Inspection on 12/05/09 for Bramley Court

This inspection was carried out on 12th May 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bramley Court 05/08/08

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bramley Court Bramley Court Care Home Chivers Way Histon Cambridgeshire CB4 9YR     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: Janie Buchanan     Date: 1 2 0 5 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: Bramley Court Chivers Way Bramley Court Care Home Histon Cambridgeshire CB4 9YR 01223236105 01223234289 charlie.carter@carebase.org.uk 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) : Carebase (Histon) Ltd care home 67 Number of places (if applicable): Under 65 Over 65 0 67 dementia old age, not falling within any other category Additional conditions: 67 0 The maximum number of service users who can be accommodated is 67 The registered person may provide the following categories of service only: Care Home with nursing - Code N To service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Bramley Court is a new, purpose built residential care home with nursing that provides care and accommodation for 67 older people. It opened on 17 March 2008 and is owned by Carebase (Histon) Ltd who already own and manage three residential and four nursing homes. Weekly fees for residents vary between £650 and £950 depending on their needs. Care Homes for Older People Page 4 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: For this inspection we (The Care Quality Commission) looked at all the information we had received about the home. This included the annual quality assurance assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. We visited the home and talked to 6 residents, four visitors and six members of staff. We checked a sample of medication storage and administration records, toured the premises to check on health and safety, and viewed a range of the homes policies and documents. An expert by experience (ex by ex) was part of our inspection : an ex by ex is someone who has direct experience of using or are involved in running social care services. During this inspection our ex by ex looked at the quality of activities, mealtimes and how staff interacted with residents. His feedback is Care Homes for Older People Page 5 of 27 included in this report. We sent the manager a number of surveys to be distributed to residents, relatives and staff. Unfortunately we only received 10 responses in total which is a poor result given the size of the home and despite us sending them out well in advance of our inspection What the care home does well: What has improved since the last inspection? What they could do better: The recording and administration of medications needs to be much tighter so that there is a clear and accurate record of what residents have received. There should be better signage and more orientation aids on the dementia unit to help these residents find their way about in their very unfamiliar environment. Long and similar looking corridors in the home should be made more interesting and source of stimulation for residents. Information about adult protection procedures should be made more available and accessible around the home so that residents, relatives and staff have the information they need should they wish to report any concerns. At least 50 of staff should have an NVQ level 2 in care to ensure that residents receive their care from staff who are appropriately qualified and whose knowledge and competence to look after older people has been assessed. Prospective employees should only start working at the home once a full CRB check has been undertaken to ensure that residents are protected and only the right people are employed to look after vulnerable adults. The home should actively involve its residents in the recruitment and selection of new staff so that they have an active say in the people who are to look after them. Care Homes for Older People Page 7 of 27 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. The homes admission procedures are good ensuring that peoples needs will be meet there. Evidence: There is a booklet about the home that is given to all prospective residents which gives details about the services on offer as well as a sample menu and list of activities available to residents. It also contains specific information about the homes dementia unit. In addition to this, there is an information folder in the foyer for residents and visitors which includes the homes statement of purpose, its service user guide, the most recent inspection report and also the most recent contracts monitoring visit. All prospective residents and their families are invited to look round the home to assess its quality and we saw two people being shown round during our visit. Residents who completed our survey told us that they did receive enough information about the home before they moved in so they could decide it was right for them. Care Homes for Older People Page 10 of 27 Evidence: Residents are also given a contact detailing the terms and conditions of their stay at the home. However one resident had not received a contract which caused considerable distress and a dispute with the Carebase Ltd. as to how much she owed them at the end of her stay there. All files we checked contained good evidence that peoples needs had been fully assessed before thy moved in to ensure they could be met there. One resident told us: I was happy with the assessment process and my daughters visited the home to check it was alright for me. