Inspection on 29/09/08 for Edge Hill Residential Home

This inspection was carried out on 29th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Edge Hill Residential Home 14/05/09

Edge Hill Residential Home 04/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Edge Hill Residential Home 315 Oldham Road Royton Oldham Lancashire OL2 6AB     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: Fiona Bryan     Date: 2 9 0 9 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 28 Information about the care home Name of care home: Address: Edge Hill Residential Home 315 Oldham Road Royton Oldham Lancashire OL2 6AB 01616248149 F/P01616248149 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Brown Type of registration: Number of places registered: Mr Sunil Odedra,Mrs Shanti Odedra care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The home is registered for a maximum of 36 places to include: *up to 28 service users in the category of OP (Old age not falling within any other category). *up to 5 service users in the category of DE(E) (Dementia over 65 years of age). *up to 3 service users in the category of PD(E) (Physical disability over 65 years of age). The service must employ at all times a suitably qualified and competent manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Edge Hill is a privately owned care home, which is registered to accommodate 36 people. The home is situated on the main Royton to Oldham road and is within easy Care Homes for Older People Page 4 of 28 Over 65 5 28 3 0 0 0 Brief description of the care home reach of shops and public transport services. The building is a detached property with pleasant gardens to the front and car parking space to the rear. Accommodation for service users is provided on the ground and first floors of the building. A passenger lift has been installed between these two floors, and ramped access has been provided externally. There are 30 single bedrooms, 12 of which have en-suite toilet facilities (some of which are shared), and three double bedrooms, all of which have en-suite facilities. Fees for accommodation and care at the home range from #360.00 to #380.00 per week. A service user guide is available on request. Care Homes for Older People Page 5 of 28 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: This key unannounced inspection, which included a site visit, took place on Monday 29th September 2008. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with residents. visitors, the manager and other members of the staff team. The care and services provided to three residents was looked at in detail, looking at their experience of the home from their admission to the present day. Care Homes for Older People Page 6 of 28 A selection of staff and care records was examined, including medication records, training records and staff duty rotas. Before the inspection, we asked for surveys to be sent out to residents and staff asking what they thought about care at the home. Nine residents and seven staff returned their surveys. Comments from these questionnaires are included in the report. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form well and showed that she had a good understanding of what parts of the service could still be developed. What the care home does well: What has improved since the last inspection? Since the last inspection the manager has improved recruitment procedures and the requirement we made at our last inspection had been met. This means that proper checks have been made before new staff started working at the home to make sure they were suitable to work with older people and to protect the residents living there. Improvements had been made in how staff manage medicines and a report from a recent visit by the pharmacist from the PCT showed that staff were following the correct policies and procedures so residents were at less risk of errors being made in the management or administration of their medicines. The owner had invested money into the home and staff said the environment had improved a lot over the past year. A number of rooms had been redecorated and carpets and curtains had been replaced. New flooring was being provided in all the toilet and bathroom areas. Care Homes for Older People Page 8 of 28 Staff also said that they had received more training over the past year and the manager had focused on accessing relevant training to make sure staff had the skills and knowledge to look after the residents well. There had been a safe guarding investigation, which found that some staff had not used good moving and handling techniques. Following this the manager had arranged additional training and showed that she had acted on the findings of the investigation to ensure residents were protected from harm in the future. 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 9 of 28 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 28 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 were assessed before they came into the home to make sure their needs could be met. Evidence: Information about the home in the form of a service user guide was provided in each residents room and was available on request from the manager. 