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Inspection on 24/03/09 for Cherry Tree Lodge

Also see our care home review for Cherry Tree Lodge for more information

This inspection was carried out on 24th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The home has warm and friendly atmosphere. There are good quality care plans in place that are easy for staff to follow. The people living at the home have good relationships with staff and they are relaxed with them. There is a stable staff group and staff know the people who live at the home well. People living in the home are supported to maintain their independence and enduring interests, which enhances their quality of life. People have good access to local General Practitioners and specialist healthcare when required. Visitors are made welcome and people are encouraged to maintain contact with family and friends.

What has improved since the last inspection?

Care plans are now reviewed every month. This means that that staff are up to date with people`s needs. Medication practices at the home have improved and are now safe. There is now an active NVQ programme and over 50% of staff have completed are undertaking the NVQ qualification. A full employment and life history is sought from staff and any gaps in their employment are explained in writing.

What the care home could do better:

Two written references need to be obtained before staff start work at the home. This is to make sure that staff are suitable to work with vulnerable people. The following good practice recommendations have been made: The staff that administer eye drops should sign for them. This is so there is an accurate record of administration. A referral should be made to a community psychiatric nurse for support and guidance on how to best support one person. This is so staff know how to safely care for and support the individual. People at the home should be consulted on the current arrangement for flexible menu and meal planning. The results of the consultation should inform whether any changes to the current arrangements need to be made.A menu board should be displayed in the home. This so that people know what is for lunch and tea. Records of any of the quality monitoring systems in place should be kept. This is to demonstrate that people are consulted and involved in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cherry Tree Lodge 100 Wick Lane Southbourne Bournemouth Dorset BH6 4LB     The quality rating for this care home is:   two star good 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: Jo Johnson     Date: 2 4 0 3 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: Cherry Tree Lodge 100 Wick Lane Southbourne Bournemouth Dorset BH6 4LB 01202429326 Telephone number: Fax number: Email address: Provider web address: sj.watts@virgin.net www.abbey-rose.co.uk Name of registered provider(s): Mr John William Watts,Mrs Audrey Martha Watts,Mr Simon John Watts care home 20 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 20 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Cherry Tree Lodge is registered as a care home, providing accommodation for up to twenty older persons. The home is situated in a quiet residential area of Wick, approximately 10 minutes walk from the shops and facilities of Tuckton. The home is Care Homes for Older People Page 4 of 29 Over 65 20 0 Brief description of the care home registered in the name of Mr and Mrs Watts and their son, Mr S Watts. Mr S Watts is in day-to-day charge of the home. Accommodation at Cherry Tree Lodge is arranged over two floors. On the ground floor there are nine single bedrooms all with en-suite WC and wash hand basins. There is also a communal bathroom with WC and two further communal lavatories. On the first floor there is one double and nine single bedrooms all with en-suite WC and wash hand basin. Two also have baths in the en-suite facilities. All bedrooms have been personalised by their occupants and reflect individual taste. The communal space on the ground floor comprises a lounge with adjoining dining room. Both rooms are attractively furnished and have a welcoming, relaxed atmosphere. A stair lift is available to assist residents between floors, leaving just one step to negotiate to access the first floor. There are also some other single steps around the home. The home has level, well-maintained gardens surrounding it and limited off road parking. There is also ample parking on the roads surrounding the home. The home has a number of pets including a cat, dogs and a parrot. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. Care Homes for Older People Page 6 of 29 This key inspection was brought forward following the Annual Service Review and changes in management arrangements at the home. This inspection visit was unannounced (we did not let the home know that we were coming) and took place on 24th March between 9.40 am and 3.00 pm. The manager was present throughout the inspection. The inspection involved: An expert by experience talking with individuals and observing people who live at the home. The phrase experts by experience is used to describe people whose knowledge about social care services comes directly from using social care services. observations of and talking with people who live at the home, relatives, the staff on duty and the management team. Four people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. This inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. What the care home does well: What has improved since the last inspection? What they could do better: Two written references need to be obtained before staff start work at the home. This is to make sure that staff are suitable to work with vulnerable people. The following good practice recommendations have been made: The staff that administer eye drops should sign for them. This is so there is an accurate record of administration. A referral should be made to a community psychiatric nurse for support and guidance on how to best support one person. This is so staff know how to safely care for and support the individual. People at the home should be consulted on the current arrangement for flexible menu and meal planning. The results of the consultation should inform whether any changes to the current arrangements need to be made. Care Homes for Older People Page 8 of 29 A menu board should be displayed in the home. This so that people know what is for lunch and tea. Records of any of the quality monitoring systems in place should be kept. This is to demonstrate that people are consulted and involved in the home. 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 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. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: The manager told us that people and or their families come and visit the home before making a decision about moving in. One person who had recently moved into the home told us that they had come to look around before moving in. Four surveys from people told us that they had enough information before moving into the home. The manager undertakes a pre admission assessment before determining whether they can meet someones needs. A fuller assessment, risk assessments and a social history assessment are completed with people as soon as they move in. From this a care plan is developed. Care Homes for Older People Page 11 of 29 Evidence: The assessments for the last two people to move into the home were seen. Information was sought from care management assessments, and where appropriate other health professionals. People spoken with, surveys and records seen told us that they had enough information about the home and have a contract. 