicationor medication precribed as a variable dose. To make sure medication is given safely and consistently. 7 9 13 An effective system of medicines auditing must be put on place. To make sure that any concerns about medication handling can be identified and rectified to ensure the staff handling of medication at all times. 16/07/2010 Care Homes for Older People Page 28 of 30 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 8 9 13 All staff administering prescribed medication (including creams) must have appropriate up to date training. To protect residents health and well being. 16/06/2010 9 9 13 All medication must be 16/06/2010 stored safely and securely at all times. Controlled drugs must always be stored in a controlled drugs cabinet which meets current legislation. To make sure that medication is not mishandled. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Information in the care plans must be followed and food and fluid charts completed to ensure that residents receive the correct level of care and monitoring needed. To ensure that activities meet the needs, expectations and capabilities of the residents. 2 12 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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