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

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Laureate House Laureate House, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT Date of Inspections: 12 December December 2013 Tel: Date of Publication: February 2014 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 Safeguarding people who use services from abuse Supporting workers Assessing and monitoring the quality of service provision Met this standard Action needed Met this standard Met this standard Met this standard Inspection Report Laureate House February

2 Details about this location Registered Provider Overview of the service Manchester Mental Health and Social Care Trust Manchester Mental Health and Social Care Trust provides mental health NHS services and Local Authority services on behalf of Manchester City Council. The trust provides services to meet the needs of adults of working age and older adults with mental health problems. The trust provides inpatient care including from Laureate House which is on the Wythenshawe Hospital site. The wards at Laureate House include a psychiatric intensive care unit (PICU), an acute mental health ward, a mental health older adults ward and a mother and baby unit for women with pre or post natal mental health needs. Community mental health services also operate from Laureate House. Type of services Regulated activities Community healthcare service Community based services for people with mental health needs Hospital services for people with mental health needs, learning disabilities and problems with substance misuse Supported living service Community based services for people who misuse substances Assessment or medical treatment for persons detained under the Mental Health Act 1983 Diagnostic and screening procedures Personal care Transport services, triage and medical advice provided remotely Treatment of disease, disorder or injury Inspection Report Laureate House February

3 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'. Summary of this inspection: Page 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 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Safeguarding people who use services from abuse 10 Supporting workers 12 Assessing and monitoring the quality of service provision 13 Information primarily for the provider: Action we have told the provider to take 15 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report Laureate House February

4 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 carried out a visit on 9 December 2013 and 12 December 2013, observed how people were being cared for, checked how people were cared for at each stage of their treatment and care and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and used information from local Healthwatch to inform our inspection. We were accompanied by a Mental Health Act commissioner who met with patients who are detained or receiving supervised community treatment under the Mental Health Act What people told us and what we found On this visit, we visited all the wards at Laureate House, which included Blake ward which is a psychiatric intensive care unit (PICU), Bronte ward which is an acute mental health ward, Cavendish ward which is a mental health older adults ward and Anderson ward, which is a mother and baby unit for women with pre or post natal mental health needs. On this occasion, we did not inspect the community mental health services which are also provided at, and from, Laureate House. We visited with the Mental Health Act Commissioner who considered whether the trust was working within the Mental Health Act and the Mental Health Act Code of Practice. We spoke with several informal and detained patients during our visit. We made contact with people in the communal areas of the ward and also saw patients in private where appropriate. One patient told us: "The care is good and I know what I have to do to get out of here." Another patient said: ""I can't praise them enough, they [staff] deal with things in a very professional way." Patients did comment on the food which the trust was working to improve; patients on Bronte ward said that staff were very busy and therefore did not respond to patients requests as quickly as they would have liked. Detained patients told us that they had been given information about their rights. We found that the trust was compliant at this location with most of the outcomes we looked at including respect and involvement, safeguarding, staff training and supervision and quality assurance. We found that the trust was not compliant at this location with the outcome relating to care and welfare. This was principally because when patients were given rapid tranquillisation treatment, we found that appropriate physical health observations had not been carried out or recorded to ensure patient safety. Inspection Report Laureate House February

5 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 20 February 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 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. Inspection Report Laureate House February

