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Inspection on 12/08/09 for Abbeyfield Dene Holm

Also see our care home review for Abbeyfield Dene Holm for more information

This is the latest available inspection report for this service, carried out on 12th August 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home values equality and diversity and works hard to meet individual needs in a creative and supportive way. There is a well trained staff team, from diverse backgrounds and experience, who are committed to providing a high standard of care in the home. Seventy percent of the staff now hold the National Vocational Qualification (NVQ) at level two or above. The home is well maintained and has a welcoming and calm atmosphere. The home is well managed and run in the best interests of the residents. There are regular residents and relatives meetings. Relatives say that the home communicates well with them.

What has improved since the last inspection?

The management of the home has become more focused. Staff recruitment and performance management have improved and there is less sickness absence. This has meant that the home now hardly ever has to use agency staff so there is more consistent care and support for the residents. There has been an increased focus on person centred care and activities are now more frequent and tailored to individual needs and wishes. The home has worked more closely with local health and social care professionals. A particular success of this improved liaison is that several residents have been able to reduce the amount of medication that they are taking. Staff training has improved and more staff have gained the NVQ at level two or above. Staff are receiving better support and guidance in the form of one -to-one supervision, appraisals and structured training schedules. There have been some significant improvements to the environment. There has been a complete refurbishment of a lounge/dining area, several bedrooms have been redecorated, the sluice and the laundry room have been divided to lessen the infection control risk and a new ironing room has been created. A new post of care co-ordinator has been created and this has made staff roles and responsibilities clearer.

What the care home could do better:

The service has a plan to continue the improvements to the environment. These plans include the conversion of a large room, once use as a day centre, into an area where a variety of social activities can take place and members of the local community can be welcomed; as well as making the garden more accessible and re-carpeting some rooms. The home should continue to ensure the improvements are on schedule.