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 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. The principles of respect, dignity and privacy are put into practice. Medication practices are safe and people have their medication as prescribed. Evidence: We looked at three peoples care records and care plans. Each person had a care plan, daily records and monitoring records. Care plans were based on information gained during the initial care needs assessment and were being developed as staff got to know the individuals. Risk assessments were completed for falls, tissue viability, mobility, and nutrition. People were weighed on admission to the home and this was recorded in their plans. There was additional information available on medical conditions. The care plans seen were of a good quality and were easy to follow. For example: Care Homes for Older People Page 13 of 29 Evidence: there was a clear continence management plan for one person. This had been successful as before they moved into the home they were incontinent. Care plans had been reviewed on a monthly basis and as and when peoples needs have changed. Daily records are written for each person and reflected how they have spent their time and the care and support they have received. One person has presented some challenges to staff due to their mental health needs. It is recommended that a referral be made to a community psychiatric nurse for support and guidance on how to best manage these challenges. The manager took immediate action and telephoned the GP to make a referral. People living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. Garments were clean and well maintained. People spoken with said that staff take care to make sure they are well dressed and their appearance is cared for. Staff observed had good relationships with the people living at the home and were patient and encouraging. Staff respected peoples privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. Discussion with the manager, staff, and observation of care plans and daily records tell us that people living in the home have access to health professionals such as GP, dietician, dentist and specialist consultants and chiropodist. The medication records for four people were looked at. The medication records were completed correctly and medications were stored safely. The home has recently had a pharmacy visit and the manager is following the recommendations from the pharmacist. The manager or assistant manager administer medication apart from one persons eye drops that care staff administer. At the moment the manager is signing for these although care staff are administering them. Care Homes for Older People Page 14 of 29 Evidence: The controlled drugs record book and stock were seen and were correct The three surveys from health professionals told us that the home always seeks advice and ensures that peoples health care needs are met. The surveys included the comments: Attentive and Empathetic and I would rate this as a well above average rest home and I have no complaints about the standard of care. Care Homes for Older People Page 15 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. People living in the home are supported to maintain their independence, contact with important others and lifestyle, which enhances their quality of life. Evidence: People spoken with said that their visitors were made to feel welcome whenever they visited. The home supports people in their spiritual needs by the involvement of ministers of varying denominations. There is not a structured weekly or monthly activity programme in place. Cherry Tree Lodge provides occasional organised activities such as concerts from visiting musicians, exercise classes and various games such as bingo. The care staff also organise a few activities. One person told us There are exercises once a week. Another said, There is plenty of entertainment, singers, exercises, bingo which Im not keen on. Surveys from people told us that there are always or usually activities arranged by the home that they can take part in. Care Homes for Older People Page 16 of 29 Evidence: People chose where to spend their time during the inspection. One person who chooses to spend time in their room told us Im not interested in social activities, as I have my computer for scrabble, dominoes and bridge here in my room. The radio was turned on for a brief time by a one person whilst waiting for their lunch to be served. A mobile library and hairdresser visit the Home. Following discussion with one person who is partially sighted the manager arranged for the local library to bring some talking books. There is a positive focus on promoting peoples independence at the home. one person told us , I was on a zimmer-frame when I came here but Ive got well since Ive been here. Ive been looked after and Im not worrying about things. We observed people during lunch, the atmosphere was relaxed and there were enough staff to serve the meal at a suitable pace. All meals were served hot and any support needed from staff was given discretely and sensitively. There is a four weekly menu for main meals but from discussion with the manager there is flexibility around the menus. There is not a specific choice of meal each day but people and surveys told us that they are satisfied with theses arrangements. comments from surveys and people included They dont like you asking about meals, theyre so busy, The meals are wonderful, they do try and help me with (dietary requirements) and The food is good,we have a roast twice a week. From discussion with the manager at the home fresh fruit is incorporated into the menus as people did not eat the fruit when it was in bowls. It is recommended that the people at the home be consulted on the current arrangement for flexible menu and meal planning. The results of the consultation should inform whether any changes to the current arrangements need to be made. It is recommended that a menu board be displayed so that people know what is for lunch and tea. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures make sure that peoples, relatives and representatives concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. Evidence: The complaints policy is in the service users guide and displayed in the home. From discussion with the manager and information provided in the AQAA, there have been no complaints in the last twelve months. There have been no complaints made to the commission in the last twelve months. People spoken with and surveys told us that they all knew whom they would talk to if they were unhappy or needed to complain. One person said, if Im not happy I talk to the manager. Staff spoken with and surveys told us that they know what to do if a person at the home or relative or friend has concerns about the home. Staff have attended training in the Protection of Vulnerable Adults (POVA) and completed a work book so that they are aware of the different ways vulnerable people Care Homes for Older People Page 18 of 29 Evidence: are at risk of abuse, and would know how to respond. There have been no adult protection safeguarding referrals in the last twelve months. Care Homes for Older People Page 19 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 is maintained and furnished so that people live in a homely and comfortable environment. Evidence: A tour of the premises confirmed that Cherry Tree Lodge is very well maintained. It is light and airy throughout and is furnished and decorated to a good standard. The atmosphere is homely, calm and relaxed. There is an ongoing programme of refurbishment. There are communal toilets, bathrooms and assisted baths are available. A number of bedrooms also have their own en-suite facilities. All rooms are centrally heated and have natural light and opening windows. Bedrooms are comfortably furnished and personalised to varying degrees. One person said, Youre allowed to bring what you want. another person had had their chair raised on blocks with a foot-rest in front of them with a helping-hand gadget close at hand. There were a number of comments from people at the home who raised that the temperature can be very variable. We discussed this with the manager who advised us that not all of the radiators have thermostatic controls and that there had been a Care Homes for Older People Page 20 of 29 Evidence: recent problem with the heating. They try and keep the temperature comfortable for most people at the home and will make alternative arrangements for people who need additional heating or ventilation where possible. The laundry in the home is small, but sufficient to meet the needs of the people and the size of the home. The laundry room was seen to be organised and clean. Systems are in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub are available and used by staff when handling soiled linen and when supporting people with personal care. The surveys from people living at the home show that the home is fresh and clean. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are in the main protected by suitable recruitment practices and supported by a competent and managed staff team. Evidence: Clear staffing rosters are in place that show who is on duty, when and what jobs they do. There are usually three care assistants on duty in the mornings from 9am to 3pm and two in the afternoon from 3pm to 8.30pm. In addition to this there are domestic staff and a cook. The manager and assistant manager work in addition to the care staff. Both have a hands on approach to their work and are readily available to assist when needed. Two care staff are on duty at night. During the inspection, there were enough staff to meets the needs of the people living at the home. People spoken with and surveys told us that staff are always or usually available when they need them. Two staff files were seen including the most recently recruited staff. Files included evidence of CRB (Criminal Records Bureau) checks and POVA (Protection of Vulnerable Adults) checks for those staff that had started work at the home. One staff was awaiting for references to be returned and was currently being employed via an Care Homes for Older People Page 22 of 29 Evidence: employment agency. The other staff file only had verbal references instead of written references. Two written references must be obtained before staff start work at the home. This is to make sure that staff are suitable to work with vulnerable people. References should be sought from staffs last care sector employment and be from the the manager. This is to make sure that references are relevant and from a suitable person who can comment on their suitability. There is a staff induction in place that is based on skills for care standards. Staff spoken with and surveys told us that the induction and staff training covered everything they needed to know. From discussions with the manager, the training programme, discussions with staff and surveys there is a training programme in place that focuses on mandatory training and the specific needs of the people living at the home. Care Homes for Older People Page 23 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. People benefit from living in a home that is managed by experienced providers, peoples views are informally sought about the service provision, and they are listened to. Evidence: People living at the home told us that they felt confident about being cared for by a management team that they have known for a long time and liked the consistency. There were clear lines of accountability in the home; the management team comprises the owners, manager, and assistant manager. The manager has nearly completed the Registered Managers award. The manager completed the AQAA (Annual Quality Assurance Assessment) poorly and did not return it when we first asked for it. We bought forward the key inspection following discussion with the manager who identified that there had been some Care Homes for Older People Page 24 of 29 Evidence: changes at the home following the departure of the previous assistant manager. He now acknowledges and understands the importance of the AQAA and recording the informal monitoring and quality assurance systems that are in place at the home. During the visit staff appeared confident in their roles, the home was relaxed and people appeared at ease and comfortable. Staff spoken with commented positively about the management team, their job role and the people living at the home. The manager told us that they do not manage or keep any monies for people living at the home. Information provided before the inspection, by the manager in the AQAA (Annual Quality Assurance Assessment) shows that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. Staff training in mandatory areas, including fire safety, health and safety, moving and handling, emergency aid, and basic food hygiene, is ongoing. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 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 29 19 Two written references must 01/06/2009 be obtained before staff start work at the home. This is to make sure that staff are suitable to work with vulnerable people. 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 7 It is recommended that a referral be made to a community psychiatric nurse for support and guidance on how to best support one person. This is so staff know how to safely care for the individual. The staff that administer eye drops should sign for them. This is so there is an accurate record of administration. It is recommended that the people at the home be consulted on the current arrangement for flexible menu and meal planning. The results of the consultation should inform whether any changes to the current arrangements need to be made. It is recommended that a menu board be displayed in the home. This so that people know what is for lunch and tea. 2 3 9 15 4 15 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 5 29 References should be sought from staffs last care sector employment and be from the the manager. This is to make sure that references are relevant and from a suitable person who can comment on their suitability. Records of any of the quality monitoring systems in place should be kept. This is to demonstrate that people are consulted and involved in the home. 6 33 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. 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