6 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 On this visit, we visited all the wards at Laureate House, which included Blake ward which is a psychiatric intensive care unit (PICU), Bronte ward which is an acute mental health ward, Cavendish ward which is a mental health older adults ward and Anderson ward, which is a mother and baby unit for women with pre or post natal mental health needs. On this occasion, we did not inspect the community mental health services which are also provided at, and from, Laureate House. We visited with the Mental Health Act Commissioner who considered whether the trust was working within the Mental Health Act and the Mental Health Act Code of Practice. We noted that on all the wards we visited that the hospital was caring for and treating patients with significant levels of acuity of severe and enduring mental health needs with many also having ongoing significant physical health problems, alcohol or illicit drug use issues and diagnosed personality disorder issues. We saw the pressures on acute inpatient beds within Manchester leading to many of the wards having higher levels of bed occupancy than the recommended levels on a routine ongoing basis and some patients being treated out of area. We also noted that many patients ready for discharge had ongoing social care issues which prevented or delayed their effective discharge. We spoke with several informal and detained patients during our visit. We made contact with people in the communal areas of the ward and also saw patients in private where appropriate. The wards at Laureate House are locked to help keep patients safe and so we asked informal patient about their rights to leave the ward. One patient told us: "The care is good and I know what I have to do to get out of here." Another person said: "They treat us all with respect all the time". However the provider may wish to note that a number of patients on Bronte ward reported that staff were often too busy, which meant that requests had to be made repeatedly before being fully addressed. Detained patients told us that they had been given information about their rights, for Inspection Report Laureate House February

7 example one patient confirmed they had been given information about their right to appeal to a mental health tribunal on admission to the ward and had a forthcoming tribunal. We looked at the files of informal patients and people who were currently detained under the Mental Health Act. We saw records showing that informal patients had discussions about their admission onto the ward. We saw records showing that people were involved in their treatment and records made of these discussions, for example when medication was first given or when there were changes to the care plans. Records confirmed that detained patients had been given information about their rights whilst they were detained under the Mental Health Act. People had an opportunity to be involved in decisions about their care and treatment through attending ward rounds. We saw that patients and their families were supported to attend and discuss their concerns to the doctors and staff with independent advocacy support where this was available. On Cavendish Ward, we saw that improvements had been made to showing evidence that patients were involved in their care as we saw records which showed that the named nurse had gone through the care plan with each patient. Patients on Anderson ward did tell us that they would like more information about the involvement of the wider multi-disciplinary team in their and their child's care, for example health visitors and social workers. This was summed up by one person we spoke with who said: "I didn't know why a social worker came to the ward round, no one made me aware of this." We spoke with the partners of people on Anderson Ward who stated they would like more involvement in ward rounds. The provider may wish to ensure that patients and partners of patients on Anderson ward are, where possible, made more fully aware of the multidisciplinary approach to their care and that of their baby to ensure fuller involvement. Each ward had a welcome pack available for patients. This gave information to patients and their carers about the ward and what people could expect from their stay in hospital. We saw a range of information on the ward which provided people with information and enabled them to make informed choices about the care and treatment available to them. We saw that there was other information available such as Patients Advice and Liaison Services (PALs) information on ward notice boards. PALs staff ran listening exercises on some wards and fedback what action had been taken from people's comments. The wards also had community meetings or forums where people could contribute ideas to how the ward was run and what services and activities they would like. Comment cards were also readily available on the wards. We saw improvements that had been made to ensure that detained patients had been told of their right to access the Independent Mental Health Advocacy service through posters displayed on the wards and records held on most people's files. Inspection Report Laureate House February

8 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 delivered in a way that was intended to ensure people's safety. 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 Patients we spoke with were happy with the care and treatment they received. One detained patient told us: "This hospital is not so bad compared to others". Another patient on Anderson unit said: "Nurses are very supportive, they let me sleep and get some rest when I first came in. They put baby in the nursery so you can rest." A third patient confirmed that: "Everything's fine. They have treated me well." We looked at the care plans for informal and detained patients. We found that each patient had care plans created from assessments carried out with them. On admission, staff completed a risk assessment for each patient to establish any risk of harm to themselves or others. We saw patients had their mental health care needs assessed and reviewed. We saw that where people were deemed to be a risk to themselves or others, they were placed on increased visual observations to keep people safe. Patients told us that they had, or were offered, a physical health check. We saw from records that people had a physical health check when they were admitted to the ward. Some patients refused to have a physical examination and their right to refuse was accepted. Records we saw confirmed patients were having a physical health check on admission and at appropriate intervals. There was evidence that the care received and written care plans were recovery focused to help to ensure that people were supported to develop their daily living skills and work towards discharge from hospital. The staff we spoke with had a good understanding of the patient's individual support needs. The care plans we saw showed that patients were involved and were written in an individualised way. Care plans were comprehensively written and provided good written instruction on the care and support plan for each patient for any member of staff to pick up and understand. The provider may wish to ensure that fuller patient involvement is evidenced in the care plans on occasions, for example by ensuring that the patients' own self assessed priorities in recovery from their acute mental health crisis is recorded. This would ensure that the trust is properly evidencing the guiding principle of the Mental Health Act Code of Practice around participation. Inspection Report Laureate House February