Key inspection report Care homes for older people Name: Address: Abbeyfield Dene Holm Dene Holm House Dene Holm Road Northfleet Gravesend Kent DA11 8JY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Mills     Date: 1 2 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Abbeyfield Dene Holm Dene Holm House Dene Holm Road Northfleet Gravesend Kent DA11 8JY 01474567532 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: deneholm@abbeyfieldkent.org The Abbeyfield Kent Society care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 47. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Dene Holm is a large purpose built residential unit situated in Northfleet, on the outskirts of Gravesend. The home provides support to older people and people with dementia. The downstairs unit in the home is dedicated to supporting people with dementia. The building is accessible to wheelchair users with lift access to the first floor. Dene Holm has a team of staff covering a 24-hour rota. Current fees range from £373 to £590 per week. Care Homes for Older People Page 4 of 27 2 4 0 9 2 0 0 8 47 0 Over 65 0 47 Brief description of the care home Further information about the home can be obtained by contacting the home manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced and formed part of the annual regulation process of the Care Quality Commission (CQC). The process takes into account information we have gathered during this visit and information that we have received from a variety of sources prior to the visit. This includes things the home is required to tell us in their Annual Quality Assurance Assessment (AQAA) and in notifications, and things that other people, such as relatives and visiting health and social care professionals, have told us about the home. This evidence is then used to make a judgement about the quality rating for the home. During this visit we spoke to five of the people who use this service and three of their relatives. We spoke to two members of staff and the Care Co-ordinator in private held in depth discussion with the manager of the home. We examined important documentation such as care plans, medication records and staff files. We made a tour of the home and used direct and indirect observation throughout the time we were in Care Homes for Older People Page 6 of 27 the home. The people who use this service were all very positive about the care and support they receive. Their relatives spoke highly of the staff on duty and said that they are very happy with the way the home communicates with them. Visiting health care professionals told us that communication with the home has improved over the past year and that the home works well with them to promote the health of the residents. The people who use this service said that they would like to be referred to as, Residents, and therefore this is the term that will be used to refer to them throughout this report. We found that the home had met all the requirements placed at the last inspection and no requirements were placed as a result of this visit. The residents, their relatives, staff and manager are all thanked for the welcome they gave and their help throughout this visit. As a result of the improvements this inspection identified, the quality rating for this home is now judged to be 2 Stars. This means that the residents of the home experience good outcomes in all aspects of their care. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives prospective service users and their supporters plenty of information so that they can make an informed decision about moving into the home. Evidence: Since the last inspection the Statement of Purpose and Service User Guide have been updated. They are now presented in a user-friendly pack. For those people who are unable to understand the contents due to lack of mental capacity, their relatives and supporters are made aware of their rights and responsibilities. Observation of those people who lack mental capacity showed that they know that they can move freely around the home and can expect, and receive, the support of staff to help them do the activities of daily living that they wish. Examination of the initial assessments of those people who were most recently admitted to the home showed that thorough pre-admission assessments are made. These assessments ensure that their needs can be met before a place is offered. Care Homes for Older People Page 11 of 27 Evidence: The home does not offer intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes the health and well being of the residents in a way that respects their privacy and dignity. Evidence: There are clear policies and procedures in place to ensure the privacy and dignity of the people who use this service is maintained. Staff were observed to treat the residents with respect. They knocked on doors, spoke to the residents in a kindly way and addressed them by their preferred name at all times. Since the last inspection the home has adopted the Eden Alternative values. In short, these are:- that the organisation will treat its staff in the way it wants the older people it cares for to be treated; that the organisation brings decision making back to the older person and his or her supporters; that the organisation takes positive steps to make the environment rich in plants, animals and children and finally, that there is a real commitment to growth and improvement for everyone, including those suffering from severe lack of mental capacity and/or disability. This has led to care in the home becoming much more person centred and staff working in the home having a much Care Homes for Older People Page 13 of 27 Evidence: greater understanding of a progressive way to provide care. Residents and their relatives praised the staff on duty, saying that they are, Really lovely. The staff who were spoken confirmed that they have received god training in the core skills needed to help them care for the residents. Four care plans were examined in detail. These were up-to-date and in good order. Care plans are important documents because they are one of the ways in which the residents and their supporters can be assured that their needs and wishes have been clearly identified and will be met in they way they would like. In addition, they are an important source of reference for staff who must ensure that they deliver care and support in a consistent and professional manner. Further, care plans can provide a basis upon which decisions can be made on behalf of those people who no longer have the mental capacity to make these decisions for themselves. The care plans contain good information about each resident. They identify cultural and religious needs, health and personal care needs and likes and dislikes as well as other needs and wishes. There are clear written details as to how needs and wishes will be met. The manager said that the home is currently reviewing the care plan format to see if it can be made even more person centred. He showed us a template for an improved care plan which the home is likely to adopt. Since the last inspection the home has worked hard to improve relationships with local health and social care professionals. All the residents are registered with local General Practitioners (GPs). Many of the residents are registered with the GP practice that is very close to the home. The District Nurse visits daily and the home provides her with a room that is set aside for her work. There is now very good communication between the home and the doctors and nurses and they have recently been able to work together to reduce medication levels for some of the residents. Medicines are stored safely and securely in the home. There has been a change in the pharmacy that the home uses since the last inspection. This has improved the communications between the home and the pharmacy and introduced better systems for ordering medicines and returning unused medicines. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides the residents with a variety of activities with the opportunity to take part individually or in a group. This makes life in the home more interesting and meaningful. Evidence: Activities in the home have significantly improved since the last inspection. The home has adopted the Eden Principles, an accepted approach to care and support that is much more person centred. Although there are still some visiting entertainers, activities are now more spontaneous and tailored to individual needs. The home has now decided that staff will not wear uniform to make the home feel more relaxed and friendly. The homes Annual Quality Assurance Assessment (AQAA) confirmed that there is a good understanding of equality and diversity and that this is valued by the home. On the day of this visit some of the residents had gone out shopping with some staff members whilst others were joining in a music group and some were playing a game with a soft ball. Some residents prefer not to join in group activities and these people were observed to move freely around the home or spend time in their rooms if they Care Homes for Older People Page 15 of 27 Evidence: wished. The home has now opened a shop selling sundry items such as toiletries, sweets and canned drinks. The shop is run by one of the residents. This person told us how much she enjoys the time she spends in this activity. The home also has a number of games and arts and crafts materials. Staff say they enjoy encouraging residents in a variety of activities from crafts to group games such as softball and giant Connect Four. The staff team have a wide age range and come from varied cultural backgrounds and experiences. This makes the residents lives more interesting as the staff share these experiences. Staff from local ethnic groups cook food from their cultures so the residents can try these if they wish. The home celebrates a variety of religious festivals such as Christmas, Easter and Divali and representatives from a local church visit to hold Christian services for those who wish to attend. The manager confirmed that he has control of the budget for food and that there are no restrictions on the amount spent on food. On the day of this visit there was plenty of fresh and healthy, locally purchased food in the home. Food services at the home have improved since the last inspection and there has been a change in catering staff. residents said that they enjoy the meals at teh home and that there is plenty of choice. We observed the evening mealtime and noted that there was a wide choice of food at this meal. Previously there were a number of complaints about food but there have been none recently. Residents say that they enjoy their meals and have plenty to eat. Special diets are catered for and special occasions are celebrated. