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| Inspection Report | Green Park Care Home | September 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.

Green Park Care Home

Southwold Crescent, Great Sankey, Warrington, WA5 3JS

Tel: 01925791121

Date of Inspections: 03 September 201429 August 2014

Date of Publication: September 2014

We inspected the following standards in response to concerns that standards weren'tbeing met. This is what we found:

Care and welfare of people who use services Action needed

Staffing Action needed

Supporting workers Action needed

Assessing and monitoring the quality of service provision

Action needed


Details about this location

Registered Provider Leyton Healthcare Limited

Registered Manager Mrs Dianne Bailey

Overview of the service

Green Park is a purpose built care home situated in Great Sankey, which is approximately two miles from Warrington town centre.

The home has a total of 105 beds that are separated into five units. Cavendish unit provides residential dementia care. Devonshire unit provides residential care. Balmoral unit provides general nursing care. Windsor units on the ground and first floors provide nursing care for people with dementia.

Type of services Care home service with nursing

Care home service without 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 5

More information about the provider 6

Our judgements for each standard inspected:

Care and welfare of people who use services 7

Staffing 10

Supporting workers 12

Assessing and monitoring the quality of service provision 14

Information primarily for the provider:

Action we have told the provider to take 16

About CQC Inspections 18

How we define our judgements 19

Glossary of terms we use in this report 21

Contact us 23


Summary of this inspection

Why we carried out this inspection

We carried out this inspection in response to concerns that one or more of the essential standards of quality and safety were not being met.

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 29 August 2014 and 3 September 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, reviewed information given to us by the provider, reviewed information sent to us by other authorities and took advice from our specialist advisors.

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

We inspected Green Park Care Home because we had received information of concern about the staffing arrangements in the home. We visited the home at 6.40 a.m. so that we could see the level of night care staffing. We stayed in the home until 5 p.m. so that we could see staffing levels in the day time.

During our inspection we talked with 18 of the people who lived in the home and with 5 relatives of people who were visiting at the time of our inspection. We also spoke with 27 members of care staff and their supervisors as well as catering and other staff. We met with the registered and assistant manager and a member of regional staff. We looked at staff rotas as well as training records.

We looked around the building. Green Park Care Home is purpose built for 105 people arranged over three floors. There were 104 people living in the home at the time of our inspection. Two units specialised in the care of people who are living with dementia whilst another provided nursing care. The remaining units provided residential care for the people who live in them.

We found that the provision for people living with dementia was good. The home had made arrangements for the provision of activities throughout the different units. People who lived at Green Park Care Home said that the care was good but most people and theirrelatives as well as some staff said that more staff were required particularly at certain times of the day.


Staff at Green Park Care Home did not always receive adequate support in the form of supervision or training. Whilst there were quality assurance systems in place these had failed to identify these issues and help the management to prioritise them for attention.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer some of the five questions we always ask;

oIs the service safe?oIs the service effective?oIs the service caringoIs the service responsive?oIs the service well led?

Below is a summary of what we found –

Is the service safe?

We found that the staffing levels at Green Park Care Home were as described by the manager on the day of our inspection. However we saw that on previous days some shifts had not been covered meaning staffing levels fell below this.

Is the service effective?

We found that not all staff had received sufficient training to provide effective care.

Is the service caring?

We found that the staffing levels at Green Park Care Home meant that staff did not have time to spend on an individual basis with the people who lived in the home. Staff were under particular pressure at mealtimes which affected the experience of the people living in the home.

Is the service well led?

The arrangements made for the quality assurance of the service at Green Park Care Home had not always helped to identify improvements in the service that were required.

This was a responsive inspection to look at concerning information and we did not look specifically at other areas.

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 28 October 2014, setting out the actionthey 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

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.

Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

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.

