Inspection Report

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

Glen Lee
Wavell Road, Bitterne, Southampton, SO18 4SB Date of Inspection: 01 November 2012 Tel: 02380473696 Date of Publication: January 2013

We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Meeting nutritional needs Safeguarding people who use services from abuse Cleanliness and infection control Management of medicines Staffing Assessing and monitoring the quality of service provision Met this standard

Action needed Met this standard Met this standard

Met this standard Enforcement action taken Action needed Met this standard

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Details about this location

Registered Provider Registered Manager Overview of the service

Southampton City Council Mrs. Theresa Dyer Glen Lee is registered to provide accommodation and care to a maximum of 34 people. There is no nursing provided at this home. There is a registered manager responsible for the service. Care home service without nursing Accommodation for persons who require nursing or personal care

Type of service Regulated activity

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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 How we carried out this inspection What people told us and what we found What we have told the provider to do More information about the provider Our judgements for each standard inspected: Respecting and involving people who use services Care and welfare of people who use services Meeting nutritional needs Safeguarding people who use services from abuse Cleanliness and infection control Management of medicines Staffing Assessing and monitoring the quality of service provision Information primarily for the provider: Action we have told the provider to take Enforcement action we have taken About CQC Inspections How we define our judgements Glossary of terms we use in this report Contact us 17 18 19 20 22 24 6 7 9 10 11 12 14 16 4 4 4 4 5

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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 1 November 2012, 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 and talked with staff. What people told us and what we found We spoke with 11 people, six visitors and the staff who were on duty at the time of our visit. To help us to understand the experiences of people, we observed how people spent their time, the support they received from staff and whether they had positive outcomes. People told us that they were treated with respect when receiving care and they liked living at the home. Relatives told us that their relatives were "very well looked after". They told us that the staff were "very good". People said that the staff were very busy and there were not always enough staff. People and relatives said the food was very good and choices were available. Care plans and risk assessments were in place although these did not always reflect the current needs of people. People were provided a choice of meals that met their needs, although support with meals were at times lacking. Relatives were confident that any concerns they raised would be taken seriously and staff would help them to resolve the issue. Medicines were not managed appropriately and may put people at risk to their health and welfare. There were not always adequate staff and this may impact on the care that people received. The infection control procedures at the time of the inspection were inadequate and may put people at risk to their health. There was an audit system that looked at the service delivery. 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 05 January 2013, setting out the action they will take to meet the standards. We will check to make sure that this action is taken. We have taken enforcement action against Glen Lee to protect the health, safety and
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welfare of people using this service. 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.

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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 privacy, dignity and independence were respected. 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 told us that they were very happy living at the home. Relatives told us that their relatives were "very well looked after". They told us that their privacy and dignity was respected when receiving care. Relatives were complimentary about the care that the service provided. We observed care across all areas of the home and saw that people's privacy and dignity were respected. We saw that personal preferences were taken into account when providing support and people's choices were respected. Staff interacted with people appropriately, using their preferred names and explaining what was happening and asking what people wanted to do. From the interactions observed, this showed that the staff and people who use the service had developed good relationships with each other. We looked at nine care records and found that the information relating to people's life history was detailed. A staff member told us that this helped them to talk to people and found this useful as most people suffered from varying degrees of dementia. We did not find appropriate information concerning people's end-of-life care, nor was there sufficient evidence of next-of-kin involvement in the care records. The provider may wish to note that this may impact on people's care due to their cognitive difficulties as they were unable to participate in their care planning. The staff told us that they tried to get people's relatives involved and more work was needed. Relatives told us that they were encouraged to bring into the home items of people's personal belongings. Some of the bedrooms were personalised with a variety of family photos, pictures and other personal items. We saw that other bedrooms were sparse and not individualised. The manager told us that the bedrooms had been redecorated and the pictures had been taken down, this was being addressed.

