inspection report - care quality commission · |inspection report | prince george duke of kent...

| Inspection Report | Prince George Duke of Kent Court | August 2014 www.cqc.org.uk 1

Inspection Report

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Prince George Duke of Kent Court

Shepherds Green, Chislehurst, BR7 6PA Tel: 02084670081

Date of Inspections: 20 June 201419 June 2014

Date of Publication: August 2014

We inspected the following standards as part of a routine inspection. This is what we found:

Respecting and involving people who use services

Met this standard

Consent to care and treatment Met this standard

Care and welfare of people who use services Action needed

Safeguarding people who use services from abuse

Met this standard

Staffing Action needed

Assessing and monitoring the quality of service provision

Met this standard


Details about this location

Registered Provider Royal Masonic Benevolent Institution

Registered Manager Ms Gillian Khalighi

Overview of the service

Prince George Duke of Kent Court provides nursing and residential care for up to 78 older people. At the time of our visit 60 people were receiving a service.

Type of service Care home service with nursing

Regulated activities Accommodation for persons who require nursing or personalcare

Diagnostic and screening procedures

Treatment of disease, disorder or injury


Contents

When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

What we have told the provider to do 6

More information about the provider 6

Our judgements for each standard inspected:

Respecting and involving people who use services 7

Consent to care and treatment 9

Care and welfare of people who use services 11

Safeguarding people who use services from abuse 13

Staffing 14

Assessing and monitoring the quality of service provision 16

Information primarily for the provider:

Action we have told the provider to take 17

About CQC Inspections 19

How we define our judgements 20

Glossary of terms we use in this report 22

Contact us 24


Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 19 June 2014 and 20 June 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific wayof observing care to help us understand the experience of people who could not talk with us.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

What people told us and what we found

The inspection team consisted of an Inspector, Inspection Manager and an Expert by Experience. Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service Safe?People living in the home had assessments of possible risks to their health and safety and these were reviewed as and when required.

Staff had the training and knowledge they needed to make sure people living in the home were cared for safely. We saw all communal parts of the home and some people's bedrooms (with their permission) and found the premises and equipment were safe and well maintained.

Is the service effective?


People's care needs were assessed and they told us staff understood their needs and provided the care and support they needed. People were involved in making decisions about their health and personal care wherever possible. If people could not contribute to a specific aspect of their care plan, staff worked with other professionals to assess the care they needed.

Care records we saw showed that some people had not received care in line with their care plan. Most of the care plans and risk assessments we looked at were up to date, had been reviewed and updated monthly, and / or as and when people's needs changed to reflect their current needs. However, some of the care plans we saw were not up to date. The health care records we looked at demonstrated that people had access to external health care professionals' support as required.

Is the service caring?Each of the care plan files we looked at described the person's likes, dislikes and daily routines.

All the seven people who use the service told us that they felt the care staff were helpful. For example, and one person said care staff were "very helpful and willing to assist with any requests". We observed staff maintained an individual's dignity and demonstrated respect whilst providing care and support. However, the provider may wish to note that a person using the service told us, "I was upset and surprised to have a man come into my room to change my pad." She had not been asked if she was comfortable with this arrangement and had not been offered any alternative.

Is the service responsive to people's needs?Most the people we spoke with confirmed staff sought consent before care was provided. Staff we spoke with were able to demonstrate how they would seek consent from a personusing the service. We observed staff treated people with respect and involved them in making choices and decisions about their care for example, during mealtimes.

When people did not have the capacity to consent, the provider had acted fully in accordance with legal requirements. However, the provider may wish to note that in some cases there was no evidence of capacity assessments or any best interest decisions. For example, a family gave consent to catheterise a person but there was no capacity assessment or best interest decision in place. There were not enough staff at all times to meet people's needs in a timely manner. Most of the staff we spoke with told us that sometimes they had experienced difficulties in providing timely support to people when required; and said they sometimes struggle with staffing due to the dependency of people who use the services.