Reasons for our judgement

One person who lived in the home told us "It's good here. People say 'oh, you're in a home– what's that like?' and I say 'It's ok'". They said "It can be good and it can be not so good. But when it's not so good they usually fix it". A relative told us "The care here is very good.There are sometimes little things that need to be put right – nothing major – but I just have a word with the staff and it is put right". Another relative said "My (relative) has been here four months and the staff have been excellent, the nurse in particular has been helpful, thorough and taken time to explain things".

We asked another relative if they were happy with care at Green Park Care Home and they told us "oh yes excellent … cannot fault it … if there's ever a problem (they) always ring, let you know". When we asked if their relatives who lived at the home were treated with respect and with dignity two relatives' comments included "yes definitely "and "by and large yes". " One person we spoke with said "It is an excellent home - they are very dedicated and very caring".

Some of the people who lived at Green Park Care Home were living with dementia. Peoplewho are living with dementia sometimes appear to be confused or disorientated. Because of this not everyone was able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time observing what was going on in the home and helped us to record how people spent their time, the type of support they received and whether they had positive experiences.

We carried out three SOFI observations in the communal areas of the units for people whoare living with dementia. The majority of interactions we observed with people who lived in the home were positive. The staff we observed were skilled in their approach and they


appeared to know the people that they were supporting well. We saw that staff had warm relationships with people who lived in the home and were responding to their requests for help in a timely manner. We saw staff chatting with people about how they were planning to spend their day. We saw staff communicating with people and encouraging them to make choices about where to sit and what drink to have.

During our visit we saw one of four activity coordinators engaging positively with people. We saw that staff encouraged and supported people to be involved in activities to improve their well-being. These included dominoes and craft activities and making biscuits for birds. They clearly knew the people well, addressed them by name and gave them choicessuch as whether they wore an apron or not. The coordinators told us there was a nine week programme over which a variety of activities were offered.

We saw that consideration had been given to the physical environment in the units designated for people living with dementia. This made it engaging for the people who wereliving there. The corridors were decorated with pictures and objects that people could touch to reminisce or enjoy the feel of them.

We saw breakfast being served in one unit and lunch being served in another. We did not think that this was a pleasurable experience for the people who lived on these units. Care staff were task focussed and were rushing around, not giving time to individual people. Wesaw that in another unit at lunchtime there were no condiments, jugs, drinking cups or glasses available on the tables. Staff in one unit told us that salt was not made routinely available on the table because some people had tipped too much on their meals or other people needed their salt intake monitored. There were no place mats and only half of the tables had table cloths. People who lived in the home were all sitting at the table fifteen minutes before any food arrived and when it did little or no choice was offered to people with regard to what they had to eat.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We looked in some detail at the care and support plans for eight people who lived in the home. These records included the person's care plans, risk assessments, and records about the support they had received from professionals outside of the home. We found that the care plans were up to date. Howeverwe found the information in each person's care plan was very task orientated and did not reflect how the person wished to be cared for. The plans were not person-centred and verylittle life history information was recorded. There was little evidence in some of the plans that they had been written with the individual's involvement or that of their relatives or representative. In other plans there was evidence of annual reviews that relatives had attended but they were not signed or dated by them to show this.

In relation to the care plans and their involvement one relative told us "I haven't actually seen one for quite a while but I do know there's one in existence" they went on to add they "had been to reviews more recently but (were) not shown the care plan or asked to sign or document anything". However they visited every day and said staff always gave them a verbal update. Another relative told us they had seen one a month ago at a routine review but could not recall signing anything to confirm this.

We saw one care plan which related to a person who had a history of falls and also might be at nutritional risk. Risk assessments were ticked to say the person's care had been reviewed but they did not match the current situation. The file recorded that the person hadhad three falls recently and following the last one had required hospital treatment. The fallsrisk assessment had not been reviewed in line with this and the person was assessed as a


medium risk. The nutritional assessment was all ticked "usual weight" and "usual appetite".On closer investigation we saw that the evaluation section was documented as the person only having a small appetite and their appetite being described as variable. Records of what this person ate and drank were not sufficiently detailed to allow adequate monitoring of their nutrition. We brought these anomalies to the attention of the manager who said that they would review the care plan.