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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. People experienced care, treatment and support that mostly met their needs and protected their rights. There was at times a lack of detailed care plans to show how identified risks would be managed and to reflect the current needs of people. We have judged that this has a moderate impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement People told us that they were treated with respect when receiving care. Two relatives told us that they "know she's being looked after". People said that the staff were" very good." People's needs were assessed and some care and treatment plans had been developed. Three of the care plans contained detailed information about people's needs and support they needed. We saw that one person had been identified as high risk of falling and they were receiving one to one support on the day of our visit. Their relatives told us that they felt that staff supported this person well and they were "well looked after". We observed staff supporting people in a calm and respectful way. Staff were knowledgeable about people's needs and interacted appropriately with them. People who had been identified as at risk to their pressure areas had "profiling beds" in place. We found that the care plans were variable and did not contain adequate information when risks had been identified. A person had a sensor mat in place; however we could not see a risk assessment to show how the level of risk was assessed and decision reached. This mat was to monitor this person's movements when they were in their rooms as it would alert the staff they were up and about. There was no information about how the level of risk and what staff needed to do to monitor this person at other times when they were not in their rooms. Another person was newly admitted and their records contained basic information and were not adequate as it did not reflect this person's current needs. Their record showed that they had three falls and a pressure mat was in place. This meant that staff would be alerted when this person was up and about. There was no other information about the support this person's needed to manage their risk of falls. This person care records showed that they had difficulty following instructions and it was unclear what support they needed. The manager told us that care plans should have been developed as this person had been at the home for a week. This meant that they may be at risk of their needs not being met in a consistent way. The record for another person showed that they were at risk if they left the home and needed one to one supervision. We found this person asleep in a spare room. We spoke
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to the staff and they were not aware of this person's whereabout. The manager told us that staff should have been monitoring this person to ensure their safety. This meant that people may be put at risk to their welfare. The records of three people showed that they were at risk of weight loss and had lost weight in the last three months. One person was to be weighed weekly and the other fortnightly, there was no record that this had been done. A staff member told us that this had been missed and it would be looked into. This meant that people may not always receive care as planned. People were supported to access external health care support and advice. Staff confirmed that the healthcare teams were consulted for advice and support. The manager said that people were supported to attend appointments in the community as needed. We saw that a referral had been made for a dentist as a person had lost their dentures. This meant that people's healthcare needs were met and people were supported to access these. An external entertainer was visiting the home to provide some activities in the afternoon of our inspection. We observed a large group of people took part and people told us that they enjoyed the activity. Staff told us that there were few organised activities as the coordinator left a couple of months ago. We noted activity sheets had not been filled in for the last three months. This meant that people were not supported to take part in activities to meet their needs. The Deprivation of Liberty Safeguards was only used when it was considered to be in the person's best interest. Staff received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff said that they would involve people's family and healthcare professionals to ensure that they acted in the best interests of people who use services. The manager told us that there was no one currently at the home who was subject to a DoLS authorisation. We saw that this had been in effect for one person which had recently expired.

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Meeting nutritional needs

Met this standard

Food and drink should meet people's individual dietary needs

Our judgement The provider was meeting this standard. People were protected from the risks of inadequate nutrition and dehydration. They were supported to eat and drink and they had choices available to them to meet their needs. Reasons for our judgement People spoken with were complimentary about the food. They commented that the food was very good and they were offered plenty to eat and drink. Relatives told us that they felt the meals were good and choices were offered to people. People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed the lunchtime meal in different areas of the home and found that this was well presented. There was a choice for the main course and desserts were available to people. We observed that the staff assisted people with their food and drinks in a sensitive manner. Throughout the day we observed that hot and cold drinks were available to people. The chef told us that snacks were available to people at bed times. The dietary records contained details about people's likes and dislikes. We saw a list was in the kitchen that identified the types of meals such as puree or diabetic meals as needed. We observed that a person was prescribed and needed a thickening powder to be added to their drinks as they were at risk of aspiration due to their swallowing difficulties. A staff member was seen serving drinks and they were aware of that person's need and an appropriate drink was served to that person. People were offered choices and staff used visual prompts for meals and drinks. This meant that people were informed and supported to make choices regarding their meals and drinks. Some people were having their food and fluids monitored. The provider may wish to note that records of food and fluids were inadequate as we were told the staff were failing to record what people had eaten and drank. The staff in charge told us that staff had been reminded to complete the food records and this would be addressed.

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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 The provider was meeting this standard. 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. Training in safeguarding was available to the staff. Reasons for 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 home had in place a safeguarding policy and procedure which included the local authority safeguarding procedures that they used. The manager described the procedure that they would follow and alert the safeguarding team as needed. Three staff spoken with were able to tell us of the types of abuse that could occur and the action they would take if abuse was suspected. They were confident that they could approach the manager or the provider and actions would be taken to protect people. They said that they were aware that they could raise an alert with the local safeguarding team. They knew about the whistle-blowing policy and felt they would have management support. A staff told us that would also be prepared to go outside of the organisation if their concerns were not dealt with. The staff told us that they had completed training in safeguarding adults. We saw records showing this training also formed part of the induction process for all staff. This meant that people could be assured that staff had the necessary skills to report any allegation as required.

