Inspection on 11/12/08 for Ellerslie

This inspection was carried out on 11th December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ellerslie 29/09/09

Ellerslie 16/06/08

Ellerslie 19/06/07

Ellerslie 14/07/06

Ellerslie 21/11/05

Ellerslie 24/06/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ellerslie 108 Albert Road Pittville Cheltenham Glos GL52 3JB     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: Sharon Hayward-Wright     Date: 1 1 1 2 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. 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 28 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 28 Information about the care home Name of care home: Address: Ellerslie 108 Albert Road Pittville Cheltenham Glos GL52 3JB 01242514384 01242255804 manager.ellerslie@osjctglos.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Orders of St John Care Trust Name of registered manager (if applicable) Mrs Susan Rose Alakija 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: Date of last inspection Brief description of the care home Ellerslie is a large three-storey building, which has been converted and extended to provide accommodation for up to 31 people who require nursing and personal care. It is situated close to Cheltenham town centre, a short walk from Pittville Pump Rooms and the racecourse. The Care Home is equipped with shaft lifts to assist those unable to manage the stairs. In addition, a variety of aids and adaptations have been provided throughout the property to help people who use the service. With the exception of two spacious double rooms, all the bedrooms are for single occupation. Only two rooms have en suite facilities but assisted bathrooms and toilets have been installed throughout the property. The communal facilities consist of three well-appointed lounges and a dining room. A Day Centre has been developed within the property; this is in use 4 days a week but may also be used by people at weekends. The private gardens are easily accessible and may be enjoyed by people in warm weather; they Care Homes for Older People Page 4 of 28 0 Over 65 31 care home 31 Brief description of the care home are well protected from the busy main road by tall mature trees. Adequate parking is provided for staff and visitors. The provider supplies information about the home, including the most recent CSCI report in a file at the entrance of Ellerslie. Current fees range from 545 pounds to 763 pounds per week. Information about the Funded Nursing Care contribution (FNC) is provided by the home. Hairdressing, chiropody and any personal items are charged extra. 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: 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: Two Inspectors carried out this inspection over two days in December 2008. One inspector was a Pharmacist who works for us (The Commission) and he looked at the medication systems used by the home. At this inspection we did not asked the home to complete an Annual Quality Assurance Assessment (AQAA) as we received one prior to the previous inspection that took place within the last year. We looked at a number of systems the home has in place to include, care records, medication, staff recruitment, staff supervision and activities. Care Homes for Older People Page 6 of 28 Where possible, people living at the home were spoken with to ascertain their views on the care and services provided and any visitors to the home. Staff were observed interacting with people who use the service. The comments received from speaking to people during the inspection have been used in the report. The Registered Manager has retired since the last inspection and a new manager appointed. A Representative from the company was available during the inspection as were other members of the homes team and staff spoken with throughout the inspection were helpful and co-operative. 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 Care Homes for Older People Page 8 of 28 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. The home has systems in place that include a full assessment of prospective peoples needs prior to admission to make sure the home can meet these. Evidence: A pre admission assessment of a recently admitted person was examined. It was completed whilst the person was in hospital by the new home manager. The assessment was very detailed and contained information about this persons care needs and family involvement. The deputy manager said this persons family visited the home prior to their relative moving in. A copy of the letter the home sends to people confirming their needs can be met was seen at the last inspection. Ellerslie does not provide intermediate care. Care Homes for Older People Page 11 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 adequate 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 people receive is based on their individual needs, however care records are not always reflecting this. The principles of respect, dignity and privacy are put into practice. There are some safe arrangements in place for the management of medicines although we found some weaknesses that need addressing in order to help reduce risks with medication for people living in this home. Evidence: At the last inspection a number of issues were identified with care plans and these included people not having care plans in place for all assessed needs and one person that did not have any care plans in place. Following this inspection the company that owns and manges this home have brought in an outside adviser to help the staff in the home to review and update care records. One persons care plans were examined as they were recently admitted to the home, on the whole they were individual to this person and had evidence of this persons family being involved. However there were some areas that still need improvement and these were discussed at the inspection. Care Homes for Older People Page 12 of 28 Evidence: The deputy manager said that qualified staff have received training