Inspection on 22/06/09 for Brookside Care Home

This inspection was carried out on 22nd 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brookside Care Home 06/08/08

Brookside Care Home 13/11/07

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brookside Care Home 39-41 Chestnut Grove Borrowash Derby Derbyshire DE72 3JP     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: Janet Morrow     Date: 2 2 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 29 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 29 Information about the care home Name of care home: Address: Brookside Care Home 39-41 Chestnut Grove Borrowash Derby Derbyshire DE72 3JP 01332666522 Telephone number: Fax number: Email address: Provider web address: j_odimay@hotmail.com Name of registered provider(s): Olugbolahan Adesanya,Mrs Josephine Olaide Adesanya care home 11 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Mr and Mrs Adesanya may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories:, Dementia, aged 54 years of age and over - Code DE Mental disorder, excluding Learning Disability or Dementia aged 54 years of age and over - Code MD The maximum number of service users who can be accommodated is: 11 Date of last inspection Brief description of the care home Brookside is situated in a quiet cul-de-sac in a residential suburb on the outskirts of Derby, and is a home that is converted from two semi-detached houses. Residents are Care Homes for Older People Page 4 of 29 Over 65 0 0 11 11 Brief description of the care home on two floors, with lounges and dining areas situated on the ground floor along with one of the bedrooms; all other bedrooms are on the first floor and include two shared rooms. Lift access to the first floor is available. The home is registered as a care home for 11 people with Dementia or mental disorder aged over 54 years and not falling within any other category. This was changed when the current providers, who were registered on 26 June 2007, took over the home and decided to target their activities on a younger age group, the previous registration being for people aged over 65 years. Nursing care is not offered at the home. Information provided by the home in June 2009 stated that fees ranged from £344.64 - £364.32. Copies of inspection reports are available on request from the home and on the Care Quality Commissions website: www.cqc.org.uk Care Homes for Older People Page 5 of 29 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 inspection visit took place over one day for a total of 6.75 hours and concentrated on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last inspection carried out in August 2008. The manager/owner, two staff and five of the nine people currently accommodated in the home were spoken with during the inspection visit. One visiting professional was contacted by telephone after the inspection visit. Eight surveys were returned to the Care Quality Commission; two from staff, one from a relative and five from people living in the home. Case tracking methodology was used which means that the records of one person were looked at in detail and feedback was sought from relevant staff and visitors to find out Care Homes for Older People Page 6 of 29 what impact the service had for the persons well being and quality of life. Care records, staff records and a random sample of policies and maintenance documents were examined. A partial tour of the building was undertaken. Two informal concerns had been raised with the Care Quality Commission (previously the Commission for Social Care Inspection) since the last inspection visit in August 2008 concerning missed appointments and concerns regarding the number of staff on duty and their knowledge of systems and procedures. These were discussed with the manager and are addressed in the relevant sections of this report. Written information in the form of an annual quality assurance assessment was provided by the service prior to the inspection visit and informed the inspection process. 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 Care Homes for Older People Page 8 of 29 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. There was sufficient admission information available to ensure that peoples needs could be met. Evidence: The written information supplied by the service stated that there was a pre-admission assessment document that was completed for all people admitted to the home. One persons care file was examined and this had an assessment in place that gave sufficient information to establish that needs could be met and there was information available from the assessment and care management process. Risk assessments were in place on the file for nutrition, dependency level, falls and pressure sores. Those people living at the home confirmed that their care needs were met. One Care Homes for Older People Page 11 of 29 Evidence: person said they were very satisfied. A visiting professional spoken with confirmed that the home was able to meet needs and said the person they were involved with had improved since being at the home. The relatives survey received responded that the home always met needs and the five surveys from people living in the home responded that they always received the care and support needed. Care Homes for Older People Page 12 of 29 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. Inconsistencies in care planning and medication procedures had the potential to put peoples health at risk. Evidence: One persons care records were examined on this visit. These had a care plan for physical areas of health such as personal hygiene, mobility and eating and drinking that gave sufficient detail for care to be provided and was being updated on a monthly basis. The written information supplied by the service stated