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sound policies and procedures for handling concerns complaints and safeguarding that staff understand and act upon. This means that the views of the residents and their supporters are listened to and acted upon and that the home does all in its power to protect the residents from harm. Evidence: There are clear polices and procedures for managing concerns, complaints and safeguarding. There is a copy of the complaints procedure in the Service User Guide and on display in the home. All complaints are recorded and these records were available for inspection. Complaints were of a day to day nature and all were investigated and resolved quickly and to the satisfaction of the complainant. The homes Annual Quality Assurance Assessment (AQAA) told us that, as a result of concerns about food, the catering staff have changed and as a result of complaints about lost laundry, laundry systems have been changed and more staff hours have been allocated to the laundry. There are robust systems for handling any residents monies that the home looks after. The home does not hold large amounts of cash or act as appointee on behalf of any residents. Small amount of residents monies are kept, checked and accounted for on a daily basis. Receipts are kept for all expenditure. Staff receive training to enable them to help keep the residents safe from harm . Care Homes for Older People Page 17 of 27 Evidence: Three staff files were examined and were seen to contain good evidence that this training has been completed successfully. Staff receive regular one-to-one supervision. The supervision sessions give them the opportunity to share any concerns with their supervisor. Staff spoken to were clear about their responsibilities in respect of safeguarding and said that they would have no hesitation in reporting any concerns to a senior member of staff or the manager. They said that they would always be prepared to raise concerns on behalf of a resident should the need arise. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a welcoming atmosphere and is well maintained and clean. This gives the residents a safe and homely place in which to live. Evidence: The home has a welcoming and calm atmosphere. There have been a number of improvements to the environment since the last inspection. The lounge/dining area has been completely refurbished, several bedrooms have been redecorated, the laundry has been divided to provide a separate sluice room and an ironing room has been created. There are now plans to change the use of a very large room that was once used as a day centre to provide a large recreation area and to provide a decked area outside to make the garden more accessible to the residents. A tour of the home was made. All areas were seen to be safe, clean and clutter free. There are sound infection control measures in place. The laundry systems have been greatly improved since the last inspection with separate ironing and sluice rooms. The homes Annual Quality Assurance Assessment (AQAA) told us that all safety certificates such as electrical and gas safety are up-to-date. There are robust systems Care Homes for Older People Page 19 of 27 Evidence: for keeping the environment safe that include regular health and safety checks and safe handling of substances hazardous to health (COSHH). Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training, staff team work and staff morale have all improved and there are robust systems for staff recruitment. This means that the residents are cared for by a well trained, carefully vetted and cheerful staff team. Evidence: There has been a great improvement in staff performance management, training and recruitment. Reduction of sickness absence and improved recruitment have led to less need to use of agency staff and provides a more consistent service for the residents. Since the last inspection a new structure for staff has been put in place. A post of Care Co-ordinator has been created and more robust administrative support has been put in place. This means that roles and responsibilities are much more clearly defined and staff are more confident about the reporting mechanisms. Staff spoke very positively about this new arrangement. One said, The care co-ordinator is brilliant, she is easy to talk to and we can ask any questions without feeling stupid. The residents and relatives spoken to said that the staff are kind and caring. One spoke of the staff on duty as, Absolutely lovely, hard working, smiley and good at their jobs. The homes monthly quality visits, that are made by a representative of the provider, confirm that there has been an improvement in staff morale and job satisfaction. Care Homes for Older People Page 21 of 27 Evidence: Three staff files were examined. These provided good evidence that staff training has improved. Statutory training is up-to-date and staff are also receiving training in specialist areas such as dementia care and diabetes. Two members of staff were spoken to in private during the course of this visit. They confirmed that they have received plenty of training. Since the last inspection more staff have gained the National Vocational Qualification (NVQ). Seventy percent of staff now hold the NVQ at level two or above. The staff files provided good evidence that the home carried out robust recruitment procedures to ensure only those staff suitable to work in a care home are offered employment. A full employment history is obtained and two written references are sought. Criminal Records Bureau (CRB) checks are made on all staff before they begin work at the home. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who use this service. Their views, and those of their supporters are listened to and acted upon. Evidence: The manager of the home took up his post just before the previous inspection and is currently applying to register with the Care Quality Commission (CQC). He has many years experience in a variety of care settings including residential and day care and holds a Diploma in Psychology from the University of Wales and a post graduate management qualification. Since becoming home manager he has become an Eden Alternative Associate Member and has worked hard to rid the home of some historic institutionalisation and to make the home much more a part of the local community. Staff spoke very positively about the manager. They said that they could see the improvements made since he took over the running of the home. One said, Our manager is very fair, he listens to what you have to say and never makes you feel as though you shouldnt be saying things Care Homes for Older People Page 23 of 27 Evidence: so we fell happy to put our own ideas forward to make things better for our residents. The organisation has robust quality assurance systems in place. A representative of the registered provider visits each month and carried out a quality inspection of documentation and the environment. Staff and residents are spoken to to seek their views about the home. In addition, there are regular residents and relatives meetings as well as staff meetings. The manager completed the Annual Quality Assurance Assessment (AQAA) that is required by CQC on time. It was comprehensive and gave us good information about the progress the home has made since the last inspection. The home has now established one-to-one supervision for all staff. This takes place every two months. In addition there are annual staff appraisals. Those spoken to said that they find the one-to-one sessions very helpful as it gives them an opportunity to discuss any practice issues and to identify training needs. Records are stored securely and are kept confidential. All documentation that was requested during this visit was readily to hand and was in good order. The AQAA confirmed that the home is well maintained and that there is an improvement plan for the environment. It told us that regular health and safety checks are made and that there are rigorous fire prevention policies and procedures in place. No health and safety hazards were noted during this visit. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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