Is the service well-led?All the staff told us they felt supported by their line manager. They also told us they understood their roles and responsibilities.

The provider had effective systems to regularly assess and monitor the quality of service that people received. These included regular audits of medication, care plans, health and safety. There was evidence that learning from these audits took place and appropriate changes were implemented. For example, following these audits, an action plan was developed and implemented to address the issues identified; these included majority of bank staff were booked for mandatory training, staff meeting were held to discuss timely call bell response, mattress replaced when found dirty and care plans were reviewed andupdated as and when people's needs had changed. However, the provider may wish to


note that two relatives had told us when concerns were raised with management and werelistened to but not acted upon. Complaints records we saw showed that at the time of our inspection two complaints investigations were in progress. As the investigations were not completed at the time of our inspection therefore, we were unable to assess the impact of this action.

You can see our judgements on the front page of this report.

What we have told the provider to do

We have asked the provider to send us a report by 12 August 2014, setting out the action they will take to meet the standards. We will check to make sure that this action is taken.

Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service(and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases we use in the report.


Our judgements for each standard inspected

Respecting and involving people who use services Met this standard

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run

Our judgement

The provider was meeting this standard.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

Reasons for our judgement

People expressed their views and were involved in making decisions about their care and treatment. All people we spoke with told us they were involved in making decisions about the way in which care was delivered to them. For example, care plans demonstrated preferences for morning, day and evening routines such as when to get up, or go to bed and bathing preferences. Several care plans had end of life advanced care plans, which included wishes from people who use the service and their families. One relative told us, "we were involved in the care plan when Mum was admitted." Most of the care plans we looked at showed that people or their relatives had signed to confirm that they had agreed to the care and support that would be provided.

People's religious and cultural needs were taken into account and reflected in their care plans. Staff we spoke with understood people's cultural needs and explained how they supported people. People were encouraged to participate in activities and there were notices detailing the calendar of varied activities displayed in the home so people could choose what they would like to do. For example, a "fellowship" meeting was taking place for most of the morning in the main lounge, and this was well attended by both people whouse services and their relatives.

The deputy manager told us that there were resident and relatives meetings held regularly.The minutes of the March and May 2014 meetings we looked at showed that people were able to express their views about the service, giving feedback on what they liked and improvement required. For example about the choice of food and activities, and we saw that their views were taken into consideration and changes made.

People were treated with dignity and respect. Staff we spoke with told us and we observedthat they maintained an individual's dignity, and demonstrated respect for them by knocking on their doors, and only entered the person's room when given permission to do so. We saw that staff closed people's bedroom doors when they provided personal care. We also saw that staff lowered themselves to the person's level and maintained eye


contact when communicating with them to ensure that the person understood them. For example, a relative told us, "my mother is treated respectfully and staff allow her to make choices, about clothes and drinks."


Consent to care and treatment Met this standard

Before people are given any examination, care, treatment or support, they should be asked if they agree to it

Our judgement


Where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.


Where people did not have the capacity to consent, the provider had acted in accordance with legal requirements. The provider's policy for consent set out guidance for staff and stated how the Mental Capacity Act (2005) applied to the home. The majority of people's care records we looked at included formal capacity assessments that had been completed in line with the Mental Capacity Act (2005). This included assessing an individual's capacity to make specific decisions about their care and treatment, using the provider's standardised capacity assessment tool. For example, in relation to personal care, we saw when people did not have capacity the provider had participated in reaching a best interestdecisions to maintain people's dignity. Subsequently staff guidance was put in place to support people with their personal care. However, the provider may wish to note that in some cases there was no evidence of capacity assessments or any best interest decisions. For example, a family gave consent to catheterise a person, but there was no capacity assessment or best interests meeting in place.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Staff demonstrated understanding of the importance of obtaining and acting in accordance with a person's consent when they provide care. We saw detailed care plans in place to help staff better understand someone's individual needs. The staff we spoke with told us they would discuss a specific aspect of care with the person, explain any risks involved and if the person was able to make an informed decision staff would respect their wishes. Staff also gave us examples of how they supported people to exercise choice, in relation to personal care, how they spent their time and in the choice of meals.

