Inspection on 04/06/09 for Attwoods Manor

This inspection was carried out on 4th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Attwoods Manor 16/05/08

Attwoods Manor 11/05/07

Attwoods Manor 07/06/06

Attwoods Manor 16/09/05

Attwoods Manor 22/04/05

Attwoods Manor 24/11/04

Attwoods Manor 27/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Attwoods Manor Mount Hill Halstead Essex CO9 1SL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Neal Cranmer     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Attwoods Manor Mount Hill Halstead Essex CO9 1SL 01787476892 01787477769 attwoods.manor@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Golden Age Management Limited care home 65 Number of places (if applicable): Under 65 Over 65 0 65 dementia old age, not falling within any other category Additional conditions: 65 0 The registered person may provide the following categories of service: Care Home with Nursing - N To service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Old age not falling into any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 65 The total number of service users accommodated in the home must not exceed 65 persons. Date of last inspection Brief description of the care home The owner of Attwoods Manor is Golden Age Management Limited and there is currently no registered manager. Attwoods Manor is situated approximately one mile from the town of Halstead. This is a large detached period property set within approximately three acres of grounds. The home comprises of 59 bedrooms of which 3 are double rooms. The remaining rooms are all single and are mainly en-suite. There are 5 communal living rooms and a very Care Homes for Older People Page 4 of 27 Brief description of the care home large dining room/restaurant. There is ample car parking facilities at the front of the house. The grounds are well maintained and pathways around the home are designed for the use of wheelchairs and other mobility equipment. An attractive patio area at the front and side of the house is an ideal area for service users to use and to meet visitors. In October 2007 a large extension was registered, this compiled of 25 single en-suite bedrooms 4 large bathrooms, a large dining room and kitchen and sluice facilities. The home is registered for 65 older people who need residential care including 10 places for people who have dementia and nursing care needs. As at 4th June 2009, the Provider advised that the fees for accommodation ranged from £458.68 to £750.00 per week. 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: one star adequate 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 report follows a key unannounced inspection of the home, which took place over one day on the 4th of June 2009. The report has been written using accumulated evidence gathered prior to and during the inspection visit. The registered provider was available throughout the course of the inspection and we thank them for their contribution. During the course of the inspection we were invited by residents to join them for lunch. We would like to thank them the chef and the staff for their hospitality. This inspection visit included discussions with a number of residents, two relatives, the registered provider and a number of the care team. Care Homes for Older People Page 6 of 27 During the inspection a range of documents and records were sampled, most of which were found to be in order. A tour of the premises was also undertaken during the course of the inspection, which included looking at the homes bathing and toilet facilities, as well as communal areas and gardens. 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 following this report, you can contact them using the details set out 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 8 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 9 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. People who may use the service and their representatives are provided with the necessary information to enable them to make an informed choice about the homes ability to meet their assessed needs. Evidence: The home had a Statement of Purpose and Service users Guide. Both documents provided prospective residents with information about the structure of the service, the qualifications and experience of the staff employed, and the facilities provided by the home. Both documents also included reference to the homes complaints and admission processes. Both documents were comprehensively detailed and between them provided prospective residents or their representatives with the necessary information to enable them to make an informed choice about the homes Ability to meet their assessed needs. Care Homes for Older People Page 10 of 27 Evidence: Since the last key inspection undertaken in June 2008 there have been a number of new admissions made to the home. Records for four of these individuals were examined. The records showed that a comprehensive assessment of need had been undertaken covering a range of areas including: communication, emotional support, mobility, nutrition, personal care and medication. In addition to reviewing records discussion took place with the Provider regarding the homes admission process. The Provider explained that referrals are received by the home either by telephone, e. mail or directly from the service placements teams. Following receipt of the referral arrangements are made for a representative of the home to visit the service user to undertake an assessment. All assessments are undertaken by either the Manager of the home, the Provider or one of the homes Registered Nurses. If following assessment it is felt that the home can meet the persons needs, then wherever possible opportunities are set up for the person to visit the home. The initial six week period following admission