78 of residents that returned surveys said that they had been given enough information about the home before they decided to live there. The care files for three residents were looked at in detail. Pre admission assessments had been undertaken for 2 of them that identified their abilities and care needs. One person had been admitted as an emergency and their care needs had been assessed within the first few days of admission. Care Homes for Older People Page 11 of 28 Evidence: The care that one person required when they were first admitted had been appropriate to the range of services the home provides, but as their physical condition had improved a lot since their admission their placement was no longer really appropriate, as their needs were very diverse from the main population of the home. There was evidence that the manager had tried to address this with the placing authority and a more suitable placement was being found but this was taking some time. Care Homes for Older People Page 12 of 28 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. Residents health and personal care needs were generally well met by staff who knew their preferred routines and abilities. Evidence: In the AQAA the manager confirmed that care plans were in place for all residents that were reviewed monthly. The care files for three residents were looked at in detail. Care plans had been written for each of them that generally identified their care needs, although they were quite basic in detail. Care plans were not always dated and although it was evident they had been reviewed and amended, the dates of changes were not always recorded. This meant staff could not always check to see if changes they had made to the care plans had been beneficial, as it was not clear when they had been implemented. Care Homes for Older People Page 13 of 28 Evidence: Although care plans appeared to have been regularly reviewed it was not clear that associated risk assessments had also been reviewed and there had been some changes to some of the residents, which should have prompted a review of their risk assessments. Staff must also make sure that where risk assessments outline particular actions to monitor residents health that these are undertaken. For example, the GP had requested that one residents blood pressure be checked monthly but this had not been done. Residents looked clean, well cared for and were dressed appropriately. One resident who returned a survey said they would like to be offered help to have more baths. Records showed that residents had seen GPs, opticians, podiatrists and dentists. One person commented, Staff will always arrange and give medical care. It was noted during the inspection, that staff responded calmly and competently when a resident collapsed and required hospital attention. The manager informed the residents family immediately and a carer from the home escorted the resident to hospital, which is good practice. All 9 residents that returned surveys said that they always or usually received the care and support they needed. It was noted that charts kept in a residents room to record what food and drinks they had taken and when other care had been delivered were completed very well. This meant that an accurate record was available for the manager and senior staff to assess if there were any changes to the residents condition. No issues were identified regarding the management of medicines within the home. A pharmacist from the Primary Care Trust (PCT) had visited the home recently to check in detail how staff dealt with medicines at the home. A report of this visit was available and this said that medicines were managed well. Staff were able to describe residents care needs, routines and preferences. Residents said that staff were kind and generally treated them with respect although one residents did say that she sometimes felt staff told her what to do too much. Care Homes for Older People Page 14 of 28 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. A lack of detailed planning means that residents social and recreational expectations may not always be met. Evidence: In the AQAA the manager said that routines in the home were flexible and that residents could have a lie in and get up late if they wished. Residents confirmed this and said they got up and went to bed when they wanted, could entertain visitors when they wanted and go out of the home with them if they wished. It was also reported in the AQAA that a member of staff had been designated to organise and coordinate social activities and stimulation for 4 hours per day on 4 days per week. However many of the residents did not seem to be fully aware that there was an activities organiser and a number said they did get bored and said they would like more to do. One resident said, they dont do anything to keep you going in the afternoons - you just sit here all day. Several residents told us they had been on a trip the week before the inspection, to Blackpool, which they had greatly enjoyed and another trip to Hollingworth Lake had Care Homes for Older People Page 15 of 28 Evidence: taken place. Some residents said they would like to go out more, especially residents that seemed to have enjoyed time spent outdoors when they lived in their own homes. One resident when asked if she spent time in the garden said, I ask permission to go in the garden - sometimes they give it, sometimes they dont. I am used to walking - I didnt have a car. I feel bored - I am not very good at being told what to do. Of residents that returned surveys 66 said there were always or usually activities provided and 33 said activities were sometimes provided. One person had quite diverse needs to the rest of the residents living at the home. Although staff had tried to meet these needs it was acknowledged that they found this difficult and a more suitable placement was being located. However, whilst the resident was still staying at the home, more work should be done to consider how their social care needs can be met. There was no key worker system in operation at the home and the manager should consider developing this. This system means that each member of staff has designated residents that they take a particular interest in and work more closely with to try to make sure that the residents feel they have a named staff member that they can talk to and who can ensure arrangements are made to meet any special requirements. This would enable staff to spend time with individual residents and discuss peoples more diverse needs and plan how to meet