that one of the ways the home wanted to improve was by having a full review of the care every six months. However, there was no detail or information on the care plan examined on how to deal with needs associated with dementia, which was relevant for the person concerned. There was a dementia assessment document in the file but this had not been completed. There were daily communication logs on the file. There were records that showed input from a range of other professionals; optician, General practitioner (GP) and chiropodist. Care Homes for Older People Page 13 of 29 Evidence: A visiting professional spoken with confirmed that they thought the person they were involved with was being looked after and that there had been an improvement in their well being since admission to the home. It was observed during the inspection visit that staff and people living at the home enjoyed warm relationships and privacy and dignity was upheld. Three of the five surveys received from people living in the home responded that carers always listened and acted on what they said and two responded that they usually did and all five responded that they always received the medical support required. The relatives survey received responded that the home always gave the support and care expected. Four medication administration record (MAR) charts were examined for accuracy of recording. These showed that staff were signing the charts appropriately and the amount of medicines received was recorded. Photographs were in place on the charts to aid identification. One persons MAR chart was then examined in more detail and was completed accurately, with medicines being administered from the blister pack as signed for. There were no controlled drugs currently in use in the home but there were discrepancies on the controlled drugs register. One medicine, morphine sulphate tablets, was signed as being returned to the pharmacy in February 2009 but was still in the drugs cabinet. The returns book was not being used in sequence so it made it difficult to track other controlled drugs that had been returned to the pharmacy on the same date. There was no verification by signature on the returns record to show that these medicines had been removed from the home. The manager stated that the medicines were still in the home as the pharmacy had not been able to take them on the date indicated in February and there had been no collection of medicines since then. Although medication audits were taking place, this discrepancy had not been identified. The home had a medication policy that included what to do if there was an error in administering medication and how to deal with controlled drugs as well as guidance from the Nursing and Midwifery Council. However, it did not have an up to date copy of the Royal Pharmaceutical Society guidelines or an up to date medicines reference book. Care Homes for Older People Page 14 of 29 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. Meals, activities and contact with the community were well managed, which enhanced peoples quality of life. Evidence: The written information provided by the service stated that exercises, reminiscence, bingo, church services and hand massages were some of the activities provided. The manager also showed examples of new games that had been provided including memory joggers and a musical quiz. There were notices on display that specified an activity for morning and afternoon each day. However, on the day of the inspection visit, there was little activity apart from a ball game and most people sat quietly in the lounge. The care file examined had obtained a life history of the person concerned which gave useful information on the persons interests and activities throughout their life. Observation during the inspection visit showed that routines were flexible and some people opted to remain in their own rooms or were able to go out independently. All five surveys received from people living in the home responded that there were Care Homes for Older People Page 15 of 29 Evidence: always activities arranged. There were no relatives available during the inspection visit but people spoken with confirmed that their visitors could call at any time and the relatives survey received confirmed that that they were able to keep in touch. The home had received information on the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards, although staff had not received any training on this. Discussion with the manager identified that no one currently had an advocate and that the manager was familiar with the implication of the Act and its safeguards. The serving of the lunchtime meal was observed and those people spoken with enjoyed the food. The meal served was well presented and nutritious. The dining tables were laid with cloths and condiments. One person said we get good food , one person described the food as okay and another said the food was not bad. Four of the five surveys received from people living in the home responded that they always liked the meals and one responded that they usually did. Staff spoken with were knowledgeable about individual food likes and dislikes and were able to cater for these, saying they could offer alternatives to the menu if someone did not like what was on offer. Staff had not undertaken any training on nutrition in older people. Food stocks in the kitchen were good and showed that a balanced diet was available and examination of the menus also confirmed this. Care Homes for Older People Page 16 of 29 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. Lack of knowledge about safeguarding procedures and how to make a complaint has the potential to compromise peoples safety. Evidence: The home had a clear complaints procedure that was on display in the entrance to the