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

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Darna House Groby Road, Altrincham, WA14 2BQ Tel: Date of Inspection: 03 April 2013 Date of Publication: April 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 Safeguarding people who use services from abuse Requirements relating to workers Assessing and monitoring the quality of service provision Action needed Action needed Action needed Action needed Action needed Inspection Report Darna House April

2 Details about this location Registered Provider Registered Manager Overview of the service Darna House Limited Mrs. Tracy Lynn Lidster Darna House is registered to provide nursing care and accommodation for 19 older people. The home is situated in its own grounds in a residential area of Altrincham. Accommodation is arranged over three floors and access to the first and second floors is provided by stairwells and stairlifts. The home has good onsite parking facilities and is situated close to public transport routes into Manchester and surrounding areas. Type of service Regulated activities Care home service with nursing Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Darna House April

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 Requirements relating to 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 19 How we define our judgements 20 Glossary of terms we use in this report 22 Contact us 24 Inspection Report Darna House April

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 looked at the personal care or treatment records of people who use the service, carried out a visit on 3 April 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information we asked the provider to send to us. We reviewed information sent to us by local groups of people in the community or voluntary sector, talked with commissioners of services and talked with other regulators or the Department of Health. What people told us and what we found Care plans contained information about the preferences of people living in the home. However, care records did not provide evidence that people were receiving support to make decisions about how their care and support was provided. Although the majority of people living in Darna House had been diagnosed with dementia, the manager told us that their capacity to make decisions for themselves had not been assessed. Care records did not provide evidence of who had made decisions on behalf of people using this service. People living in the home had their needs assessed and iindividual risks to the safe delivery of care were being managed well. Staff had failed to recognise that one person's needs had changed and they should have been referred for healthcare advice, in line with their protocol on nutrition. Darna House did not have a programme of activities in place to provide people living in the home with stimulation, interest or social interaction. Serious concerns were found in relation to the recruitment of staff. The required preemployment checks had not been carried out by the manager to determine if the staff appointed were suitable to work with vulnerable older people. We spoke with three relatives and several healthcare professionals during our visit. The majority of feedback was positive about the personal care and treatment people received. However, we found that the manager had not regularly assessed or monitored the quality of the service provided. You can see our judgements on the front page of this report. Inspection Report Darna House April

5 What we have told the provider to do We have asked the provider to send us a report by 11 May 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 referred our findings to Local Authority: Safeguarding and Local Authority: Commissioning. We will check to make sure that action is taken to meet the essential standards. 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 Darna House April

6 Our judgements for each standard inspected Respecting and involving people who use services Action needed 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 not meeting this standard. People's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care. 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 Our inspection visit took place over two days at the beginning of April We looked at the home's Statement of Purpose (SOP) for evidence of how the provider recognised the diversity, values and human rights of people who used the service at Darna House. The aims and objectives in the SOP told us that, "Our residents are involved with input into their care plans. Each resident can maintain control over all aspects of daily living where choice is paramount, be it meal times, choice of food, rising or retiring." We looked at three care plans to see how people were enabled to make, or participate in making, decisions relating to their care and treatment. We saw that care records detailed individual's preferences in relation to their religion, preferred forms of address and times of getting up and going to bed. At the back of each care file we found forms for recording person centred information, such as routines, relationships and activities of daily living that were important to the individual. These forms had not been fully completed, although two of the records included detailed social histories compiled by relatives. When asked why the person centred information was incomplete the manager said, "We have been looking for a more appropriate way of recording this information." We discussed this with the manager and it was agreed that the quality of the information recorded was more important than the system being used. One of the person centred forms gave us good information about what was important to the person. It told us about the type of music that they enjoyed listening to and specified that they disliked it played loudly. We noted that this person was cared for in their room at all times, so we asked the manager if they had any recordings of the person's preferred music to play in their bedroom. The manager said that they didn't. This person's care records gave us further information about preferences in relation to how their personal care needs were to be met. On 6 January 2012 they were assessed as Inspection Report Darna House April