them according to peoples individual strengths and abilities. In the service user guide, information was provided about the key worker system, which gave helpful and practical advice to carers about the role and the manager could use this to implement the system. In general residents said they liked the food provided at the home. A choice of 2 options was usually provided at lunchtime and teatime and a cooked breakfast was optional at weekends. The menu rotated over a 4 week period. The main meal of the day was served at lunch and included dishes such as pies, stews, fish, roast dinners and cottage pie, with alternatives of beef burgers, sausages, spam, salad, jacket potatoes and pasta. The tea time menu was lighter and always consisted of sandwiches with hot options such as chip muffins, soup and rolls, cheese or beans on toast, tripe or omelettes. Examination of the menu did show that pies were served frequently and we thought there could be more variety. One of the residents commented that some garnish with the sandwiches at teatime would make them more interesting. The manager said that the menus were about to be reviewed. Care Homes for Older People Page 16 of 28 Evidence: Lunch on the day of the inspection was served at 12.30pm. Residents were offered a choice of minced beef pie, potatoes and vegetables or egg, chips and beans. A sample of the egg and chips proved to be hot and tasty and all the residents that were asked said they enjoyed their meal. Some residents were eating a soft diet, which had been presented quite well. Adapted crockery and cutlery were provided for some residents to maintain their independence. Care Homes for Older People Page 17 of 28 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. Policies and procedures for protecting residents from harm were satisfactory. Evidence: The service user guide contained a copy of the homes complaints procedure. All the residents that returned surveys said they knew how to make a complaint and several spoken to on the day of the inspection said they would speak to the manager or a carer if they had any concerns. The 7 staff that returned surveys all said they were aware of the complaints procedure. The manager kept a record of complaints made and this showed they had been investigated and dealt with properly. Since the last inspection 2 incidents have been reported to the Stockport safe guarding adults team. Evidence from the records about these incidents showed that the manager and staff cooperated with the safe guarding team to determine the causes of these incidents. Care Homes for Older People Page 18 of 28 Evidence: The investigation into the first incident was withdrawn as the preliminary findings indicated there was no neglect on the part of the staff. The second incident found that staff had not used the correct techniques when moving a resident and there were concerns about the attitude of one staff member. Following the outcome of this investigation the manager had taken action to make sure the issues were addressed so such incidents would not happen again. Staff spoken with during the inspection were aware of the procedures to follow to protect residents from abuse and to report suspected abuse. Information was clearly displayed in the staff office, detailing contact numbers for staff to call if they had concerns. Those staff that had undertaken NVQ training had covered safe guarding adults as part of that training. However, none of the staff had attended specific training in this topic run by Oldham MBC. It is recommended that staff attend this training, as it relates specifically to local inter-agency policies and procedures. Care Homes for Older People Page 19 of 28 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. Recent investment has improved the appearance of the home, creating a comfortable and safe environment for the residents living there. Evidence: A partial tour of the home was undertaken. This included lounge and dining areas and a selection of residents bedrooms. There were several lounges where residents could spend time or they could access their rooms whenever they wished. Residents rooms had been personalised, with ornaments, pictures and photographs. Everywhere was clean, tidy and smelled fresh. All of the residents that returned surveys said the home was always fresh and clean and one resident spoken to during the inspection said that a cleaner came into her room every day to help her keep it clean and tidy. Staff said that over the past year they felt one of the main improvements had been in the decor and upkeep of the home. The manager said in the AQAA that the owners had invested money into the home, decorating bedrooms and hallways and providing new carpets and curtains. All the bathrooms, toilets and shower rooms were about to be fitted with new flooring. The kitchen had been painted and retiled. Care Homes for Older People Page 20 of 28 Evidence: Several double glazing units had blown and the manager said these were being replaced. Care Homes for Older People Page 21 of 28 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. Recruitment vetting practices, staffing levels and training were appropriate to meet residents needs and promote their health and safety. Evidence: Staff spoken to during the inspection generally thought that there were enough staff to provide proper care to the residents. Of the 7 staff that returned surveys, 6 said there were usually enough staff on duty and 1 said there always was. 89 of residents returning surveys said that there were always or usually staff available when they were needed (1 person did not answer the question). However, several residents spoken to said they did not feel there were always enough staff on duty and that staff did not often have time to sit and chat with them. At the time of the inspection there were 32 residents living at the home. It