We told the manager that we found the care plans difficult to follow. They agreed with this and told us that they were introducing new documentation which would address the shortcomings we had identified.


Staffing Action needed

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

Our judgement


There were enough qualified, skilled and experienced staff to meet people's needs.

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.


The information of concern that we received before this inspection suggested that there were insufficient staff on duty in the home. We started our inspection at 6.40 a.m. so that we could check the levels of staffing in Green Park Care Home during the night. We checked the rotas in each of the five units and found that these were accurately reflected by the number of staff on duty. Where there were only two carers on a unit we asked staff how they managed people who needed two carers to help with their mobility when they received more than one request at the same time. They told us that people might have to wait until two carers were available. They would reassure the person who was waiting. Wesaw that where required agency staff had been brought in to cover staff absences.

We stayed in the home until the late afternoon so that we could see staffing levels during the rest of the day. We checked that the rotas given to us by the home reflected the staff that were on duty. We saw that where staff shortages might be created by sickness or other absence that these were often covered by either bank or agency staff. However when we looked in detail at the rotas for one unit we saw that some shifts had not been covered on consecutive days. This meant that on those days staff cover had reduced below the minimum level specified by the home.

We saw that care staff were well supported by housekeeping and laundry staff as well as activities organisers. However where this support was not available, such as at mealtimes,we saw that care staff were under the most pressure and the quality of care could be compromised. We saw in one unit that at breakfast time staff were constantly going from one person to the next and had no time to sit and engage with people positively. The result was that people who needed encouragement to eat were approached by three different staff that only had time to give brief words of encouragement and move on. Of thethree staff one duty one was a bank carer who was new and it was their first day. This meant they did not know anybody and had to keep asking who everybody was and what todo. This placed further pressure on the remaining staff members.

The senior carer had to give instructions to staff about care tasks whilst administering medicines thus increasing the risk of error. In one instance we saw that three people were


brought into the dining room in wheelchairs but the time was not taken to transfer them to a chair to eat their meal.

We asked people who lived in the home as well as their relatives if they thought there wereenough staff. One person told us "We could do with a few more staff". One relative told us "I don't think they have enough staff. They don't have time for much one to one care. But it's never caused a problem for personal care. If someone needed care urgently they would get it". Another relative said "It would be really helpful to have a member of staff stationed in the lounge all the time, just in case someone needs something". Four people we spoke to in one unit said that at certain times the staff appeared to be "run off their feet" and suggested that maybe the home were short of staff at times.

We asked one person living in the home if they had to wait for a long time when they called for help using the call bell system. They told us that sometimes it could be fifteen minutes. Another person told us "There is seldom a delay. When I call them they come quickly". A third person estimated that the time taken to respond to call bells could be "between five and fifteen minutes". During our inspection we saw that staff responded promptly to call bells.

Relatives told us that the staff were competent and knew what they were doing. However, in relation to staff numbers one of the relatives told us "like everybody (they're) strapped for cash … (they) do their best but quite a lot of patients need two people to assist and if one (member of staff) has to go with somebody else the lounge is left unsupervised. I know and they know that I know but can't do anything about it". Similarly the other relative we spoke with told us "they (staff) have a lot to deal with …. they need more staff".

This was echoed by some of the staff we spoke with who felt the people who lived at Green Park Care Home would benefit from more staff in the mornings as that was when they were particularly stretched. Their comments included "worse time is mornings …. we need another member of staff who knows the residents" and "we need four (staff) in the morning as it's difficult".

Other staff told us that on the whole they felt the staffing numbers were sufficient to meet the needs of the residents provided that the staff they were working with were regular staff and knew the residents well. One member of staff said "When you are working with peoplewho know the residents and know what they are doing it's a really good shift but if you are working with agency or new staff it can get really hard". When we looked at the staff rotas we saw that three of the units in the home had been dependent upon bank staff for at leastpart of each of the last four weeks cover.


