Inspection on 11/11/08 for Dussindale Park Nursing & Residential Home

This inspection was carried out on 11th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dussindale Park Nursing &... 26/06/07

Dussindale Park Nursing &... 30/06/06

Dussindale Park Nursing &... 07/11/05

Dussindale Park Nursing &... 05/05/05

Dussindale Park Nursing &... 26/10/04

Dussindale Park Nursing &... 29/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dussindale Park Nursing & Residential Home Mary Chapman Close Dussindale Norwich Norfolk NR7 0UD     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: Ruth Hannent     Date: 1 1 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Dussindale Park Nursing & Residential Home Mary Chapman Close Dussindale Norwich Norfolk NR7 0UD 01603701900 Telephone number: Fax number: Email address: Provider web address: dussindale@schealthcare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Care Services Ltd care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Fifty-eight (58) Service Users may be accommodated of either sex who are aged over 65 years. From time-to-time 2 service users between the age of 50 and 65 years may be accommodated. The total number not to exceed fifty-eight (58). Date of last inspection Brief description of the care home Purpose built in 1994, Dussindale Park is situated in a modern residential suburb of Thorpe St Andrew on the outskirts of Norwich. The home can accommodate 58 older people with residential or nursing needs, in single and double rooms; 38 of the rooms have en-suite facilities and some of the ground floor rooms open up to patio areas. The accommodation is on the ground and first floor levels, and can be accessed by passenger lift. The second floor is used for offices and storage. The surrounding lawns and garden areas are well maintained and can be accessed by service users. There is ample parking space at the front and to the rear of the premises. The local GP Care Homes for Older People Page 4 of 27 Over 65 58 0 Brief description of the care home practices and other health professionals support the home. The range of fees charged is 460 pounds - 600 pounds. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out this inspection by using evidence collected from the last inspection which included, an Annual Quality Assurance Assessment (AQAA), surveys received from residents and their families and notifications that have been sent from the home over the past year. A visit to the home on the 11th November over a period of 9 hours took place to look at care plans, medication procedures, records of maintenance, personnel files and staff training. A tour of the building took place and staff, residents, health professionals and families were spoken to. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 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 8 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service Users Guide has recently been updated but as a new Manager is in post this is about to be changed with the new Managers name added. Other information in this document is detailed and gives a thorough picture of the service offered. The potential resident will have their needs assessed and the service offered has the capability to meet those needs. Potential residents know the home will meet their needs if the staffing levels to meet those needs are correct. Evidence: The home has a comprehensive document that is used to assess potential residents before they are admitted to the home that will enable the assessor to make a judgement as to if the persons needs can be met by the home. Three assessments Care Homes for Older People Page 9 of 27 Evidence: were seen in total and residents observed could have there needs met within the registration of the home. Residents and family members spoken to (5 in total) all, at different times said the home could meet the needs of their family member if there was enough staff. The home does not specialise in intermediate care. The area of concern is the numbers of staff to carry out the needs. The skills are within the home but the numbers of staff cannot always meet the full needs that have been assessed. Care Homes for Older People Page 10 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. The residents health and personal care is recorded but more effort is required to ensure their social needs are recorded and met. The health care offered is promoted well and residents do have access to the health services they require. The residents are protected by qualified staff who follow procedures for managing all aspects of medication. Residents are treated with respect and privacy but their dignity is not always upheld creating distress and upset. Evidence: The majority of this visit we spent looking at records held on the first floor. (The home is divided into two areas). In the neat office on the first floor the care plans are held for 27 residents. Three care plans were chosen at random. The information in the care Care Homes for Older People Page 11 of 27 Evidence: plans gave a detailed picture of need for the resident. The paperwork had all been reviewed on a monthly basis with signatures and dates seen. The formats of these care plans all appeared to be health led and do not give enough detail about the social support. Noted were some forms that had not been completed at all to ensure the whole persons wellbeing is part of the person centred care the home should provide. On the day of this visit two staff from the Primary Care Trust (one Occupational Therapist and one