7 preferring to have showers. At some point this had been changed in the records to 'bed bath'. There was no written explanation of why this had been changed or who had taken the decision. We noted that the person had been diagnosed with dementia. Their capacity to make decisions for themselves had not been assessed as required under the Mental Capacity Act (MCA) This meant it was not possible to determine to what extent they were being enabled to make choices about the way their care was provided. When we asked the manager about this she said that she didn't think a mental capacity assessment was needed, because the person's relative was making decisions on their behalf. The manager's comments demonstrated a lack of understanding in relation to good practice guidance on compliance with the MCA. This guidance tells us that that just because a person has a mental health diagnosis, such as dementia, does not necessarily mean that they lack capacity to make decisions for themselves. The guidance further advises that anyone intending to take an action or make a decision on behalf of someone else must first assess that person's capacity to take that action or make that decision for him or herself. There was no evidence in this person's care records to verify that the MCA guidance was being followed, or that the person's preferences were adhered to by staff working in the home. The manager told us that none of the 11 people using this service had received assessments of their mental capacity. We spoke with the person's relative on the telephone. They told us they were happy with all the staff. They said, "We think the staff are amazing. They seem to understand X and know what they need." We asked if they were satisfied about X staying in their room at all times. The relative said that X had dementia and staff did their best under the circumstances. We asked the manager why all 10 people currently accommodated in the home were cared for in their rooms, with no opportunity for social interaction. They told us, "Everyone is nursed in bed according to their choice or that of their relatives." None of the three care records that we looked provided written evidence of this. We asked the views of a visiting Funded Nursing Care (FNC) Nurse who was undertaking reviews while we were present in the home. They told us that they had seen people sitting in the lounge during the course of the previous year, but that as some people's health had deteriorated they had become too ill to leave their bedrooms. They added that the only way that people could get down from the first and second floors would be to use the stair lifts, as there was no passenger lift in the home. The FNC Nurse said that most of the people accommodated would be too frail to use the stairlifts. Inspection Report Darna House April

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. People living in the home did not always experience personal care, treatment and support that met their needs in relation to their social and dietary needs. 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 saw that Darna House had published the home's philosophy of care on their website. This said that "Comfort is paramount and every effort is made to meet the physical, psychosocial and spiritual needs of our residents." The three care files we looked at provided evidence that people had received appropriate assessments of their needs relating to personal care and treatment. Risks had been identified and plans were in place to guide staff on how to manage risks safely. Two of the care records also provided evidence to demonstrate that timely referrals had been made for professional healthcare advice in relation to physical and mental health and nutritional needs. We spoke with two specialist nutrition nurses who had come to the home to assess their patient. They said, "We are quite satisfied that staff follow our instructions for patient care. They readily contact us for advice and will make timely referrals and liaise with other healthcare professionals as appropriate. We visit every three to four months and today we have found that our patient has been well cared for." We also spoke with three relatives during our visit. The relatives spoke positively about the care provided in the home. One person commented, "I visit X every day. X always looks comfortable and content. I have no concerns. My X is hoisted out of bed to sit in a chair in the bedroom. I don't have a mobile phone, so staff contact other members of the family if they need to speak with me." Two of the care plans showed that both people had lost considerable amounts of weight over a period of time. The first person was under the care of a dietician and records confirmed that staff had followed their guidance regarding the provision of nutritional supplements. In conversation with the chef it was evident that they had a good understanding of what types of food to offer this person in tempting them to eat a nutritious diet. However, there was no system in place to record the actual amounts of food and fluid intake for this person. The second person had not been referred for dietary advice and their nutritional risk assessment was found to be inaccurate. The most recent review undertaken in January Inspection Report Darna House April

9 2013, stated that the person was at low risk of malnutrition. The scoring was inaccurate, because the person's needs had changed. The review should have shown that the person was at moderate risk and required a referral to their GP for dietary advice. The frequency of weight monitoring for this person should have been increased to weekly, according to the nutritional tool being used in the home. It was also reasonable to expect that food and fluid intake charts would be in place in line with best practice guidance. It was particularly important that this person's fluid intake was monitored, because they had been diagnosed with urinary tract infections on three occasions between September and December Prior to our visit we received information from one of our partner organisations. They told us that when they visited the home around lunchtime the previous week, they did not hear or see any of the people accommodated. The manager told us that this was because all the people accommodated were being cared for in their bedrooms. They said that this was in line with their choice, or that of their relatives. We found that the people accommodated did not have the opportunity to socialise and interact with each other. We asked the manager if daily activities were being provided to keep people stimulated and interested. The manager said that staff went into people's bedrooms regularly during the day and night to ask if they were alright, but that no organised activities were provided to people in their bedrooms. This placed the people accommodated at risk of being socially isolated. None of the three care plans we saw contained evidence that people had chosen to stay in their bedrooms. Nor were there any records pertaining to discussions held with people's relatives on this subject. Furthermore, none of the three care records contained plans of care to describe what action would be taken to meet each person's social needs. The FNC Nurse, who was reviewing the care of two people during our inspection, shared her findings with us. She said, "Care plans here have not changed for years. They need to be brought up to date. Reviews are repetitive and not always accurate." We found similar concerns in the three care records we looked at. For example, one person's social needs assessment stated, "To encourage participation in planned activities and interaction with other service users, access to TV, radio, talking books and other pastimes." This person was cared for in their bedroom and none of the previous month's daily records provided evidence that any of the person's assessed social needs had been met, yet a review dated 13th March 2013 stated, "Social needs met daily." Inspection Report Darna House April