Supporting workers Action needed

Staff should be properly trained and supervised, and have the chance to develop and improve their skills

Our judgement


People were cared for by staff who were not supported to deliver care and treatment safelyand to an appropriate standard.

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.


We asked staff about the support they received in order to do their work. One person was negative regarding the support offered by the management team of the home. However allof the other staff we spoke to were complimentary about the manager and deputy. They told us that they felt they could approach them if they needed to and that they were visible and were seen walking around the home. Overwhelmingly we saw that staff were positive in the workplace and that this reflected in much of the good care we saw provided to people who lived in the home. One member of staff told us "We are well supported and training is OK - we have the skills to do our job".

We checked the records for supervision in the home. Supervision is a private meeting between a manager and a member of staff. It is usually held at appropriate intervals so that any issues can be raised by either the manager or the member of staff and plans can be made for future development. Supervision should be recorded so that actions can be agreed and followed up later if required. Staff told us that they understood that supervision should be held every two months and more frequently if required.

We found that supervision practice was inconsistent. Some of the non-care areas such as activities, maintenance and domestic services showed evidence of regular supervision meetings as did one of the units. Other areas and units showed progress at the start of theyear but had fallen behind recently. Two units in particular showed poor progress in this area. We found that most of the staff working in these units had not had supervision since January 2014 and only one staff member was up to date. Overall in Green Park Care Home only a quarter of staff had received supervision within the past two months. We brought this to the attention of the manager. When we returned to the home for the secondday of our inspection the manager told us that they had put in place a programme to correct this. We saw records that showed a number of supervision meetings which had taken place since the first day of our inspection.

We asked staff about the training they received whilst working at Green Park Care Home. One member of staff stated that they found it difficult to attend on their days off due to child


care commitments so if they wanted to attend a course they had to arrange it ahead of time to ensure they were working on that day. Another member of night staff told us that they were sometimes scheduled to return to the home for training in between two nights of duty. They felt that instead they needed to catch up on their sleep so as to be fresh for the next shift. Other staff confirmed that this had been the case.

Some staff said that it could sometimes be difficult to attend training if they were on shift asthey could not always be released from providing care. They said "Sometimes it's difficult to get there as the residents will always come first and if you are needed on the floor you just don't go (to training)". However staff said that in all the circumstances they had described they did not feel under pressure to attend a specific training event and the manager confirmed this to us when they told us "We encourage people to attend but if theyare needed on the floor then that has to take priority and we will put them on the next course". The provider might wish to review arrangements to release staff for training and tomonitor attendance so as to ensure that it is not missed completely.

The provider supplied us with a number of different sets of training records. When we looked at these we saw that they showed that in a number of key areas such as safeguarding, moving and handling and health and safety a number of staff had either had no training or the training was out of date. Another record suggested that a few staff had attended no training at all. Staff must be trained so that they can be competent to meet thehealth, care and safety needs of the people who used the service.

Induction training must be provided by employers within the first twelve weeks of employment to make sure that staff are ready to work with people in a particular setting and that they have the right skills they need to do the job. The provider was unable to show us comprehensive records to confirm that induction had taken place. We talked with some staff who had been employed more recently in the home. They told us that that they had started without formal training and were expected to attend the in house courses as and when they were scheduled. Other staff told us that they very unhappy and complainedthat they were not receiving adequate training for the role they are doing.



Action needed

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 not have an effective system to regularly assess and monitor the quality of service that people received.

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.


We asked the provider to tell us how they assessed and monitored the quality of the service provided at Green Park Care Home. We saw that there was a system of monthly monitoring provided by the company that owned the home. The most recent record showed that visits had been made in each of the two months prior to our inspection. We were told that these visits were unannounced. The monitoring was designed to replicate the Care Quality Commission's own guidance to providers in relation to meeting essential standards for care.