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Cleanliness and infection control

Met this standard

People should be cared for in a clean environment and protected from the risk of infection

Our judgement The provider was meeting this standard. The provider failed in the maintenance of appropriate standards of cleanliness and hygiene in relation to the premises. This had been rectified when we checked again at a later time. Reasons for our judgement People were not protected from the risk of infection because appropriate guidance had been followed. At 09:45 on the morning of the visit we found that four of the communal toilets and a bathroom had offensive odours, were dirty and toilets seats were smeared with faeces. In the communal bath we saw that a soiled incontinence pad had been discarded. In one of the bedrooms the flooring had brown residue that a staff member confirmed had been caused by another person. The staff in charge told us that one of the domestic staff was serving breakfast and was not able to clean the home. This meant that people were exposed to infection control risks as the toilets and their seats were not clean. We asked to see the risk assessments and infection control procedures. Staff said that they should be carrying out spot checks of the communal facilities but these had not taken place as they were very busy. We checked the home again at lunchtime and found that these areas had been cleaned and there was no offensive odour present. Relatives we spoke with said that they found the home was clean including their relatives bedrooms. Laundry arrangements for used and infected linen were in place.

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Management of medicines

Enforcement action taken

People should be given the medicines they need when they need them, and in a safe way

Our judgement The provider was not meeting this standard. People were not protected against the risks associated with medicines because the provider had inappropriate arrangements in place to manage medicines. People were put art risk of not receiving their medicines safely. We have judged that this has a major impact on people who use the service and have taken enforcement action against this provider. Please see the 'Enforcement action' section within this report. Reasons for our judgement People could not tell us about their medicines 'management due to their cognitive difficulties. We looked at the process the home had in place to ensure that people received their medication as prescribed. The home used the monitored dosage system (MDS) and a staff member said that this worked well. The MDS ran over a 28 days cycle. There were designated staff responsible for ordering medications for people who used the service. Staff confirmed that only those who had completed training in medicines' management were responsible for people's medications. Medicines were prescribed however they were not given to people appropriately. The arrangements at the time of the inspection in relation to dispensing and administering people's medicines were unsafe and put them at risk of harm. We found that staff had left a pot containing the morning medications labelled for one person in another person's bedroom. These medicines were within the reach of this vulnerable person with cognitive problems and putting put them at risk. A staff member confirmed that these tablets did not belong to that person. We found these tablets were completely different to those prescribed for this person. The staff in charge told us that they had been "potting" up secondary dispensing up to six people's medications at a time and taking them upstairs. This was due to the lift being out of order. The "potting "of medicines contradicted the home's procedure and good practice guidance. The staff were dispensing people's medicines and writing the person's name on a piece on paper placing this in the pot. This carried the risk of them getting mixed up or placed in the wrong pot and given to the wrong person. The guidance document from the Royal Pharmaceutical Society, 'handling medicines in social care setting' recommends that medicines must be given from the container they are supplied in. We also found that a person was having their medicines crushed. There were no records of which medicines were being crushed. There was no risk assessment, care plan and evidence that their GP or pharmacist had been consulted and consented to these medicines being crushed. This may put this person at risk as crushing tablets and opening capsules can change the way that medicines work. Following the inspection the provider wrote to us and sent us information to show that they had
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consulted the GP and pharmacist regarding management of crushed medicines for these people. A random sample of 16 medicine administration record (MAR) charts was also looked at. A stock check showed that staff did not record medicines that were carried forward which meant that these could not be audited. We found that the MAR records were maintained; however there were gaps on the MAR charts that staff could not tell us if people had received their medicines. We also found that for three people whose medication we were able to audit, there were extra or missing tablets that could not be accounted for. This meant that people were at risk of not receiving their medicines as prescribed.