in care planning and that they feel confident now in devising and updating peoples care records. Risk assessments were in place for this person and these included moving and handling, pressure areas, nutrition and falls. These were not in place at the last inspection for all care records examined. Again the adviser will be assisting the qualified staff in devising and reviewing these risk assessments for all people who use the service. At the last inspection concerns were identified with the lack of wound care documentation, at this inspection an improvement was found in the recording of wound care but the records were not always in one place. The deputy manager said that this will be addressed as part of the care plan updating and reviewing. At the last inspection the home had seat covers on all chairs in the communal areas to protect them in case a person was incontinent. We raised concerns about peoples dignity when they are being used on all chairs in communal areas. However at this inspection no seat covers were found in the communal areas which is an improvement. Pharmacist inspectors report about arrangements for the handling of medicines that were inspected on 11 December 2008. As part of this key inspection (but on a separate day), one of our (The Commission for Social Care Inspection) pharmacist inspectors looked at some of the arrangements for the management of medicines. This included looking at some stocks and storage arrangements for medicines and various records about medication. We saw how staff administered some medicines to people living in the home. The pharmacist spoke to the deputy manager and two nurses and visited two bedrooms. We gave full feedback after the inspection to the deputy manager. At the time of the inspection no person living in this home was assessed as able to self medicate and look after their medicines. The medicine policy indicated this could happen if a risk assessment showed this would be safe for everyone in the home. People living in the home were therefore totally dependent on the staff for this part of their care. Trained nurses administered most medication (except for certain non medicated skin products that carers applied). The nurses had received additional training about the safe handling of medicines. During the inspection we saw a nurse administer some medication for some people using a safe system. The home have made changes to the times for the administration of some medicines to help make sure that doses are spread throughout the day and with a suitable interval between doses. This helps to make sure that the medicines are effective throughout the day and that any risk of harm by receiving doses too close together is reduced. There were arrangements for keeping records about medication received, administered and leaving the home or disposed of (as no longer needed) for each person in the Care Homes for Older People Page 13 of 28 Evidence: home. Complete and accurate records about medication are very important in a care home where there are a number of different staff involved with medication. This is so that people are not at risk from mistakes, such as receiving their medicines incorrectly, and there is a full account of the medicines the home is responsible for on behalf of the people living here. Most of the sample of medicine records we looked at appeared to be in order so that there were clear records about the medicines people living in the home need and had taken. The exception was that some of the records about creams and ointments care staff had applied were made inconsistently so that we could not always tell if and how the prescribed treatments were used. We discussed consideration of alternative ways for recording these treatments so that there is a clear and consistent system that provides complete and accurate records for this. Also the directions for some medicines such as eye drops or creams were not always specific. Examples we saw were as to which eye the treatment was to be applied or where, why or how often a cream or ointment was to be applied. Sample checks showed that the medicines needed were all available. The deputy manager had found that the day before the inspection one nurse had not signed for all the medicines administered so had been contacted about this. Missed recording like this can place people at risk and may indicate some lack of competence by the staff. A number of medicines were prescribed to use as required. Since the last inspection we found there was additional written information recorded for some medicines that provided further guidance to all staff responsible for administering medication to help understand what the direction as required meant for this person and medicine. This should help make sure these people receive their medicines in a consistent way and to meet identified needs. We pointed out a number of other medicines where this information was needed so that there would be clearer guidance for staff. This included examples such as laxatives, sleeping tablets, inhalers and guidance to help decide about the dose where a variable dose was prescribed. For example three people were prescribed a tablet at night to help them sleep and records showed that these were signed as given most nights. The directions printed on the medicine charts indicated to use only if needed or occasionally or do not take every night. For one person a review of the use of a 5ml dose of one medicine three times a day when required was noted as due on 21 November 2008 yet we could find no record about a review. Records showed that the medicine was still administered regularly three times each day. We carried out some audits, checking that the amounts of medicines in stock agreed with the medicine records. This is one check we can carry out to indicate if people in Care Homes for Older People Page 14 of 28 Evidence: the home are receiving their medicines correctly and that the medicine records are complete and accurate. We were concerned that checks we made on three