Physiotherapist) were working within the home, as 11 beds are block purchased by the PCT. On talking with the two about the service, both reported that the home work well with their health colleagues and that communication was good. Noted in the diary were records of follow up visits for various residents such as the dietician required and a CPN visit to be planned. The medication on the top floor is locked in a designated trolley within a locked cupboard. The trolley, on inspecting was in a very neat order. The majority of medication is administered from blister packs but any loose medication was clearly labelled with the residents name and any liquids that had been opened such as eye drops were marked with the date opened. The temperature of the store cupboard is recorded daily with the chart seen for the month of November. The thermometer read 18 degrees and the chart had been written accurately. The medication administration records were completed correctly with no gaps on any of the days for this month. Each resident had a photograph at the front of their own record sheet and there was a copy of all the staffs signatures of who is trained to administer medication. It was noted that due to limited staffing in the downstairs areas that medication was being administered late and the task was still in progress at 10.30. (The medication is usually administered at 8 - 8.30 according to the nurse on duty the day of this visit). The staff were observed throughout the day as being kind and courteous to residents. All personal care was offered in the persons own room and conversations overheard were respectful. One family member told us that her relative had received a letter which the home had opened. Three other family members and nine comments received prior to the inspection talked of staff being too busy to help when assistance to the toilet was required. This makes the families and residents feel dignity is lost and continence is not promoted as often accidents have occurred while awaiting staff. Care Homes for Older People Page 12 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities to suit each person is not recorded and recreational needs are not all met to ensure wellbeing for each resident is in place. Visitors and contacts are welcomed in the home. Choice is limited more for the fact that the staff are not available to help with that choice. Meals are good and wholesome offering a well balanced diet. Evidence: The residents do have a designated activies staff member who plans group activities. The residents appreciate this person and some do take part but noted on the surveys returned by residents and families were comments such as. I cannot take part as no one can bring me back when I am tired. I am blind so there is no point. I am stone deaf so I cannot take part. One relative on the day told us of the film event set up but that hardly anyone could attend as staff did not have the time to bring people to the lounge as they were busy with care tasks. Special event days go well with a recent Care Homes for Older People Page 13 of 27 Evidence: Halloween party held. Noted in the office window was a trip that had taken place to Wroxham in the summer. Walking around we noticed many people in bed, with little or nothing to occupy or stimulate them and were asleep. With nothing recorded of what and how to occupy each individual, and with limited staff around it appeared that people in their rooms were left very much on their own between care tasks. Many visitors come and go as this was noted both in the visitors signing in register and on the actual day of this visit. There are places people can sit if they wish to go to a quiet area and drinks are on offer for anyone. Families spoken to commented on a good core of staff who are very welcoming. A meal was taken at lunchtime with the residents. The choice was pork casserole or vegetable pastie. The meal was cooked well with a variety of vegetables and gravy. The sweet was jam roly poly and custard or artic roll. The meal was dished up from a trolley by the cook and served by the staff. Residents in their room who needed assistance with eating were helped by staff who swapped the white disposable apron for a blue disposable apron which appears a little institutionalised. The food was placed all on the plate with no choice of quantity. Comments received by the residents stated that the meal is sometimes cold if we need help from staff to eat it but otherwise it is really good. The cook went to every resident after the meal and asked what people would like for tea. This was a pleasant experience for the residents as the conversations were jolly and everyone was smiling. Drinks were available at regular intervals throughout the day and jugs of different flavoured juices were in each lounge. Unfortunately many of the cups were plastic and stained and were not suitable for use and need to be removed and more suitable cups/glasses used. Care Homes for Older People Page 14 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. The home has a complaints procedure but relatives and residents are not reassurred that their complaints will be acted upon. Procedures are in place to protect residents from abuse. Evidence: The home has on display and also in the Service Users Guide the procedure on how to complain. The comments received from relatives and three family members spoken to on the day of the inspection said at different times they had complained to various management staff both verbally and in writing. Some of them felt that their complaints had not