10 Safeguarding people who use services from abuse Action needed People should be protected from abuse and staff should respect their human rights Our judgement The provider was not meeting this standard. People who use the service were not always protected from the risk of abuse, because the registered person had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. 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 this standard because we found concerns relating to the assessment of mental capacity in the three care records we looked at. The manager told us that none of the 11 people using this service had received assessments of their capacity to make decisions for themselves. This was of particular concern because decisions had been taken to restrict personal freedom on behalf of a person who had been diagnosed with dementia. A GP had authorised nursing staff to administer some medication covertly in the person's food and nursing staff took the decision to fit rails to their bed. Neither of these decisions had been recorded as best interest decisions in line with the requirements of mental capacity legislation. The risk assessment relating to the use of bed rails identified that the person was at risk of accidental injury, because they were able to climb over the rails to get out of bed. There was no evidence of other measures having been tried to mitigate the risk of accidental injury to this person. We did not find any evidence of an appropriate system in place to protect people using the service against the risk of decisions relating to control and restraint that may be inappropriate. Following our visit we discussed these issues with the Local Authority safeguarding team and they asked us to make a referral under the Deprivation of Liberty Safeguards. The manager said, "I have been waiting for you to come and give your opinion on the care planning system in place." The manager acknowledged that care plans needed to be updated and modified to meet the requirements of the Mental Capacity Act, The manager told us that they had done mental capacity legislation training several years ago and they proposed that they would undertake refresher training in this area as soon as possible. Training records confirmed that only five of the 21 staff employed to work in the home had received safeguarding training. We saw two supervision records dated July 2012 that identified the staff needed to attend safeguarding training. However, the manager acknowledged that this had not been followed up. She told us that staff would be booked Inspection Report Darna House April

11 onto this training at the first available opportunity. Inspection Report Darna House April

12 Requirements relating to workers Action needed People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was not meeting this standard. The registered person did not operate effective recruitment procedures, to ensure that the needs of people living in the home were met by staff who were fit and appropriately qualified and experienced. We have judged that this has a major 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 Prior to our inspection visit we received information of concern from the UK Border Agency. They told us that the registered person had not undertaken suitable recruitment checks, to ensure that care and nursing staff were safe to provide care and support to vulnerable older people. The manager told us that there were 21 care and nursing staff employed in the home. Rotas confirmed that 21 different staff had worked shifts in the previous four weeks, although there were 24 separate staff names on the rotas in total. When we asked for recruitment information for the 21 members of staff, the manager was only able to locate 17 files. She told us that two files had been returned to head office as these members of staff had resigned. The manager was not able to explain why recruitment information was not available for the remaining two members of staff. We looked at all 17 staff records and found that none of the files contained complete or up to date pre-recruitment checks. For example, there was evidence that Criminal Record Bureau (CRB) certificates had only been obtained for four members of staff, 11 staff files did not contain evidence of identity and and only eight files contained the number of required written references. The manager said that she had seen copies of documents during the recruitment process, such as passports and proofs of address, but had failed to take copies of them. The manager was unable to explain why CRBs and references had not been obtained, or why all staff had not completed job application forms. Following our inspection we spoke with the manager on the telephone. She told us that she could now confirm that enhanced CRB checks had been obtained for 20 staff and that the certificate numbers had been recorded in a book. The manager was not able to tell us why we had not been shown this evidence during our visit. The UK Border Agency told us about a person that was present in the home two weeks previously when they phoned to speak to the manager. In conversation with the manager they established that the person was applying to work in the home, although their prerecruitment checks had not been returned. The manager had given an assurance to the Inspection Report Darna House April