to the home is on a trial basis, to enable all parties to decide if the placement is right for the individual. At the end of the initial six weeks a review of the placement is carried out. Care Homes for Older People Page 11 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 health and personal care that people receive is based on their individual needs, and the principles of respect, dignity and privacy are put into practice. Evidence: Four care plans that had been generated from the homes assessment of need were examined. All of the plans were found to include all aspects of personal, social and health care needs. Care plans were in place to support people with their communication, personal care, emotional support needs and medication. Daily records were in place to support the plans of care. One resident spoke of being aware of and having been consulted with about their plan of care. All of the staff spoken with during the inspection visit said that they were involved in the development of residents care plans. All four of the plans seen were written in a person centered way e.g. I like I enjoy. All four of the care plans examined were seen to be reviewed on a monthly basis. At the time of the inspection visit the homes care planning process was moving over to a computerised system, which was explained and presented to us. This system enabled the manager and staff to track residents care in a systematic way. Staff Care Homes for Older People Page 12 of 27 Evidence: spoken with spoke of being aware of the new system, and qualified staff and senior carers had already received training on the new system. The provider spoke of their intention for this training to be rolled out to all care staff, this was confirmed by care staff to be the case during discussion with them. All four of the care plans examined showed that risk assessments were in place and covered a range of areas including: pressure area care, nutritional screening, moving and handling and assessment of falls. All of these assessments were also incorporated into the new computerised care planning system. The home now employs Registered General Nurses (RGNs) who are in the home on a twenty four hour a day basis. This is a new development and is a requirement because many of the residents in the home now have nursing needs. In addition to the support provided by the registered nurses, district nurses visit the home daily to administer insulin and carry out dressing changes to those residents who are receiving residential care. All of the residents in the home are registered with a local General Practitioner who holds a clinic in the home twice weekly. Discussion with staff and one of the visiting district nurses indicated that all examinations are always carried out in the privacy of residents rooms, or in the room set aside for the General Practitioners clinic. Other health care professionals providing support into the home included chiropodists and opticians. Discussion with the relative of a service user who required input from a chiropodist indicated that this input was not being provided as required. We discussed this matter with the provider, and were given a reassurance that this matter would be resolved, thereby ensuring that the resident would be appropriately referred. The management of medication was found to be of a good standard with appropriate records in place regarding the ordering, administration and recording of medicines given by staff. The homes medication is dispensed by a combination of a Measured Dosage System (MDS) and individually named containers. Only qualified RGNs and senior carers administer medication. Senior carers had all received training provided by the dispensing chemist. The home does retain medicines of a controlled nature, and storage and record keeping relating to these medications were found to be in order. The homes medication administration practice was robust and protected residents. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style, and are supported to develop their life skill, however they cannot be assured of being provided with social and recreational activities that meet their individual expectations. Evidence: At the time of the inspection visit the home did not have an activities co-ordinator in post, although evidence was presented to show that an advert to appoint to this role had been placed in the local newspapers. However despite the lack of a dedicated coordinator residents were seen to be supported by staff to access the homes ample gardens. Residents spoken with said that some activities were still going on in the home e.g. art sessions which are provided by an art therapist who visits the home every week. Visiting entertainers attend the home periodically and bingo is played most days. This comment was supported by feedback received in the homes AQAA. Staff spoken with said that activities currently being provided in the home were limited, although wherever time allowed that would spend time with residents, this was observed to be the case during the inspection. Discussion with the Provider and staff indicated that the home had an open door policy Care Homes for Older People Page 14 of 27 Evidence: on the receiving of visitors coming into the home, this was confirmed by discussion with one resident who said that their relatives were free to visit the home whenever they wished. They went on to explain that they were free to choose where to receive their visitors either in one of the four lounges or if they chose in the privacy of their own room. Sampling of the homes visitors book showed that people were regularly coming in and out of the home. The home has two dedicated chefs, supported by kitchen staff. The two chefs cover the home seven days a week. The home uses five weekly rotational menus which evidenced that residents