different tablets showed that not all could be accounted for. This needs investigation to find out the reason. The home had notified us in November 2008 about a medication error when one person did not receive a prescribed medicine for two weeks. This had been investigated and dealt with by the home with further training planned. We were told that the manager carries out medication audits according to the company policy but as the manager was not available during the inspection we were not able to see these. The importance of regular audit with effective action taken based on the result is highlighted by some of the findings at this inspection. There were suitable arrangements to store medicines safely and at the right temperature. We found that attention was needed to repair a lock and a bolt on two of the medicine storage units. The maintenance person began to look at these issues during the course of the inspection and a few medicines were moved until the repair could be finished. This work must be completed to make sure that medicines are stored safely and in accordance with the law. We saw that in one bedroom there was a safe arrangement to keep the creams needed for this person. Both containers had a date of opening but one tub looked very old so that the date could not be read; this particular cream was not included on the current medication chart. There are recommended periods to use creams and ointments after which a new container should be used in order to reduce risks from contamination. We saw that this procedure was in place for eye drop containers where there is a much greater risk from contamination. We looked at the controlled medication record book and found that sample checks we made on these medicines agreed with the records. Since the last inspection our previous recommendation about keeping administration records for another medicine has been put in place. There was evidence of regular checks of these medicines. There was a medication policy and procedures available so that all staff should be aware of how the company expected medication to be handled in a safe way. Staff we spoke to were aware of this. We provided feedback about the issues found at this inspection to the deputy manager. Since the inspection the Operations Manager has written to us telling us about the actions taken to address some of these issues. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have taken place with the activities provision to enable people who use the service to have more choice and to have their recreational interests met. Evidence: Since the last inspection the home has appointed an activities coordinator. Part of her role is to plan the activities for each day and other care staff are allocated to undertake these when she is not on duty. The coordinator is able to provide group or one to one sessions. She also books outside entertainers to visit the home. As the inspection was near to Christmas the home had planned a Fayre and Pantomime. Records are maintained of activities provided and what people have attended. A Church service takes place each month. Plans are in place to organise residents meetings and a monthly newsletter is devised. One person spoken with said they chose not to take part in the activities and another person said they enjoy sitting in the communal rooms as they can see what is taking place. The activities coordinator is looking to undertake training in this area and meets with other activities coordinators from the other homes with in this group. Two visitors spoken with confirmed that visiting is not restricted and they are able to Care Homes for Older People Page 16 of 28 Evidence: see their relative in the communal area or in their own room. They said that the staff are very willing to take their relative up to their room so they can sit and talk in private if they request it. At the last inspection we raised a concern that one person said they had not been receiving a pudding and that the mealtimes were taking a long time. At this inspection the home was able to demonstrate that they have a system in place to make sure that all people have had all their courses. The home has two sittings at lunchtime and it appeared to be managed much quicker meaning that the people on the second sitting were not waiting as long. A sample of the meal was tasted and it was found to be delicious and well cooked. People were observed enjoying the food provided. 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. People who use the service and their representatives have access to a complaint procedure that makes sure the views of people are listened to. Procedures are in place to protect people from possible risk of harm or abuse. Evidence: The home received three complaints since the last inspection and two of these were verbal complaints. The records relating to the formal complaint did not contain copies of any further correspondence or the actions taken by the home. However since then a new manager has started working at the home. The information held on the verbal complaints would benefit from more details about the investigation that took place. A copy of the homes complaint procedure is on the noticeboard by the main entrance to the home. The policies and procedures the home has in place to help safeguard people were examined at the last inspection. A requirement was issued for the home to send in a copy of their report into an allegation that was received. This has been addressed. Two recommendations were made at the last inspection about training and the home obtaining copies of the local Councils Alerters guide. Two copies were seen in the home and plans are in place for staff to attend the local Councils training on the Alerters guide. Care Homes for Older People Page 18 of 28 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. The physical design of the home is not purpose built, however with the continued improvements that are taking place people who use the service will live in a comfortable and pleasant