Records showed that most of staff had completed Mental Capacity Act training. We saw staff treated people with respect and involved them in making choices and decisions abouttheir care, for example when providing support with meals. Most of people we spoke with confirmed consent had been sought by staff before support was provided, for example, with personal care and medication. They told us staff always asked them what they wanted to do before they received support with their care. However, the provider may wishto note that a person using the service told us, "I was upset and surprised to have a man come into my room to change my pad." She had not been asked if she was comfortable


with this arrangement and had not been offered any alternative.


Care and welfare of people who use services Action needed

People should get safe and appropriate care that meets their needs and supports their rights

Our judgement

The provider was not meeting this standard.

Some people had not experienced care, treatment and support that met their needs and protected their rights at all times.

We have judged that this has a moderate impact on people who use the service, and havetold the provider to take action. Please see the 'Action' section within this report.


Most of people's needs were assessed and care and treatment was planned and deliveredin line with their individual care plan. All people's care records we looked at showed that people's specific needs were assessed including health and social care needs, likes and dislikes and any allergies that staff needed to be aware of. We found the assessments were used to inform the person's care plan, and the care plans we looked at included information on how the assessed needs were to be met. For example, following an assessment, it had been identified that the person required assistance with eating and drinking, bath , shower, moving and handling, and the care plan stated how this need should be met. Care records showed that staff maintained daily notes to evidence that people's care was delivered in line with their care plans. However, we found some people had not received care in line with their care plan. For example, a decision had been made with a GP not to replace a peg feed for one person due to discomfort, but to keep it clean to avoid infection. This person had occasional infections of the peg feed site, which indicated ineffective care was provided. For another person, daily observation charts showed mostly 30 minutes checks, sometime 15 minutes. These records did not demonstrate that 10 minute checks had happened in accordance with the family's wishes, which had been agreed by the manager. The deputy manager told us they intended to review this. As this review had not happened at the time of our inspection therefore, we were unable to assess the impact of this action. Also, one person using the service told us of a young staff member coming to her bedroom at night when she was in bed, the staff pulled the bed sheet tight and tucked it in and then "she just walked out without saying a word, nor even good night – that was not very nice". The person had been upset by this incident. Another person said, "some of the staff are very big and they come in when you are half asleep and stand over you demanding to know if you want anything – I just say no because I am too scared to say anything else."

Most of the time care and treatment was planned and delivered in a way that was intendedto ensure people's safety and welfare. The risk assessments we looked at related to falls, pressure sores, mobility, pain assessment, medication and personal care. These


assessments informed the care plans we looked at and contained written guidance for staff to follow to mitigate the identified risks, and to assist staff deliver care that met people's needs. Most of the care plans and risk assessments we looked at were up to date, and had been reviewed and updated monthly or as and when people's needs changed to reflect their current needs. However, some of the care plans we saw were not up to date. For example, eating and drinking care plan had not been updated to reflect changes to one person's insulin, although their medication care plan had been updated. For another person, eating and drinking risk assessment indicated the dietician should review the person, and there was no evidence to show this had happened, although daily food and drink record was maintained to show adequate nutrition was provided. For a third person their falls risk assessment score showed the same for March, April, May and June 2014, despite this person having a fall in April 2014. Risk assessment shows that where an individual has recently had a fall, this would require a higher score to be given. However, staff had not completed this assessment accurately, to reflect the risk level for staff to deliver safe care.

The health care records we looked at demonstrated people had access to external health care professionals' support such as the speech and language therapist, general practitioner, optician and chiropodist. The staff were aware of each individual's health care needs and how their care should be delivered.

There were arrangements in place to deal with foreseeable emergencies, such as sudden illness, accidents and / or fire. Staff we spoke with were aware of actions they should take in the event of emergency, for example by calling the emergency services or reporting any issues to their manager to ensure people received appropriate care.