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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. People were cared for by staff who were skilled and experienced to deliver care and treatment. There were not always adequate numbers of staff to support people and deliver care to an appropriate standard. We have judged that this has a moderate impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement We looked at the staffing structure and arrangements that were in place in order to ensure that people were supported by an adequate staffing compliment to meet their needs. We saw staff supporting people in a sensitive manner, listened to people's requests and helping them as needed. Care was provided at a pace that suited people and we observed staff and people interacted well. Relatives told us that the staff were very good and helpful. However people said they felt that there were at times staff were rushed. They said that the staff did their very best and were very busy. We talked with the six staff and a number of them had been working at the service for a number of years. All the staff told us that staffing was inadequate and this had been compounded by the passenger lift being out of order. They told us that they needed extra staff as people were unable to go downstairs and need to be supervised on the first floor. There was a training plan and the staff were supported to undertake further training and development. The permanent staff were knowledgeable about people's needs and we observed that they interacted well with the people living at the home and their relatives. The home accommodated a large number of people with complex and sometimes challenging needs. We observed on various occasions where people were left unsupervised as the staff were busy attending to other people particularly on the first floor. Two staff told us that they were unable to supervise people such as the person found asleep in an empty room, as they were busy helping people with personal care throughout the morning. This meant that people were not always monitored and received the support they needed. The lack of an activity coordinator we were told also impacted on the care that people received; as this support with activities was not available. We observed people who needed help and encouragement to eat were not given this as much as they should have been. As a result of low staffing, there was not enough support, where necessary, for the purpose of enabling people to eat and drink in a timely way. Staff told us that they relied on agency staff for support and felt they needed extra staff in order to be able to do their job
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effectively. On the day of the visit following the incident with the medicines; a staff member had contacted senior management and was told they would not be able to have extra staff at that time. It was unclear what system was in place to look at the people's dependency and staffing levels to ensure there were adequate numbers of staff on duty. We were also told that the domestic staff were not able to carry out their duties as they were helping to take trays of breakfast to the first floor. This meant that people may not always receive the care and support they needed and in a timely way.

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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 was meeting this standard. The provider regularly assessed and monitored the quality of the service provided. Risks had been assessed relating to the health, welfare and safety or service users. The provider regularly sought the views of people using the service. Reasons for our judgement People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The provider undertook a yearly survey and sent out questionnaires to people, their relatives and care professionals. The result was sent to us after the inspection and this showed that people were positive about the care and treatment they received. People felt that they were involved in the care and staff treated their relatives well. The manager held quarterly meetings with people and their relatives to keep them informed about the service and any developments and to seek their views. The passenger lift had been out of order when we visited the home. There was a risk assessment in place however this was not robust. According to the risk assessment extra staff would be in place to assist people who were unable to access the ground floor and would be remaining upstairs. The five staff we spoke with told us that staffing had not been increased. Following the inspection we received an updated risk assessment dated 7 November 2012 to inform us about risk assessments and staffing arrangements had been put in place. We saw that there was a system in place where a senior member of staff from the company carried out a care audit of the home and reported to the registered manager and provider. The manager told us that an action was developed to address any issues as identified. Health and safety audits of the environment were in place. Checks were carried out in relation to fire equipments and the staff told us that they carried out regular fire alarm checks. The manager told us that they carried out a falls' audit and action was taken as appropriate such as referral to GP and falls' clinic. The manager took account of complaints and comments to improve the service. The relatives were confident to report any concerns to the manager. There was a complaints log in place. Concerns raised were looked into and responded appropriately as per the home's policy.

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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 activity Accommodation for persons who require nursing or personal care Regulation Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services How the regulation was not being met: People experienced care, treatment and support that mostly met their needs and protected their rights. There was at times a lack of detailed support plans to show how identified risks would be managed. Regulation 9(1) (a) (b). Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010 Staffing How the regulation was not being met: People were cared for by staff who were skilled and experienced to deliver care and treatment. There were not always adequate numbers of staff to support people and deliver care to an appropriate standard. Regulation 22 This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. 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.

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This section is primarily information for the provider

Enforcement action we have taken to protect the health, safety and welfare of people using this service

Enforcement actions we have taken The table below shows enforcement action we have taken because the provider was not meeting the essential standards of quality and safety (or parts of the standards) as shown below. We have served a warning notice to be met by 30 November 2012 This action has been taken in relation to: Regulated activity Accommodation for persons who require nursing or personal care Regulation or section of the Act Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines How the regulation was not being met: People were not protected against the risks associated with medicines because the provider had inappropriate arrangements in place to manage medicines. Regulation13 For more information about the enforcement action we can take, please see our Enforcement policy on our website.

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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 "government standards". 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 dentists and other services at least once every two years. 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 but we always inspect at least one standard from each of the five key areas every year. We may check fewer key areas in the case of dentists and some other services. 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 reinspect 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.

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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. 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.

Met this standard

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 of actions 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 prosecuting a 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.

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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. We make a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation) from the breach. 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.

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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 number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential 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.

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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.

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Contact us

Phone:

03000 616161

Email:

enquiries@cqc.org.uk

Write to us at:

Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 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 the title and date of publication of the document specified.

| Inspection Report | Glen Lee | January 2013

www.cqc.org.uk

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