environment. Evidence: A tour of parts of the home was undertaken to follow up on the issues identified at the last inspection. The carpet on the stairs has been replaced and this has improved the overall look of the home. Where new carpets have been fitted the fire doors are being altered. Damage to a ceiling was being repaired during the inspection following a leak. The overall cleanliness has improved since the last inspection. No rooms were found to be odorous during the inspection. A small number of carpets were found to be heavily stained at the last inspection and one is still waiting to be replaced. Another carpet was found to stained and this was going to be addressed immediately. No clothes belonging to people who use the service were found left hanging around the home for staff to put away which is a big improvement. The laundry was not inspected as no issues were identified at the last inspection. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is confident that the numbers and skill mix of staff meet the needs of people who use the service. Improvements are needed with recruitment practices to make sure people who use the service are not put at risk. Evidence: At the last inspection we raised concerns that we were informed by the previous manager that the home does not always have four members of staff on duty at night. The Representative from the company confirmed that they always have 4 members of staff on duty at night. The staffing numbers for the day shifts remain unchanged from the last inspection. Two relatives of people who use the service felt that their relative always has their needs met by the staff. The home exceeds the 50 percent of care staff with NVQ 2 or above in Health and Social Care. Personnel records of four staff appointed since the last inspection were examined. Two personnel files contained all the required checks for recruitment but the other two did not. One did not have a reference from the last employer as they were employed as a care assistant and the other member of staff did not have a full employment history. All four people had Criminal Records Bureau Disclosures (CRB) and POVA checks Care Homes for Older People Page 21 of 28 Evidence: completed prior to starting work at the home. Requirements were issued at the last inspection in relation to recruitment checks and the home must now address these. Training and induction training were examined at the last inspection and the home has met this standard. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is now subject to changes to make sure that the service is run in the best interests of people who use the service. Evidence: Since the last inspection the Registered Manager has retired and a new manager has been appointed. She was not at the inspection due to illness. The new manager needs to apply to us to be considered for registration. Quality assurance was not examined at this inspection as it was met in full at the last inspection. The home also has safe systems in place for managing peoples monies. Staff supervision was examined and the home has systems in place but they need to look at meeting the recommended six sessions per year for care staff. All maintenance records were viewed at the last inspection and were all in place. Care Homes for Older People Page 23 of 28 Evidence: The home has started to complete their evacuation procedure. Each person who uses the service has a fire risk assessment in place but consideration should be given to reviewing the format as it asks people to sign to say they understand the procedure. However not all people can sign it due to their needs and staff are not able to check some peoples understanding of this form due to communication difficulties. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 All people who use the 01/10/2008 service must have care plans in place that provide staff with the information they need to meet their care needs. These must also be reviewed to make sure peoples care needs are current. The home must make sure that all the required recruitment checks are undertaken as listed in this Regulation prior to the new worker starting work at the home. This will help to reduce any risks to people who use the service. 01/10/2008 2 29 19 Care Homes for Older People Page 25 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 1 7 15 All people who use the 06/04/2009 service must have care plans in place that provide staff with the information they need to meet their care needs. These must also be reviewed to make sure peoples care needs are current. This will provide staff with up to date information on how to meet peoples needs. 2 9 13 For any medication labelled for use when required, as directed or with a variable dose, make sure there is always clear written direction for staff on how to make decisions about administration for each person and medicine and taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the 06/03/2009 Care Homes for Older People Page 26 of 28 correct levels of medication in accordance with their needs and planned actions. 3 9 13 When any medication is administered to people who live in the home it must always be clearly and accurately recorded. (This particularly relates to records for prescribed treatments applied to the skin). This is to help to make sure people receive their prescribed medication correctly and to help reduce risks of mistakes. 4 29 19 The home must make sure that all the required recruitment checks are undertaken as listed in this Regulation prior to the new worker starting work at the home. This will help to reduce any risks to people who use the service. 05/03/2009 06/03/2009 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 38 The home should review their fire risk assessment in relation to people or their families signing it as this is not always possible for everyone due to their needs. 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 © (2009) Commission for Social Care Inspection (CSCI). 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