home. The written information supplied by the service stated that no complaints had been received by either the owner or staff at the home since the last inspection visit in August 2008. However, there had been two informal concerns raised with the Commission, both of a similar nature relating to not keeping pre-arranged appointments, staffing arrangements and lack of staff knowledge. One of the concerns had described the home as haphazard. One concern had been addressed by the manager and a full response had been given to the Commission, the other was discussed as part of this inspection visit. The manager stated that one of the missed appointments had been re-arranged in advance and that the other had been cancelled, although the complainant disputed the latter. The issue regarding staffing arrangements are detailed under the staffing section of this report. There was no formal mechanism in place to record the outcome of complaints or whether the complainant was satisfied with the action taken. The manager stated that staff would use an empty notebook to record any complaints and the action taken. Care Homes for Older People Page 17 of 29 Evidence: However, there was no designated notebook for this purpose at the time of the inspection visit so it was unclear where any complaints would be located. There was mixed feedback on the surveys received from people living in the home in relation to making a complaint. Three of the five surveys responded that they knew who to speak to informally and two did not give a response; two responded that they knew how to make a formal complaint, two responded that they did not know and one did not give a response. The relatives survey also responded that they did not know how to make a complaint but said the home had always responded appropriately if concerns were raised. A safeguarding adults policy and procedure was in place and the home had a copy of the Derby and Derbyshire Local Authority Social Services procedures. The homes training record stated that safeguarding training had occurred in July 2008 and December 2008 and staff interviewed confirmed this. However, there was a lack of clarity from staff on what to do if an allegation was made; one member of staff did not appear to fully understand the question and another stated that they would discuss the issue with the alleged perpetrator before reporting it. This was raised as an issue at the last inspection in August 2008 and although further safeguarding training had occurred, staff did not appear to be fully conversant with the procedures. Care Homes for Older People Page 18 of 29 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 was well maintained that ensured people living there had safe and comfortable accommodation. Evidence: A partial tour of the building was undertaken and two bedrooms were seen, which had been personalised with individual possessions. The building was odour free and was clean, tidy and well maintained. There was an outside garden that was available for use, although some improvements were needed to make it more attractive; for example, there were no flowers and old, broken furniture was visible in the outside building. The written information supplied by the service stated that employing a gardener was how they intended to improve the environment over the next twelve months; however, this had been identified as part of the improvement plans from the last inspection visit in August 2008 and had not yet been addressed. All five surveys from people living in the home responded that the home was always fresh and clean and two commented that cleaning was something the home did well. One staff survey received also commented that the home did cleaning well and the other said all the staff do their best to make sure the home is clean. Care Homes for Older People Page 19 of 29 Evidence: The laundry area was secure and had one washer and one dryer, which were industrial style equipment and suitable for purpose. Peoples feedback about the laundry service was positive and all people in the home wore clean and well-presented clothing. Staff spoken with confirmed that they had undertaken infection control training and there were also certificates on their files that verified this had occurred in December 2008. They were knowledgeable on how to prevent the spread of infection and confirmed that there was always a plentiful supply of protective equipment, such as gloves and aprons. Care Homes for Older People Page 20 of 29 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. There were sufficient well-trained staff to ensure peoples needs were met. Evidence: The staff rota for 22nd June 2009 - 19th July 2009 was examined. This showed that there were two care staff on the shift in the day and one at night. Shifts were long, in excess of twelve hours, and care staff also completed cleaning, cooking and laundry duties. This arrangement was discussed with manager and staff; both indicated that this worked to everyones satisfaction and staff confirmed that there was sufficient time in the day to provide the care required and have social time with people as well. One of the two staff surveys received responded that there were always enough staff to meet individual needs and the other responded that there usually were. Four of the five surveys received from people living in the home responded that there were always staff available when needed and one responded that there usually were. The written information supplied by the service stated that three of five members of staff had a National Vocational Qualification at level 2 and a further two staff were undertaking the training. The home was therefore meeting the target of having 50 of staff having an NVQ2. Mandatory health and safety training had taken place since the last