9 Patients detained under the Mental Health Act can have leave from the hospital provided it is authorised by the patient's responsible Clinician. On most files we saw that where leave was authorised there was an appropriate form to record authorised section 17 leave. However on Bronte Ward where most leave was authorised we saw that many forms which were lacking in detail as to the frequency and location of leave and also the dates during which authorised leave had been agreed was also absent. Older leave forms had also often been left on file and not struck through. This meant that patients and staff may not have been fully clear about the parameters of the leave which had been authorised and may increase incidents of absence without leave occurring. We saw that most of the people at Laureate House were currently detained under the Mental Health Act. The Mental Health Act has special rules around treatment and consent to treatment for mental disorder, including a formal procedure and safeguard if treatment is given beyond three months (section 58 of the Mental Health Act). We saw that where people had been detained under the Mental Health Act for more than three months, their treatment was properly authorised on the proper legal form. The trust had procedures in place to ensure that these special rules and safeguards were adhered to. Sometimes when these legal forms were completed, the records did not always show that an assessment of the patient's consent and capacity to consent to that particular treatment had occurred in line with guidance from the Mental Health Act Code of Practice. On occasions people may be prescribed medicines to help with extreme episodes of agitation, anxiety and sometimes violence. This is known as rapid tranquillisation. We saw information about the use of rapid tranquillisation and the trust had an up to date policy covering this type of treatment. Following rapid tranquilisation, nursing staff were required to record regular observations of the patient's blood pressure, temperature, oxygen saturation and respiratory rate. We looked for completed observation forms which showed that the patient had been properly cared for after being given rapid tranquilisation. However, when we checked the care records for patients on two wards who have been given rapid tranquillisation, we found these observations had not always been recorded. This meant that there was a risk to this patient's health and welfare. We discussed these with the managers of the unit who acknowledged that staff had not been following the Trust's policy correctly. We also saw one incident where proper records had not been maintained in the clinical records involving one patient assaulting another patient. The separate incident record also lacked detail. This meant that it was difficult to understand what actually occurred during and following the incident, including action taken to ensure that the patient received appropriate care following the assault. The managers of the hospital accepted the need for improved recording of this particular incident and recognised the difficulties trust staff may have in supporting the patient to pursue further action including support in any criminal proceedings due to the limited nature of the record made. A small number of staff did comment on the limited opportunity to provide a robust handover of patient care especially at the evening shift due to there only being a 15 minute overlap between the staff working on the different shifts. This was particularly commented on Bronte ward which was the largest ward with the most patients to discuss during these handovers. It was reported that this was managed by trust staff frequently staying later to provide proper handover. The trust should consider how they can assure that a proper handover is maintained at all times to ensure patient safety. Inspection Report Laureate House February