We saw that the record of the monitoring visit was comprehensive and detailed. Some of the results mirrored the findings of our inspection particularly in respect of staff training. However no action was recorded as a result of this. The account of the arrangements for mealtimes gave a much more positive view of arrangements than what we saw on the day of our inspection. We were concerned about how much use was made of the information in these reports if they identified areas for attention such as around training which had not then been actioned.

There were two systems for auditing care plans to make sure that they were up to date and complete. The monthly monitoring visit included a check of a sample of 10% of care plans with comments recorded for action by the home. We saw that there was also an internal audit of care plans which had been undertaken by the management of the home. We were told that this audit should take place monthly but the records we saw suggested that it took place three monthly. We saw that this had resulted in a number of recommendations for amendments to individual care plans.

We checked three examples of these by looking at the care plans and found that the action specified had been taken to bring the care plans up to the required standard. We saw that one unit in the home had its own third system for making sure that care plans were updated. This provided regular prompts to staff. We brought this additional system to the attention of the provider who might wish to consider implementing it more widely in the


home.

We saw that a number of other internal audits had been undertaken including of medicineswhere the provider also had arrangements for individual managers to spot check each other's practice. We saw that accidents and incidents were monitored and trends identifiedso that appropriate action could be taken. We looked at records of infection control audits and saw that these were undertaken monthly. The home scored consistently better than 90% and most recently had scored 98%.

We asked the provider to show us how they found out about how the people who lived at Green Park Care Home and their relatives experienced the care there. We saw that the provider used a suggestions box and analysed the comments made at intervals. The most recent of these included messages of thanks for the care provided as well as suggestions for ways in which the service could be improved. The manager had included responses to these comments.

We saw two sets of recent minutes of a meeting held for people living in one of the units which showed that the home sought their views on aspects of care such as activities and meals. However whilst we saw other older records of meetings throughout the home we did not see evidence that these meetings were frequent or were held on a regular basis inall the units. We saw that there were more comprehensive records including staff meetings, for the previous year.

There were nearly 100 staff working at Green Park Care Home. We asked the provider to show us any systems they had for assuring themselves that each of the staff had the appropriate training to do the job and that this was up to date. We were shown different systems. One was inadequate because although it showed the date when the next proposed training would take place it did not show the date when the training had last been completed. The other was incomplete. It was not possible for the provider to reliably use these systems to ensure that care was provided by staff who had the right or up-to-date training.

We asked the provider for information about their complaints system and saw that a complaints procedure was prominently displayed in the reception area of the home. We were told there had been one formal complaint this year. The Care Quality Commission had been made aware of this complaint at the time and we saw that the manager had retained records showing that they had responded to the complainant. The manager told us they sought to respond to concerns at an early stage so as to resolve them before they became formal complaints.

We were told that the owner of the company that owns Green Park Care Home visited the home periodically but that these visits were not recorded anywhere.

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 registered person did not take proper steps to ensure that each service user was protected against the risks of receiving care or treatment that was inappropriate or unsafe, Regulation 9(1)





Regulation 22 HSCA 2008 (Regulated Activities) Regulations2010

Staffing


In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled andexperienced persons employed for the purposes of carrying on the regulated activity. Regulation 22


This section is primarily information for the provider






Supporting workers


The registered person did not have suitable arrangements in place in order to ensure that persons employed for the purposes of carrying on the regulated activity were appropriately supportedin relation to their responsibilities, to enable them to deliver care and treatment to service users safely and to an appropriate standard, including by —(a) receiving appropriate training, professional development, supervision and appraisal. Regulation 23(1)








The registered person must protect service users, and others who may be at risk, against the risks of inappropriate or unsafe care and treatment, by means of the effective operation of systems designed to enable the registered person to —(a) regularly assess and monitor the quality of the services provided in the carrying on of the regulated activity against the requirements set out in this Part of these Regulations; and(b) identify, assess and manage risks relating to the health, welfare and safety of service users and others who may be at risk from the carrying on of the regulated activity. Regulation 10(1)

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 28 October 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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