were being provided with a varied and nutritious diet. All of the menus seen provided two choices at each main mealtime. Discussion with one of the chefs indicated that residents who were able were asked about their choice of meal. For those people unable to make a choice themselves this was done by staff on their behalf based upon staffs knowledge of peoples likes and dislikes. Discussion with the chef indicated that twelve residents required their meals to be presented in a pureed form, the chef explained that the items of the meal were individually pureed which ensured that the residents were provided with an attractive meal and were able to taste the different flavours and textures. We were invited by four of the residents to join them for lunch. The meal was pleasantly presented and very enjoyable. Residents were seen to be provided with alternative meals of their choosing if the menu was not to their liking. They confirmed that this was always the case. Residents requiring assistance to eat were seen to be supported on a one-to-one basis. The menu for the day was displayed on a white board just inside of the dining room, and residents spoken with were aware of what was on the menu. Residents comments regarding the meals provided included the food has improved greatly we now always receive a choice. During the course of the meal it was noted that the chef came into the dining room and went to each and every table and asked residents if everything was to their liking. Residents confirmed that the chef often took the opportunity to do this, and from our observation it was evident that this was much appreciated by the residents. All of the residents spoken with said that the chef was very nice and amicable, and would go out of their way to meet peoples needs and wishes. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, however residents cannot be assured that all staff have the necessary skills to ensure that they are protected from abuse. Evidence: The home had a complaints procedure, which as mentioned previously was incorporated into the homes Statement of Purpose and Service Users Guide. Since the last inspection undertaken in June 2008 the home had received six complaints, all of which had been referred on as safeguarding referrals. All of the referrals had been investigated by the relevant agencies, and only one of the six was upheld. Residents and relatives spoken with during the course of the inspection visit were aware of how and to who they should direct any complaints or concerns. Copies of the homes complaints procedure were displayed throughout the home. The home had a policy in place regarding adult protection, which included a definition of abuse, the types of abuse that might occur, and guidance for staff on what to do in the event of an allegation of abuse being made. Since the last key inspection six referrals have been made to the relevant agency. All of these referrals were investigated, and as mentioned above one was upheld. Staff recruitment and development files examined indicated that staff had received training in adult protection. However this was not confirmed to be the case from discussion Care Homes for Older People Page 16 of 27 Evidence: with staff, a number of who said that they had not received this training. This does not imply that all staff have the necessary skills to ensure that residents are adequately protected. Care Homes for Older People Page 17 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 physical design and layout of the home enables people to live in a safe, well maintained and comfortable environment. Evidence: The home is fit for its stated purpose, as set out in the homes Statement of Purpose, being set in extensive pleasant grounds, which on the day of the inspection visit residents were seen accessing. The home is spacious and provided adequate communal space for the number of residents in residence. The lighting in all of the communal areas was good, and provided sufficient light to enable residents to carry out such activities as knitting and reading newspapers. The furnishings and fittings in the home were of a good quality and were in keeping with the age and style of the property. The home was equipped with adequate toilet and bathing facilities to meet the needs of the number of residents in residence, and these were situated in close proximity to all communal areas, to enable residents to gain easy access. The homes laundry room was equipped with the necessary equipment to enable the needs of residents to be met. Residents were well kempt and their clothes were well cared for. Cleaning materials used by staff for the purpose of keeping the home clean Care Homes for Older People Page 18 of 27 Evidence: and tidy were seen to be safely and securely stored. On the day of the inspection visit the home was found to be clean and tidy and there was not any evidence of any unpleasant smells or odours. Care Homes for Older People Page 19 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 in the home were well trained and skilled, and were generally available in sufficient numbers to meet the assessed needs of the residents, and to support the smooth running of the home. Evidence: Examination of the homes duty rota indicated that there were seven staff on duty in the morning with six in the afternoon. This staffing complement is made up of one RGN, a senior carer and four or five support staff. Night support is provided by one RGN and four support staff. In addition to the care staff there were catering and domestic staff available. Discussion with staff indicated that these staffing levels were adequate to meet peoples needs, however they did state that there were occasions when staff levels did fall below those recorded on the homes duty rota. Residents spoken with stated that the staffing