10 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 in-patient 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. Reasons for our judgement We spoke with several patients. One patient stated they felt safe on the ward. Another patient stated "yes, yes, yes" when asked whether staff on the ward kept them safe and went on to state: "they wouldn't be doing their job [if they didn't keep patients safe]." There was information available on the wards for patients and visitors on abuse and what to do if abuse was suspected. We spoke with ward staff who were able to identify what abuse is and the actions to take if abuse was suspected. Safeguarding Adults was part of the trust's mandatory training programme with additional training for senior practitioners and managers in relation to undertaking investigations. On Anderson ward, there was a safeguarding link worker link on the unit. We saw that on occasions, patients and their children on Anderson ward were subject of safeguarding concerns or safeguarding alerts prior to their admission. We saw that appropriate liaison occurred with health visitors and children's social workers to ensure that these safeguarding issues were properly looked into or managed. We saw that local contacts and links maintained with local safeguarding teams. We saw that on Blake ward, the ward manager had kept us informed regularly about the action they were taking to support one patient who made several allegations directly to us. This showed that the hospital took allegations of abuse seriously and took appropriate action to deal with the allegations of abuse. The trust had safeguarding children and safeguarding adults policies available on the trust's intranet and the trust's website. This means staff and the public have easy access to the policy and procedure where abuse occurs or is suspected when people are receiving or in contact with trust services. We asked the managers of the hospital for details of current or recent safeguarding issues from incidents within the in-patient services at Laureate House. We saw that, from the records provided, these incidents included allegations made from patients about other Inspection Report Laureate House February

11 patients on the ward. From these records we saw that ward staff had taken appropriate action such as involving the police, involvement of the safeguarding lead and holding multi-disciplinary meetings as well as immediate action to ensure that the situation was managed. For example we saw that where an allegation of sexual inappropriate behaviour was alleged, we saw that patients were moved to prevent this from occurring. We also saw that appropriate liaison occurred with community mental health services to ensure that any ongoing safeguarding issues were followed up by community mental health workers as many of the safeguarding issues occurred before people came into the hospital or whilst they were out on leave rather than incidents which occurred whilst people were receiving treatment for in-patient services. The trust is on a commissioner assurance framework currently which includes safeguarding. This meant that the trust has to provide further reassurances to the clinical commissioning group on how the trust is managing safeguarding issues on a trust wide level. On the day we visited, there were people detained under the Mental Health Act on the ward. People who were detained under the Mental Health Act had access to an Independent Mental Health Advocacy (IMHA) Service to safeguard and promote their rights as detained patients. When we visited, no one at Laureate House was subject to further restrictions such as restraint, seclusion or deprivation of liberty safeguards. We looked at seclusion records on Blake Ward and this showed that seclusion was not used very often. Where seclusion was used the safeguards of the Mental Health Act Code of Practice were met, for example through regular nursing and medical reviews and appropriate records being maintained. The trust notified the National Reporting and Learning System about incidents including incidents of abuse or allegations of abuse. We then receive these notifications on a regular basis. This meant that appropriate organisations received information about important events such as safeguarding incidents and allegations so they can take appropriate action, where necessary. Inspection Report Laureate House February

12 Supporting workers Met this standard Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement We spoke with several informal and detained patients during our visit. Patients commented positively on the staff on the unit. One patient commented on the staff within the unit stating: "I can't praise them enough, they [staff] deal with things in a very professional way"; another patient commented: "I love some of the staff." We were told that all staff had attended relevant induction, including core training in areas such as orientation, moving and handling and safeguarding awareness. All staff were required to attend regular mandatory training. This included health and safety, moving and handling, fire safety, infection control, customer care, equality and diversity and safeguarding. We spoke with a number of staff including qualified nursing staff who told us that they felt well supported and gave details of recent training they had attended. For example a new member of staff spoke about the comprehensive induction training they had undergone. We spoke with one member of staff who had returned from maternity leave who told us about the updates they received on their return from maternity leave. The nursing staff we spoke with showed good understanding of ways of working with people with mental health needs. Staff we spoke with had a good understanding of the Mental Health Act. The trust had a system in place which identified what training was needed for care staff and when updated training was due. We saw the training matrix for the staff and this showed that staff were supported to access training, mandatory training and nurses were supported to meet their own professional development and requirements of the relevant professional bodies, such as the Nursing and Midwifery Council. Training records indicated that staff were up to date with their training, or there were plans in place to ensure they were up-to-date within reasonable timescales where there were shortfalls. Staff told us that they had regular annual appraisals and regular supervision and felt well supported by their line managers. Supervision included line management supervision and clinical supervision. We saw a sample of these records on some of the wards we visited which corroborated this. Inspection Report Laureate House February