Safeguarding people who use services from abuse Met this standard

People should be protected from abuse and staff should respect their human rights

Our judgement


People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.


The provider had safeguarding vulnerable adults and whistle-blowing policies and procedures in place. Staff had access to up to date procedures to make sure people were cared for safely. Staff training records we looked at showed that all staff had attended safeguarding training. Staff we spoke with understood their responsibilities in relation to safeguarding vulnerable people and the whistle-blowing procedures. They were familiar with the incident recording and reporting procedures, if they witnessed abuse, or had concerns that it might be taking place. All the six relatives we spoke with felt this home was a safe environment and the people who used the service were kept safe. One relative said, "Mum feels safe here" and a person told us, "I am safe here".

At the time of the inspection, we were aware of four safeguarding referrals that had been notified to the Care Quality Commission. We saw the provider had reported four safeguarding incidents to the local authority safeguarding team, and had taken appropriatesteps as a result of the outcome of their investigation. For example, when staff did not flag up concerns soon enough after one person developed a pressure sore; the staff members were disciplined and booked onto pressure sore awareness training.


Staffing Action needed

There should be enough members of staff to keep people safe and meet their health and welfare needs

Our judgement

The provider was not meeting this standard.

There were not enough staff at all times to meet people's needs in a timely manner.

We have judged that this has a minor impact on people who use the service, and have toldthe provider to take action. Please see the 'Action' section within this report.


There were not enough staff at all times to meet people's needs in a timely manner. At the time of our inspection 60 people with varying levels of nursing and personal care needs, lived at the home. The deputy manager told us that they had determined their staffing levels based upon people's assessed care needs and occupancy levels, and some people required double up care. We looked at the previous two weeks staff rota and found that there was one qualified nurse and seven care staff on duty for morning shift; and one qualified nurse and six care staff in the afternoon shift; and one nurse and two care staff in the night shift, supporting 23 people in the nursing unit. There were six care staff in the morning and five care staff in the afternoon and three care staff for the night shift, for 37 people in the residential unit. The home manager was on leave and the deputy manager worked as part of the roistered team.

During our inspection we noted that people received support during lunch time in a timely manner. All the staff we spoke with were aware of people's health and social care needs. They confirmed that some people required two care staff to attend to their mobility and personal care needs. Most of the staff we spoke with told us that sometimes they had experienced difficulties in providing timely support to people when required. And said they sometimes struggled because some people had high levels of care needs and there were not enough staff on duty.

The call bell records for the month of May and June 2014showed that in majority of instances call bells were responded to in less than five minutes. However, in some cases the people's bedrooms call bell response time was from six to fourteen minutes; and the call bell response time in the lounge was from 13 minutes to 28 minutes. Two relatives we spoke with both talked about delays in call bells being answered. Of these, one relative said, "while I was here all you could hear were call bells going off all the time. There did not seem to be enough staff on duty". One person using the service told us, "sometimes it can take half an hour before they answer the call bell. I find it distressing and humiliating tohave to wait so long for my pad to be changed."

We looked at provider's internal observation record of 11 June 2014, which noted that


"with a group of eight residents one member of staff is not adequate to actively engage everyone and meet their individual needs and it is advised at least two staff should be available to support each other. This is particularly important where there is one resident who requires significant individual support."

We looked at the relatives' meeting minutes for the month March 2014, which showed that relatives had raised concerns where their relatives had to call for care staff to assist some people who were in the main lounge to use the toilet, and care staff came and told the person that they would have to wait as they have taken someone else to the toilet. In the minutes, it was further noted that this practice had caused undue stress, making people very anxious.

There was no evidence to demonstrate that the provider had undertaken people's dependency assessment, to determine whether the current staffing levels were appropriate to meet the needs of the people on each shift. The deputy manager told us that their head office had developed a people's dependency assessment tool, which had been piloted in other locations. They said that they would undertake people's dependency assessments using this new tool, and make suitable arrangements in relation to staffing levels, to ensure that people were supported adequately in a timely manner on all shifts. We were unable to assess if this had been completed and the findings implemented as it had not happened at the time of our inspection.