levels had over recent months improved, they commented that there was a lot less use of agency staff, (this was also referred to in the homes AQAA) and that staff seemed to be not so rushed of there feet, and had more time to interact with them socially. The home employs twenty-seven care staff, of these sixteen have a National Vocational Qualification (N.V.Q) at level 2 or above. N.V.Q training was not just exclusive to care staff the provider reported that the homes administrator, kitchen Care Homes for Older People Page 20 of 27 Evidence: and domestic staff also had or were undertaking N.V.Q training. This was confirmed during discussion with some of these staff. The homes recruitment practice was examined through the viewing of five staffs files. All contained evidence of all of the required information and checks necessary being carried out before they commenced working in the home. These checks included references, proof of identity and protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) clearance. Other information found in files included copies of the persons application form, copies of questions asked during interview and a copy of the persons job description. All of which indicated a robust recruitment process. Staff training and development files examined indicated that staff had received training in fire safety, food hygiene, moving and handling, health and safety, adult protection, nutritional screening, and the safe handling of medicines. Discussion with staff indicated that they felt that access to staff training was generally good. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is generally based on openness and respect, however it does not have in place effective processes for keeping under review the quality of its service provision. Evidence: The home does not currently have a Registered Manager in post, however the provider provided evidence to show that an advert had been place in the local newspapers for the appointment of a manager. At the time of the inspection visit the home was being managed day-to-day by an Acting Manager supported by the Provider, a team of registered Nurses and a full-time office manager. The homes Acting manager was unavailable to speak with on the day of the inspection. The homes quality assurance process is based upon the use of surveys which are used to gauge the opinions of the residents. At the time of the inspection visit no surveys were available to assess the quality of this process. Service users spoken with about Care Homes for Older People Page 22 of 27 Evidence: this survey process did not have any awareness of it. Over recent months due to the lack of there being no registered manager in the home the provider has been in virtual day-to-day contact with the home, therefore Regulation 26 visits have not been taking place (these are visits required by legislation that the registered provider of the home must undertake on a monthly basis , when not in day-to-day control of the home). The home only manages money on behalf of one resident. Everyone elses money is managed on their behalfs by members of their family, or if the resident is placed by the local authority a corporate appointee is appointed by the placing authority. The records for the person whos money was managed by the home was examined and found to be in order, with clear evidence of an audit trail of income and expenditure. The homes safe working practices were looked into by the viewing of a range of safety certificates, these included records relating to portable appliance tests, electrical installation certificate, environmental health report, and weekly hot water checks. All of which were current and up to date. Staff training and development files included evidence of training on health and safety, infection control and fire safety. The records looked at indicated that the home was providing safe working practices. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 33 24 Quality assurance surveys 31/08/2008 must include resident?s views and the results of the whole quality assurance process must be made available to those taking part, and to the Commission. This is to ensure that the views of residents are taken in to account. This is now a repeat requirement; the previous requirement date of the 01/08/07 was not met. 2 36 18 All staff must be 31/08/2008 appropriately supervised and receive regular formal recorded 1-1 supervision. This is now a repeat requirement; the previous requirement date of the 01/08/07 was not met. Care Homes for Older People Page 24 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 1 12 16 Following consultation 31/08/2009 provide residents with a range of stimulating activities that are suitable to their needs and of their choosing. To ensure that residents are provided with a range of stimulating activities that meets their needs. 2 18 18 The Registered Person must ensure that staff receive the training that they require to carry out their work safely and effectively. This relates specifically to the need for all staff to be trained in adult protection. To ensure that service users are supported by a staff team who have the training and skills to ensure that their needs are meet. 31/08/2009 Care Homes for Older People Page 25 of 27 3 31 8 The Registered Provider must make provision for the appointment of a Registered Manager to run and manage the home. To ensure the effective running and management of the home. 31/08/2009 4 33 24 The Registered Person must 31/08/2009 ensure that there is a process in the home for reviewing and keeping under review the quality of the homes service provision. This is now a repeat requirement. To enable the homes service provision to be kept under review. 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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