was reported that there were normally 4 carers on duty from 8am to 10pm and 3 carers at night. In addition the manager worked full time throughout the week, the activities organiser worked four days a week and there were additional ancillary staff such as the cook and cleaners. All the staff that returned surveys confirmed that the manager had carried out checks Care Homes for Older People Page 22 of 28 Evidence: such as police checks before they started working at the home. Two staff personnel files were examined. Both contained the documents and evidence needed to ensure that the people recruited were suitable to work in a care home. The AQAA said that 66 of the care staff employed at the home had achieved NVQ level 2 or above. The manager also confirmed in the AQAA that all new staff completed induction training that covers the common induction standards as set out by Skills for Care. All staff that returned surveys said their induction had given them all the information they needed to start doing the job. Staff on the day of the inspection said that training was another area that they felt had improved significantly since the last inspection. Staff returning surveys commented training is ongoing in and out of the home and training is relevant to the role. Details about training, provided by the manager showed that staff had received training in a range of topics including dementia care, the Mental Capacity Act, care planning, health and hygiene, risk assessment, First Aid and nutritional screening. Care Homes for Older People Page 23 of 28 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 management of the home promotes the health, safety and well being of the residents. Evidence: The registered manager has achieved the Registered Managers Award and confirmed she had undertaken other training over the past year to ensure that she keeps up to date with changes and practices in social care. Residents and staff said the manager was approachable and supportive. The manager is well supported by the owner of the home who visits very regularly and who came on the day of the inspection to listen to feedback about our findings. Comments about the home and the manager included With this home what you see is what you get and it suits the needs of X whose comment once she had recovered from arriving here was yes, its alright here they dont fuss you, The home is very relaxed and has a good atmosphere and the manager is very approachable. We have regular Care Homes for Older People Page 24 of 28 Evidence: staff meetings and individual appraisals. The manager said that she tended to talk with residents in small groups in each of the lounges rather than holding larger more formal meetings, as she had found that most residents did not show much interest in meetings. However, one resident said they thought residents meetings would be a good idea and the manager said she may try this again to get residents ideas about food they would like on the menu, suggestions for social events etc. The minutes of staff meetings seemed to indicate that staff pay and conditions were the main items discussed. However, staff said they did discuss topics such as routines in the home and ways to deliver care to individual residents etc and were able to put forward their own suggestions. The manager had undertaken some resident and relative satisfaction surveys, but the minutes of the staff meetings did not show that the manager had fed back any comments from these to the staff. This would be good practice and the manager should also record how she has addressed these comments and used feedback to develop the service. The home achieved accreditation for Investors In People in 2005 and a recent review of this in May 2008 has resulted in them maintaining their accreditation. The systems for the safe keeping of residents money were satisfactory. Maintenance records showed that the building and equipment were checked and serviced frequently in accordance with health and safety guidelines. Fire drills had been carried out but the times of the drills were not recorded. Drills should be held at various times of the day to ensure that all staff including night staff have the opportunity to take part. From the information supplied in the AQAA it was evident that the manager had identified the areas of the service that still need improving. All sections of the AQAA were completed and the information gave a good picture of the current situation within the home. Care Homes for Older People Page 25 of 28 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 28 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 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 All care plans and risk assessments should be dated and all appropriate parts of the documentation should be amended when there is a change in the residents condition. This means that staff can then see when changes have occurred, what actions they have taken or implemented and can assess whether these have improved the condition of the resident. Further consultation should take place with the residents to determine the type of social events and activities they would find enjoyable, to improve the level of social and mental stimulation they receive. The key worker role should be developed to enable staff to identify, with individual residents, recreational outlets that are meaningful to them. 2 12 3 18 Staff should attend training in safe guarding adults run by Oldham MBC to ensure they are aware of local policies and procedures. The manager should develop a system to show how she has used feedback from the residents and their representatives to improve the service offered. 4 33 Care Homes for Older People Page 27 of 28 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 © (2008) Commission for Social Care Inspection (CSCI). 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