inspection visit in August 2008 and there had also been additional courses directly related to care, such Care Homes for Older People Page 21 of 29 Evidence: as dealing with challenging behaviour in October 2008 and tissue viability in January 2009. However, there were no in depth courses being undertaken on dementia, although this is the homes specialist registration. Both staff surveys received confirmed that staff were provided with relevant training and the relatives survey received responded that staff always had the right skills and experience to look after people properly. Three staff files were examined for recruitment information. This showed that a recruitment process was in place and that most of the information required by the Care Homes Regulations 2001 was in place, although there were some discrepancies, as follows; one person had only one written reference and did not have a full employment history and another did not have a Criminal Record Bureau (CRB) check, although there was a police check from their country of origin. This was discussed with the manager and she stated that the overseas police check had been accepted as the staff member was a new resident in this country. She agreed to apply for a full CRB check for this person. Care Homes for Older People Page 22 of 29 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 was well run in the best interests of people living there. Evidence: The manager was registered with the Commission for Social Care Inspection and had a number of relevant qualifications including the Registered Managers (Adults) Award. She had a good range of previous managerial and mental health experience. Both staff surveys received responded that the manager regularly met with them to discuss their work and to provide support. The written information supplied by the service did not provide any details in the management section. Quality assurance processes were in place that included audits of medication and food hygiene. A questionnaire for visitors had been undertaken in November 2008 and generally positive comments were seen. These included very pleasant and helpful and impressed by the recent improvement in decor. Care Homes for Older People Page 23 of 29 Evidence: The manager stated that she was not acting as appointee for anyones finances. Personal allowance transactions were recorded. Two peoples financial records were examined and corresponded accurately with the cash held. The cash was stored securely. Health and safety issues were generally addressed. A random sample of maintenance records showed that electrical wiring was checked in October 2008, the lift in in April 2009 and portable electrical appliances in March 2009. The written information supplied by the home also confirmed this. Staff training in mandatory health and safety areas had taken place since the previous inspection in August 2008. Training certificates, and staff spoken with, confirmed that courses had been undertaken in food hygiene, moving and handling and infection control. One member of staff also confirmed that they had undertaken first aid training in July 2008 and that fire safety training was due with an external trainer. Care Homes for Older People Page 24 of 29 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 18 13 (6) The manager must ensure that all staff know and understand the correct procedure if they suspect abuse may have occurred. This is to ensure that people living in the home are safeguarded. This is a previous requirement that has not been fully addressed. Timescale extended until 30/09/2009. 30/09/2008 Care Homes for Older People Page 25 of 29 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 7 15 There must always be a care 03/08/2009 plan for specialist needs related to dementia. This is to ensure the home can meet its dementia registration and that individual needs are properly assessed and met. 2 9 13 The responsible individual must review the homes medication procedures regarding controlled medicines and returning medicine to the pharmacy. This is to ensure that medication is dealt with properly and safely according to recommended guidance and to meet legal requirements. 03/08/2009 3 16 22 The home must ensure that 04/09/2009 they have a clear process for recording any complaints and the action taken in response to them. Page 26 of 29 Care Homes for Older People 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 This is to ensure that peoples complaints and concerns are addressed and properly documented. 4 16 22 The home must be proactive in ensuring that people living in the home and their representatives know how to make a complaint. This will ensure that peoples concerns are listened to objectively and dealt with accordingly. 5 29 19 A Criminal Record Bureau 03/08/2009 check, full employment history and two written references must be obtained for all staff. This is to ensure suitable people are recruited to work in the home and to meet the legal requirements of Schedule 2 of the Care Homes Regulations 2001. 03/08/2009 Care Homes for Older People Page 27 of 29 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 2 3 4 9 14 15 19 The home should obtain a copy of an up to date medicines reference book and a copy of the up to date Royal Pharmaceutical Society guidelines on handling medicines in social care. All staff should undertake training on the Mantal Capacity Act and the associated Deprivation of Liberty Safeguards. Staff should undertake training in nutrition to ensure they can provide balanced and appropriate meals. The garden area should be improved to ensure it is a pleasant area for people to sit in and enjoy Care Homes for Older People Page 28 of 29 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 29 of 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!