Assessing and monitoring the quality of service provision

Met this standard

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement


The provider did have an effective system to regularly assess and monitor the quality of service that people receive.


People who use the service, their representatives and staff were asked for their views about care and treatment and they were acted on. The residents, relatives' satisfaction survey carried out in October 2013 results we looked at showed people were able to express their views about the service, giving feedback on what they liked and improvement required. The provider had used this survey to gather people's views about the service, which were then taken into consideration and an action plan was developed inApril 2014. For example, staff training on person centred care had been introduced and the provider had proposed to improve staffing levels.

The provider had effective systems to regularly assess and monitor the quality of service that people received. These included regular audits of medication, care plans, health and safety, infection control checks, fire audits and equipment maintenance checks. There wasevidence that learning from these audits took place and appropriate changes were implemented. For example, following these audits, an action plan was developed and implemented to address the issues identified; these included majority of bank staff were booked for mandatory training, staff meeting were held to discuss timely call bell response and mattress replaced when found dirty.

The home had comprehensive complaints policy and procedures to deal with concerns or complaints. The provider took account of complaints and comments to improve the service. There was a system for reporting any concerns raised by people or their relatives. Records we looked at showed that concerns raised by a family member had been responded to by the provider. However, the provider may wish to note that two relatives had told us when concerns were raised with management and were listened to but not acted upon in a timely manner. Complaints records showed that at the time of our inspection two complaint investigations were in progress. As the investigations were not completed at the time of our inspection therefore, we were unable to assess the impact of this action.

This section is primarily information for the provider


Action we have told the provider to take

Compliance actions

The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards.

Regulated activities Regulation

Accommodation for persons who require nursing or personal care



Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010

Care and welfare of people who use services

How the regulation was not being met:

The provider did not take proper steps to ensure that all people'scare and treatment was planned and delivered in a way that wasintended to ensure people's safety and welfare at all times. Regulation 9 (1) (a) (b).

Regulated activities Regulation

Accommodation for persons who require nursing or personal care



Regulation 22 HSCA 2008 (Regulated Activities) Regulations2010

Staffing

How the regulation was not being met:

The provider did not take proper steps to ensure that there were enough staff at all times to meet people's needs in a timely manner. Regulation 22.

This section is primarily information for the provider


This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider's report should be sent to us by 12 August 2014.

CQC should be informed when compliance actions are complete.

We will check to make sure that action has been taken to meet the standards and will report on our judgements.


About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "governmentstandards".

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.

Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

You can tell us about your experience of this provider on our website.


How we define our judgements

The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action.We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete.

Enforcement action taken

If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range ofactions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecutinga manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.


How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly.

Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly.

Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.


Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant numberof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe theessential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are:

Respecting and involving people who use services - Outcome 1 (Regulation 17)

Consent to care and treatment - Outcome 2 (Regulation 18)

Care and welfare of people who use services - Outcome 4 (Regulation 9)

Meeting Nutritional Needs - Outcome 5 (Regulation 14)

Cooperating with other providers - Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse - Outcome 7 (Regulation 11)

Cleanliness and infection control - Outcome 8 (Regulation 12)

Management of medicines - Outcome 9 (Regulation 13)

Safety and suitability of premises - Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment - Outcome 11 (Regulation 16)

Requirements relating to workers - Outcome 12 (Regulation 21)

Staffing - Outcome 13 (Regulation 22)

Supporting Staff - Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10)

Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.


Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled inspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.


Contact us

Phone: 03000 616161

Email: [email protected]

Write to us at:

Care Quality CommissionCitygateGallowgateNewcastle upon TyneNE1 4PA

Website: www.cqc.org.uk

Copyright Copyright © (2011) 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 thetitle and date of publication of the document specified.

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