been resolved and that as the theme to all their complaints was around the inadequate numbers of staff on duty nothing would be done. Evidence of the reason for them to complain was noted with residents not being assisted with their needs in a timely manner. Some staff at the home (38 ) have received training on the protection of vulnerable adults with a further update to be booked shortly. This was discussed in full with the new Manager and the companies Operations Manager. On talking to two staff they understood how and what whistleblowing was and that they would report on any concerns that could potentially be abuse. Care Homes for Older People Page 15 of 27 Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do live in a safe, well maintained environment. The bathroom facilities do need improving to make them more user friendly. Individual resident rooms are comfortable and they have their possessions around them The home is clean in areas used by residents but sluices and cleaning cupboards are not Evidence: The home is split on two floors accommodating 47 residents on the day of this inspection. We checked all areas that were for communal use and visited 8 residents in various bedrooms to see their own rooms. The home is purpose built and is limited in character with long corridors and bedrooms very similar in shape and size. The decor is in reasonable condition and on the day of this visit one lounge was being painted. Some of the carpets are worn and some stains were noted but no odours were detected. The bathrooms are institutionalised in appearance and are used as a store . One had Care Homes for Older People Page 17 of 27 Evidence: various plastic chairs and equipment that should not be there. The walls are bare and there is no feeling of warmth or of it being an inviting environment. A bath list was on a chart on the wall which made it available for all to see. Who has baths and when, showing a lack of privacy. On many walls were laminated sign in bold print, giving staff instuctions on what the water temperature should be or instuctions about pads etc, which again gave the room an institutionalised look. The individual bedrooms were personalised with many family photographs, cosy bed throws and ornaments. Some residents spend all the time in their beds and need lots around them to look at, touch and smell which was not always evident. Some rooms belonging to people who have little or no contact with families were limited in personal items. The home now has a regular Maintenance Officer who has started to record all the areas of maintenance that are required. Seen were the fire records, emergency lighting records, water temperatures and boiler service record. The home had no detected unpleasant odours and the residents areas are clean. The sluice rooms and cleaners cupboard were in an untidy state and a number of urine bottles were badly stained. One sluice room was noted to have a hand wash sink but no soap. The (Chemicals Hazardous to Health) COSHH data safety sheets were available in the nurses office and a briefing sheet was on the wall in the cleaners cupboard. On talking to the cleaning staff they have not had COSHH training to date. Care Homes for Older People Page 18 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. The staff complement is inadequate to meet the needs of the residents. Residents are cared for by staff who are qualified to carry out the tasks required. The home needs to improve the recruitment procedures to ensure all records of staff are on their files ensuring residents are protected. The staff training process could be improved to ensure all staff have the correct and current training to carry out their jobs. Evidence: The staff on duty on the day of this inspection visit were 8 carers and 2 nurses. The home has no deputy manager at present and the manager appointed had only commenced her position at the beginning of the week. The families and friends of residents have said on 11 surveys returned to the Commission that there is a lack of staff on duty. On the day of this visit 4 family members asked to speak to the Inspector to share their concerns on the lack of staff that prevented the residents from having their care needs met at suitable times. Comments such as people are still being helped to get dressed at 11.30 as many now need 2 staff for most tasks and there is not enough of them and Our family member used to be continent and is now Care Homes for Older People Page 19 of 27 Evidence: incontinent due to having to wait too long for assistance.The comments also reflected on the quality of the staff at the home. They are great staff. It is just they need more. The general comments from residents, as the day progressed, were saying the staff are all very good. Observing throughout the day it was evident that staff were carrying out their duties but in a hurried manner. The home does suppport the staff with obtaining the NVQ levels in care. At present there are 46 of the staff who have acheived an NVQ 2 or above with 6 more staff in the process of completing theirs. On talking to 2 staff it was evident the support has been available for them to acheive the qualification. The recruitment process has some cause for concern as during the inspection of some personnal files three staff were found to be without the required Criminal Records Bureau clearance. The names of these staff members were also checked with the companies head office and no records could be found. The staff members could not continue to work within the home until this is rectified and action to carry this out was taken immediately by the management. Other staff records looked at were found to be correct with CRB and POVA clearance, 2 references, application, forms of identification and a contract all in place. Some training certificates are held on the staff members file and the home does have a training matrix which was seen during the inspection. Some training dates are overdue and some staff have not completed all relevant courses expected as part of the induction process. The matrix shows no training has been undertaken in pressure care and as quite a number of residents are cared for in bed this does need to be planned. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager is experienced and qualified to run this home. The home needs to have a current system in place to measure the quality of the service. The home has safe working practises but some training needs updating. Evidence: The new manager had only been in post for 2 days on the day of this site visit. A manager from another Southern Cross home was also in situ as part of the management induction and was assisting the new manager in her understanding of the companies procedures. On talking and gathering evidence it was clear that this new person was both competent and qualified. Her previous post of Manager had been held for a number of years in another residential establishment and she has achieved the Certificate in Management. Considering this was only her second day she had already Care Homes for Older People Page 21 of 27 Evidence: a lot of knowledge about the home and shared some ideas already thought of to hopefully improve the service. The home has not had a thorough quality monitoring process recently and with a new manager in post this will need to be planned fairly imminently due to concerns already raised. On talking with 4 residents families it was evident that they feel they are not really listen to especially around staffing levels. The home has no administrator and with the manager being new in post some of the management standards were difficult to evidence. The procedures for handling residents finances was discussed and it appears that the procedures are the same safe methods used in other Southern Cross homes and although, on this visit records were not seen, the procedures are in the administrators office to be followed (seen). The safe working practices within the home appear, through observation, to be working well. Residents were helped correctly by correct moving and handling procedures. Risk assessments were noted for moving and handling and fire risk assessments for different residents filed in their care plans and reviewed on the 28/03/08, 05/05/08 and 01/08/08. Servicing of equipment such as hoist and fire extinguishers were noted to have a date sticker that are within the correct timescale.(27/03/08). Safety procedures are posted in various areas or held in files easily located by staff. The COSHH safety data sheets and fire evacuation procedures are held in the nurses offices on each floor. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 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 18 The Home must ensure that 01/01/2009 medication can be administered at times stated on the MAR charts. To promote the health and welfare of all residents. 2 12 16 The home must consult with and arrange suitable activities/stimulus for residents. To ensure the well being of the resident is considered. 01/01/2009 3 16 22 The home must ensure that complaints are thoroughly investigated and the outcome reported to the person making the complaint and that the person is satisfied with the outcome.. Residents and families must feel their complaints are acted upon for the wellbeing of the residents. 01/01/2009 Care Homes for Older People Page 24 of 27 4 21 23 The home needs to improve the bathroom facilities To make them homely and inviting 01/02/2009 5 26 23 The home must be kept clean in all areas. To ensure residents are protected by good infection control procedures. 01/01/2009 6 27 18 The home must ensure enough skilled staff are on duty at all times To ensure residents are offered the care needs required correctly and timely. 01/01/2009 7 27 18 The Manager must ensure enough staff are on duty that allow residents assistance when required. To ensure all residents are helped in a timely manner 01/02/2009 8 29 19 The home must ensure that staff employed have a current CRB clearance in their personnel files. The residents must be cared for by staff who have been through the recruitment process 01/12/2008 9 29 19 Thwe home must ensure that all staff hold a current CRB clearance To ensure the residents are supported and protected by the recruitment procedures. 01/12/2008 Care Homes for Older People Page 25 of 27 10 30 18 The home must ensure that staff are up to date with training To ensure residents are cared for by trained competent staff. 01/02/2009 11 33 24 The home must ensure that a procedure for assessing the quality of the service is in place. To ensure the aims and objectives of the service meet the expectations of the residents. 01/02/2009 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 15 15 15 Plastic, stained cups should be replaced to offer drinks in a suitable cup/mug/glass. Plastic disposable apron at mealtimes should be replaced by more user friendly ones. Allowing what and how much at mealtimes, should be considered by the home enabling people further choice. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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!