13 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 had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement We spoke with people who were being cared for on the unit. Generally they told us it was well run and felt that patient concerns were listened to. One patient told us: "It's alright". Another patient said "This hospital's not so bad compared to others". We spoke with several patients - none of them had cause to formally complain about their time in hospital. During our visit we looked at the care plans of patients. Our review of the documentation and risk assessments showed that care plans and risk assessments were well collated and easy to follow. There was evidence that care plans were audited against agreed standards. On recent visits throughout the year by the Mental Health Act (MHA) Commissioner, they looked at the MHA paperwork and confirmed that on most occasions, the correct paperwork was in place and the files were well ordered. The trust had systems and checks in place to ensure it was meeting its' responsibilities under the MHA. Where the MHA Commissioner had raised issues on previous visits, there was evidence that the trust had improved its systems to prevent these issues from reoccurring. For example, the trust had recently developed a form for recording decisions relating to consent to treatment for mental disorder. The trust also took action following initial feedback on the first day of this inspection and showed us the draft action plan to improve its processes for rapid tranquillisation by the time we returned. This meant that the trust had regard for reports prepared by the Care Quality Commission. Records showed that the trust did regular checks on the quality of care provided at Laureate House, for example, through visits by the modern matron and leadership walks. These checks involved speaking to patients, reviewing incident reports, reviewing complaints and checking other records. On one ward we visited, the modern matron was carrying out one of these checks while we there. The trust had identified the need to improve the recording of physical health observations following rapid tranquillisation through their own regular audits. This meant that the trust had systems for monitoring the quality of the service and safeguarding standards of care. Inspection Report Laureate House February

14 The health and safety risks of the unit were assessed and managed, including regular checks on equipment to make sure equipment was safe to use and appropriate systems for the management of controlled drugs. The trust had assessed that the seclusion room on Blake ward as not fully meeting the requirements of the Mental Health Act Code of Practice and had well developed plans to move the seclusion room to a quieter area of the ward to afford more privacy to patients placed in seclusion. Community meetings were held with people who used the service. Staff meetings also occurred. We saw records of these meetings which confirmed they took place. This ensured that the unit had regard for the views expressed by people who used services and those acting on their behalf, as well as staff that worked in the hospital. Many patients commented to us on the poor quality and choice of food available especially for those patients who were admitted for longer periods. We heard of efforts by hospital staff to address these concerns and were assured that the trust would continue to work with the catering supplier to address patient concerns. Staff commented on changes to their shift patterns and we heard of the opportunities for staff to share their views on this and other issues including via unions. We saw that incidents were reviewed and appropriate action taken to address any learning arising out of incidents that had occurred. For example we spoke with the recently appointed director of nursing who was working with the acute NHS trust (which was based on the same site) to take action and learn lessons from two serious untoward incidents which involved both trusts. We asked for a list of recent complaints and comments from patients at Laureate House. The records showed the trust had responded to the comments and complaints and attempted to resolve complaints, offering an apology and learning lessons where appropriate. As part of the inspection we made contact with the local Healthwatch service, the local clinical commissioning group and local adult safeguarding services within the local authority. We did not receive any concerns from these services about in-patient services at Laureate House. Inspection Report Laureate House February

15 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 Assessment or medical treatment for persons detained under the Mental Health Act 1983 Diagnostic and screening procedures Treatment of disease, disorder or injury 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 were not protected against the risks of receiving care or treatment that was inappropriate or unsafe by means of the planning and delivery of care in such a way as to ensure the welfare and safety of the service user [Regulation 9 (1) (b)]. This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent to us by 20 February 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. Inspection Report Laureate House February

16 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 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 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 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. Inspection Report Laureate House February

17 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 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. Inspection Report Laureate House February

18 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. Inspection Report Laureate House February

19 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 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. Inspection Report Laureate House February

20 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 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. Inspection Report Laureate House February

21 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: 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 Laureate House February

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