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the care and medical support they need, however medication recording is not good enough to ensure there is an accurate record of what residents have received. Evidence: We checked the care plans for three residents living in the home. Residents needs were clearly identified with good detail about the action staff must take to meet them. Information in the plans was idiosyncratic and showed a good understanding of peoples particular needs. For example in one plan it stated: on Sundays when Xs wife does not come to visit, reassure him and keep him occupied. The plans had been reviewed regularly to ensure any changes in residents needs were picked up and there was some evidence that residents participated in planning and reviewing their care. Residents health care needs are monitored and their weights, nutrition and dependency level are regularly checked by staff. We checked the weight charts for a sample of residents which showed that they all maintained a healthy and stable Care Homes for Older People Page 12 of 27 Evidence: weight. Residents who completed our survey told us they received the medical support they needed. One commented: I get good support from the GP and the hospital. We checked medication storage and administration on one floor and noted the following shortfalls. The temperature of the storage area had only been recorded once in a period of two weeks; the amount of variable dose medication given to someone had not been recorded making it impossible to tell how many tablets he had actually received; a number of handwritten additions to the printed MAR sheets had not been signed or dated or checked by a second person to ensure their accuracy; one persons tablets remained in the blister pack even though staff had signed to say they had been given and it was not possible to tell if another resident had received her calcium as the MAR sheets did not tally with the number of tablets in the blister pack. We raised a number of these issue at our last inspection. Residents told us that staff treated them respectfully, however there have been some instances where residents dignity and privacy have not been promoted. We noticed a large poster hung on the bathroom door in one residents bedroom reminding staff to take the occupants teeth out at night. This is not dignified and the information should be kept discretely in the persons care plan and not on display for all to see. Laundry was something that many people raised with us as unsatisfactory. One person reported: clothing disappears and is damaged sometimes. One relative we spoke to during our inspection told us that someone elses T-shirt was in her husbands wardrobe currently. We received a serious complaint from a resident who told us that another resident had walked into her room whilst she was being changed in bed. She told us that staff failed to remove him from her bedroom in a timely fashion and she was left feeling frightened and vulnerable as a result. This same resident told us that staff often borrowed her continence pads, without asking, to use for other residents. Two residents reported that sometimes other residents wander into their rooms uninvited causing them annoyance and distress. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and mealtimes are managed well at the home, giving residents opportunities for stimulation and interaction. Visitors are made welcome. Evidence: Our ex by ex focused on activities for residents. He reported: A weekly activities sheet is prepared and advertised throughout the home and residents told me that they are verbally reminded daily of the days activities. The activities sheets for this week and last week showed a good range of activities both morning and afternoon from Monday to Saturday including gardening and outside outings. On Sunday 26 April there were activities from 10.AM until 4.PM many of them in the garden in response to the good weather. I was told that they had now introduced a themed lunch once a month [i.e. Italian] and that the key clinical staff including the head of catering the caretaker and activities coordinators meet monthly to review progress and discuss good ideas. There is a weekly activities meeting of the coordinators. The home also has access to a mini bus which is used regularly to take residents on outings and on the day we visited 6 residents went off to Duxford air museum. Relatives told us that staff made them feel welcome and were good at keeping them in Care Homes for Older People Page 14 of 27 Evidence: touch. One reported: as we live abroad the staff are excellent at keeping us informed on both my mother and uncle. Another stated: I am made very welcome can have lunch here if I want to usually on Sunday. Our ex by ex observed a lunch time meal at the home and commented: From 1pm to 1.45pm lunch was eaten by 12 residents with at least 3 staff on hand. The tables had nice tableware ,cutlery and serviettes. The tables were pleasantly arranged in groups with 4 places. There was soothing background music at a suitable volume. The only menu on display was a large print one at an entrance to the dining room it was out of date - more could be done to publicise the menu. They were offered at the outset a choice of orange or blackcurrant juice as well as a sherry. Residents were asked individually if they would like some bread. The main course was served already plated although one or two were asked about their preferences and the carer said that she was aware of preferences. The meal was nicely presented being a main choice minced beef and onion. The cook said that apart from once a week fresh vegetables were served. The sweet was meringue cream and peach. Everyone had been served both the main courses within half an hour. There was a relaxed atmosphere during lunchtime. The staff had a nice balance of keeping an eye on proceedings whilst intervening to help sensitively and often with humour when appropriate. They dealt sympathetically and fairly with a resident who was very impatient and a bit noisy. A resident who was struggling a bit to eat her soup and main course was allowed to cope unaided for a reasonable period before staff intervened sympathetically on one occasion by kneeling on the floor to make good visual contact with the resident. A resident who wasnt eating much was cajoled to eat a smaller portion and the main course was changed to help her. I heard staff comments such as Have you had enough or would you like some more and Have you got enough X and youre down for ice cream or would you like a meringue? . These are all examples of staff dealing with people as individuals and helping to make the experience a pleasant one for the residents. Overall I was impressed with what I observed. 