13 Immigration Officer that they would not be included on the rota until satisfactory clearance had been received. However, when we visited the home on 2 April we found that the person was working on the night shift as a care assistant. When we looked at this person's recruitment file, we found only an application form and passport. No references or CRB had been obtained and there was no evidence that the person had been interviewed prior to working the night shift. We also noted that they had been included on the nursing rota for the following week. Allowing people to work in the home without undertaking satisfactory pre-employment checks, potentially placed people using the service at risk of serious harm. Inspection Report Darna House April

14 Assessing and monitoring the quality of service provision 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 was not meeting this standard. The provider did not have an effective system in place to regularly assess and monitor the quality of service that people receive. 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 The manager for this service is registered with the Care Quality Commission. Darna House published their philosophy of care on their website. It states "To deliver quality care, we treat everyone as an individual and value the opinion of our residents, their relatives and friends." We asked the manager how they gathered the views of people using the service and their relatives. They showed us the result of a satisfaction survey that was carried out with healthcare professionals who visited the home in The manager also showed us a questionnaire that was was currently being developed to gather the views of the relatives of people living in Darna House. The manager said that she provided nursing support to people living in the home on a daily basis and that she constantly assessed people's wellbeing. We asked to see evidence of the quality assurance system in place at Darna House, such as audits of medication, care planning and health and safety checks. The manager told us that care plans and the medication administration systems were audited on a regular basis, although the outcome had not been recorded. We were unable to look at the health and safety system, because we were told this had been returned to the home's head office for internal audit. We also noted that recruitment and training systems had not been audited to highlight the shortfalls that we found in both systems during this inspection. Consequently, we were unable to confirm that risks relating to the systems used in Darna House were being managed effectively. The three relatives that we spoke with during our visit were positive about the care provided in Darna House. People told us that staff contacted them if they had any concerns about the welfare of their relatives living in the home. One person told us, "I am very happy with this home. The staff are wonderful and we have a laugh. I get on with them very well and have no concerns." Inspection Report Darna House April

15 The Health and Social Care Act requires registered care homes to notify the Care Quality Commission (CQC) about significant incidents occurring in the home, including deaths. We asked the manager about this because we had not received any notifications from Darna House in the previous 12 months. The home's register recorded that there had been three deaths in the home during this period. The manager told us that the notifications had been forwarded to CQC, although we had no record of these being received. We asked the manager to send these death notifications to CQC retrospectively. The provider contacted us following our visit and told us that they had taken swift action to address the concerns found during our inspection. We will revisit the Darna House again to check that compliance has been achieved. Inspection Report Darna House April

16 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 17 HSCA 2008 (Regulated Activities) Regulations 2010 Respecting and involving people who use services How the regulation was not being met: The registered person did not make suitable arrangements to enable people living in the home to participate in making decisions relating to their care and support. Regulation 17 (1) 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: Failure to effectively plan and deliver care and support in relation to individuals' social and nutritional needs, potentially placed the health, welfare and safety of people using this service at risk of harm. Regulation 9 (1) (b) Regulated activity Accommodation for persons who require Regulation Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010 Inspection Report Darna House April

17 This section is primarily information for the provider nursing or personal care Safeguarding people who use services from abuse How the regulation was not being met: Suitable arrangements had not been put in place to protect people using the service against the risk of decisions around control and restraint being unlawful or excessive. Regulation 11 (2) Regulated activities Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Regulation Regulation 21 HSCA 2008 (Regulated Activities) Regulations 2010 Requirements relating to workers How the regulation was not being met: Failure to obtain the required pre-recruitment checks placed the health, safety and welfare of people living in the home at risk of serious harm. Regulation 21 (a) (b) Regulated activity Accommodation for persons who require nursing or personal care Regulation Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service provision How the regulation was not being met: Failure to identify, assess and manage risks relating to systems and procedures used in Darna House, placed the welfare and safety of people living in the home at risk. Regulation 10 (1) 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 11 May Inspection Report Darna House April

18 This section is primarily information for the provider 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 Darna House April

19 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 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. Inspection Report Darna House April

20 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 Darna House April

21 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. Inspection Report Darna House April

22 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 Darna House April

23 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 Darna House April

24 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 Darna House April