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. Residents have access to a complaints procedure and have their concerns investigated. Evidence: The complaints procedure is displayed around the home so that residents and visitors can access it. Details of how to complain are also included in the homes statement of purpose and service users guide that are given to all new residents. We have received one serious complaint about the home since the last inspection concerning the quality of care received by a resident who eventually moved to another home as a result. This was responded to but not within the homes own timescales and not particularly sympathetically at first. The home itself has received about 7 complaints since we last inspected concerning amongst other things; missing laundry, residents wandering into peoples bedrooms, a resident not receiving enough showers and a bedroom that was dirty when the resident arrived at the home. These had been investigated and responded to appropriately by the current manager. Residents and relatives who completed our surveys told us they felt able to raise concerns should they wish. One commented: there have been instances that I (as the relative) have had to speak to the care home management about but they have all been dealt with and actioned in an effective and efficient manner. Staff have received training in how to protect vulnerable adults however there is very Care Homes for Older People Page 16 of 27 Evidence: little information around the home telling residents, staff and visitors who they should contact if they wish to report an incident. 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. Residents live in a well maintained home with access to a range of communal facilities. Evidence: Bramley Court is a purpose built home that can accommodate up to 67 older people. It has been designed and built as three separate secure units over three floors. Each unit has its own dining room kitchen facilities and large lounge with cinema facilities. Each unit is self-contained and provides single bedrooms with en-suite shower rooms (and flat screen TV) two separate bathrooms, one wet, room two toilets, a nurses station, lockable drugs storage cupboard, lockable sluice room, lounge and two quiet sitting areas within the hall-way. The home is decorated to a good standard in pastel shades and furnished with matching fire retardant furniture furnishing and curtains There are pleasant gardens surrounding the home with seating and attractive planting for residents to enjoy. Unfortunately the dementia care unit is on the top floor making access to the garden for these residents very difficult and making them utterly dependent on staff to get there. One relative reported: I would like my father to have more opportunities to go outside. He is on the second floor and has no access to the garden. Corridors in the home are long similar looking and rather bland with little of interest or stimulation for residents (especially to those who may spend a large part of the day wandering up and down them) and their visitors. There are no orientation aids Care Homes for Older People Page 18 of 27 Evidence: or signs or names on peoples doors to help them find their bedrooms on the upstairs dementia unit despite these residents needing the most help. Our ex by ex spent time on the dementia unit and described it thus: The armchairs were set out in cosy small groups the TV[large flat screen] was on without the sound being too obtrusive and there was a bookcase with DVDs books magazines and games such as puzzles, scrabble and jigsaws. A corner of the room had an attractive display of reminiscence material - postcards newspaper stories and an array of period objects. Throughout this period there was a pleasant and serene atmosphere in the lounge and in the dining room. We saw hand cleaning stations throughout the home to reduce the spread of infection however both a domestic member of staff and one of the nurses had very poor knowledge about the homes procedures in relation to a resident with MRSA and knew little of what extra precautions they might take if a resident had this infection. One member of staff told us she regularly witnesses other staff leaving soiled clothes on the floor and not using gloves and aprons appropriately. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are looked after by caring staff in sufficient numbers to meet their needs. Evidence: The ratio of staff to residents is good with a minimum of 1 carer for five residents. Residents who completed out survey told us they were staff available when needed. Staff told us they could be busy in the mornings but usually got one to one time with residents in the afternoon. However one relative told us: sometimes my cousin wet the bed as an attendant was slow in answering the bell. We received many positive comments about the quality of the staff and our ex by ex commented that the staff he observed had: a very caring and considerate attitude to the residents. The home has been relying on agency staff to cover vacant shifts for some time which was a worry to some residents and relatives. One told us: full time staff get to know the residents however far too many agency staff are used especially at the week-ends. Another commented: evening care staff tended to be hired from outside agencies and were constantly changing. On the day we visited two staff from an agency were working on the middle floor. One of the agency nurses told us she had been working there for about three weeks to cover staff shortages. However the use of agency staff appears to be getting better and one staff member told us: it was nearly all agency staff when I started; there are far less now. Care Homes for Older People Page 20 of 27 Evidence: The home employs a number of staff from overseas whose first language is not English. We asked residents if they could understand and also be understood by these staff. Most confirmed they could although one told us: there is some difficulty with English but in the end we get by. Another resident stated: I found it hard to communicate with some of them because their command of English was often minimal. Staff who completed our survey told us they received a 4 day induction that covered what they needed to know when they started the job. Training records we viewed showed that staff had received all required training. However only about 11 staff of 42 have an NVQ (National Vocational Qualification ) level 2 above in care which is well below the minimum standard that 50 of staff have this qualification. We checked the personnel files for three recently recruited members of staff. The home is routinely employing staff with just a POVA first check whilst awaiting their full CRB check. Although this is allowed in exceptional circumstances only (DOH Guidance) it is not best practice and puts residents at unnecessary risk. One person had started working at the home with just one reference having been received and the home had also received both references for another member of staff from her previous employer. None of the residents are involved in selecting the people who are to look after them. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have good opportunity to give their views and affect the service they receive. Evidence: The home has been without a registered manager for a considerable time now. A new permanent manger was appointed in January of this year and seems to be bringing some stability and much needed guidance to staff working there. One relative commented: the home has had its issues but we feel that improvements have been significant over the last 8 weeks. She has experience in running homes for older people and staff were positive about her management style. One commented: shes a good business person as well as carer, gives us confidence, a good leader. However she is yet to register with us so that we can assess her fitness to run a home for older people. Staff we spoke to reported that their morale was good and they felt supported in their job. There are regular staff meetings where they can air their views which ,they told us, were listened to. However not all staff have received supervision as Care Homes for Older People Page 22 of 27 Evidence: frequently as recommended by the standards. This was something we raised as a shortfall at our last inspection. Surveys are regularly sent to residents asking them for feedback about the meals, activity, the cleanliness of rooms and the quality of the staff. There are also regular residents meetings, minutes from which we viewed. This showed us that residents views were actively and meaningfully sought. We viewed minutes of Aprils meeting where residents talked about the homes food, laundry service, outings and the annoying call bell that constantly rang. There is also a regular newsletter for residents informing them of what is going on in the home.There are a number of audit and quality checks completed monthly by managers to ensure standards are maintained. The homes kitchen has recently been awarded 5 stars following a visit by the local environmental health officer. This is a good result and ensures that residents receive their food that has been stored handled and cooked to the highest standards. 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 9 13(2) The recording and storage of 01/10/2008 medication must improve so that residents receive their medication safely and there is a clear record of what they have taken. 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 9 17 The recording and 22/06/2009 administration of medication must improve to ensure that residents receive their medication safely and there is a clear record of what they have taken. Previous timescale of 1/10/08 not met. We take further enforcement 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 1 18 Information about adult protection procedures should be available around the home so that residents, staff and relatives know who to contact should they wish to report a concern. There should be better orientation aids in the dementia unit to help residents find their way about. Long and similar looking corridors should be made more interesting and a source of stimulation for residents Page 25 of 27 2 3 19 19 Care Homes for Older People 4 36 All staff should receive formal supervision at least 6 times a year so they can discuss their concerns and so that their working practices can be monitored and their training needs identified 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. Re-publishing this information is in breach of the terms of use of that website. 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