Inspection on 18/05/09 for Field View

This inspection was carried out on 18th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Field View 24/05/07

Field View 10/02/06

Field View 01/09/05

Field View 17/01/05

Field View 26/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Field View Hayes Lane Fakenham Norfolk NR21 9EP     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: Jane Craig     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Field View Hayes Lane Fakenham Norfolk NR21 9EP 01328856037 01263713222 fieldview66@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Imperial Care Homes Limited care home 17 Number of places (if applicable): Under 65 Over 65 17 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Fieldview provides personal care and accommodation for 17 older people. The service is owned by Imperial Care Home Limited. The home is located on the western outskirts of the market town of Fakenham. It is pleasantly situated and close to all local amenities. The home provides accommodation on the ground and first floor with flats for staff being situated on the second floor. There are two shared bedrooms and thirteen single bedrooms with all bedrooms having en suite facilities. There is a five person lift to the first floor. There is adequate inside communal space. Outside there is a patio area and large, lawned, garden, which residents can enjoy in the summer months. Information about the home, including the latest inspection report is available from the manager. At May 2009 the weekly fees ranged from 386 to 450 pounds. There were extra charges for hairdressing, chiropody, toiletries and therapy sessions. Care Homes for Older People Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 24th May 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 18th May by one regulatory inspector. At the time of the visit there were fifteen residents in the home. We met with as number of them and asked about their views of Field View. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. Care Homes for Older People Page 5 of 29 We held discussions with the acting manager, one of the owners of the home, staff and visitors. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the care home does well: What has improved since the last inspection? What they could do better: Some of the care plans did not give staff enough instructions to help them to meet residents individual health and personal care needs. Staff must make sure that risks to residents health and safety are assessed and plans are put into place to monitor, and where possible, reduce the risks. Care Homes for Older People Page 7 of 29 Improvements must be made to records of medicines to make them safer and to make sure that residents receive the correct medication as it is prescribed. The procedure for the manager and staff to follow if they suspected, or were told, that a resident was the victim of abuse was not completely clear. This could result in any incidents not being managed in the correct way. Staff must not start work at the home until their background checks have been carried out. This is so that the manager can be confident that they are fit and safe to work with residents. The acting manager must make sure that she enrols on relevant courses to ensure that she has the appropriate qualifications to fulfil the duties of the management role. In order to comply with legislation the manager must be registered with the Care Quality Commission. The systems for monitoring and improving the quality of the service should be further developed so that there is a clear picture of what the home is doing well and where it can improve. Policies and procedures had not been reviewed for a number of years and some of the information no longer reflected usual practice. This meant that staff did not have current guidance to refer to. The manager must ensure that staff have up to date fire safety training. The service must also consult with the fire officer for advice about the practice of wedging bedroom doors open. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not admitted to the home without a current assessment to ensure their needs could be met. Evidence: People thinking of moving into Field View were encouraged to spend time at the home before making a decision. This enabled them to talk to the staff and current residents and ask any questions about the service and facilities being offered. There was a statement of purpose and service users guide for the home but it was not completely clear what information was sent out to people making enquiries about admission. The manager told us that people could see the last inspection report on request. Most people who were referred to the home had an assessment by social or health care professionals. The owner or manager also carried out their own assessment to make sure that the service provided at Field View would be able to meet the persons Care Homes for Older People Page 10 of 29 Evidence: needs. The examples of the pre-admission assessments we saw provided a good overview of the residents needs and abilities in all areas of daily living. Staff told us that they could look at the assessments for new people and discuss their care with senior staff. Standard 6 was not applicable, Field View did not provide intermediate care. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of complete and up to date care plans and associated records could result in residents health and personal care needs not being met in the way they prefer. Evidence: We looked at the care records for three residents as part of the case tracking process. Each resident had a set of care plans following the activities of living model. The standard of information on the care plans varied. Some plans to support residents to meet their personal care needs were detailed and included information about the residents preferences and abilities. This helped them to maintain their independence and receive support in the way they preferred. Others used vague terms and directions. For example, plans to assist with continence. The lack of specific directions could result in staff not providing consistent and accurate care. There was no evidence that residents or relatives were given opportunities for involvement in care planning and reviews. Care plans were not signed or dated. Each care file included a monthly review. These did not link to specific care plans, which Care Homes for Older People Page 12 of 29 Evidence: made it difficult to check whether the information in the plans was still current. We saw evidence that one moving and handling plan had been updated when the residents needs changed. Residents were happy with the care they received. One told us, I am so well looked after I cant thank them enough. Another said, They make sure we get medical attention when we need it. Residents were referred to appropriate health care professionals when needed. Although the advice given was not always transferred to the relevant care plan, the information was communicated verbally to staff. Not all health care needs were recorded on the care plan. Staff told us about one resident who had an ongoing problem with their breathing and how this affected them. There was no mention of this in the care plan, which meant that new staff may not have access to this information. Each resident had a moving and handling assessment, which indicated the equipment and staff support they needed. We observed staff using appropriate techniques to assist residents. There were no other assessments to monitor risks to residents health, caused, for example, by falls or poor nutrition. The assessment for one resident showed that they had a history of falls. This had not been further assessed and there was no care plan to minimise potential risks. We were told that one of the other homes in the group was piloting a nutritional risk assessment and there was a plan for it to be introduced at Field View. Throughout the course of the visit we heard staff speaking to residents in a respectful and friendly manner. They talked to us about the importance of promoting residents privacy, dignity and independence and gave examples of how they incorporated core values into their daily practice. One said, We try to do things the way people like it, and another said, Residents do things they can for themselves and we just fill the gaps. Residents told us that staff were polite to them and respected their privacy. One said,They have every right just to come in my room but they always knock. There was a policy for managing medicines but this had not been reviewed for a number of years. Staff were due to receive an update on medication handling training later this month. The former practice of auditing medication records had stopped over a year ago. One of the residents we case tracked administered some of their own medication. The risk assessment and plan to support the resident had not been reviewed for a number of years. We were told that some residents administered some of their own creams but this was not made clear on the medication administration record (MAR) charts. Medication was stored securely and there was restricted access to the keys. Care Homes for Older People Page 13 of 29 Evidence: The manager had a safe system for ordering and checking in the monthly medication. The medicines received at the start of the monthly cycle were recorded on the MAR chart but those received mid-month were not. Stocks of medicines carried forward from the previous month were not recorded. The lack of complete records meant there was not a full audit trail. There were records of medicines returned to pharmacy. There were no gaps on MAR charts, however, the number of medicines removed from the stock did not always match the number that staff had signed as administering. It was not clear whether this was due to recording errors or whether residents did not always receive their medicines as they were prescribed. Some MAR charts were handwritten. The instructions on the MAR chart were not always clear enough to ensure that staff knew exactly what dose of medicine to give. There was no evidence that handwritten entries were checked to reduce the risk of transcribing errors. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lifestyles matched their expectations. Evidence: Residents had care plans for occupation and activities but these were not individualised. They did not take into account residents personal interests or what support they required to meet their social and recreational needs. The annual quality assurance assessment indicated that the manager was planning to improve the level of activities provided by the home. However, most residents we spoke to were satisfied with the level and range of activities. One resident said, We have entertainment of some sort every week, and another told us, We have a variety of things to do, there is certainly enough for me. There was open visiting at the home, which helped residents friends and families to keep in touch. Visitors were made to feel welcome and said they were kept in touch with what was going on. Some residents went out regularly with family and friends but there were limited opportunities for residents who needed staff escorts to go out. The manager told us that this was an area where she would like to make improvements. Care Homes for Older People Page 15 of 29 Evidence: Staff told us that all the residents were able to make their own choices and decisions in all aspects of their daily lives. One said, They have their own routines and we follow those, and another said, They are free to make their own choices. Residents also confirmed that they had choices. One said, It is very relaxed. Another told us, We are never forced to do anything or told we must do this or that. All the residents and visitors we spoke to were satisfied with the home and indicated that it met their expectations. More than one person told us, I love it here. One resident said, Other than having my old life back I would never want to leave here. Other comments included, I like to be quiet and friendly with everyone and it is easy to be like that here, and I like the home, I am very happy here. The menus showed that residents were offered a varied and nutritionally balanced diet but there was little choice. The midday, main meal was set and residents had to ask if they wanted something different. The teatime meal usually comprised of sandwiches. However, all the residents we spoke with were satisfied with the meals and told us; The food is very good, there is quite a nice variety, We do have a choice in the evening but we prefer sandwiches, Sandwiches for supper are fine as far as I am concerned. We observed lunch on the day of the visit. The dining room was attractively set out and the mealtime was a social occasion. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of clear guidance in safeguarding could result in abuse being unreported or mismanaged. Evidence: The complaints procedure was on display and all residents were given a copy on admission. Those residents we asked said they could speak to the staff or the owner if they were unhappy about anything but all said they had no complaints at the time. One resident said, I have no grievances or complaints whatsoever. There had been no complaints either to the Commission or directly to the service in the past year. Staff had received training in safeguarding and an update was booked for all staff to attend next month. There was a policy document, which had not been reviewed for several years. The policy gave staff some guidance about definitions and recognition of abuse but the procedure for reporting was not completely clear. The service did not have a copy of the local social services safeguarding procedure. Care staff we spoke to said they were confident they would be able to recognise if a resident was a victim of abuse. They were aware of their responsibility to report any suspicion, or allegation, of abuse to the manager or higher in the organisation if Care Homes for Older People Page 17 of 29 Evidence: necessary. However, the manager was not completely clear about her role and the role of social services in leading safeguarding investigations. Residents told us they felt comfortable at the home. One said, I feel safe here with the staff, and another said, No-one is ever nasty. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and well maintained and provided residents with a comfortable and homely place to live. Evidence: From a tour of the premises it was apparent that the home was well maintained. A resident told us, If anything goes wrong we report it and they sort it out. There were safety measures such as radiator guards and window restrictors. The communal areas were decorated and furnished in a comfortable and homely style. Residents had a choice of seating in the lounge or conservatory. Both had homely touches with pictures and ornaments. The AQQA told us that there were plans for redecoration of some areas of the home. There was a well kept garden that was accessible to everyone and one of the residents said they liked to sit out on the large patio area in the summer. All bedrooms had en-suite facilities and there were also communal toilets and bathrooms. The upstairs bathroom was cluttered with commodes and a wheelchair. In addition to being a trip hazard, it did not provide a pleasant place for residents to relax and bathe. Care Homes for Older People Page 19 of 29 Evidence: Many residents personalised their bedrooms with pictures and ornaments. Those who were asked said they were satisfied with their rooms. One resident described their bedroom as, nice and comfortable. Shared rooms had privacy screening. At the time of the visit all areas of the home were clean and free from offensive odours. Residents and visitors confirmed that this was always the case. The laundry was sufficiently equipped for the size of the home. On the day of the inspection it was clean and well organised. None of the residents had any complaints about the laundry. A visitor told us that their relatives clothing and bedlinen was always clean. A resident commented, The laundry is very good, we send it one day and it comes back the next, even on Sunday. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were supported by a staff team who had training to help them to understand and meet their needs but recruitment practices were unsafe and could place residents at risk. Evidence: The staffing roster showed consistent levels of staff during the day. Staff told us that their numbers were sufficient to meet the needs of the current residents, many of whom were quite independent. A member of staff said, we usually get time to sit with residents and have a chat. The AQAA told us that there were two residents who needed support from two members of staff at night. There was only one member of staff on waking watch. The other slept in on the premises and was woken to provide extra support. The roster did not name the sleeping in staff or the hours they worked. This made it difficult to track which members of staff provided care at any given time and also to audit whether the current way of working met the needs of the residents. The AQAA told us that one of the strengths of the service was the dedicated and caring team. Staff reinforced this and one told us that the team got on very well together, which helped with communication. All the residents and visitors we spoke to praised Care Homes for Older People Page 21 of 29 Evidence: the staff and said they got along with them. One resident told us, Staff are very good and kind. Another said, Staff bend over backwards to help us.. We looked at the files of two recently appointed staff. Neither had been recruited in accordance with policies to safeguard residents. For example, one had started work after a POVA first check, but was working without supervision. The other was working without a POVA first or CRB disclosure. Both had started work before their references had been returned. The lack of pre-employment checks meant that the manager could not be sure that the new staff were suitable to work with residents. New staff completed an initial induction, which introduced them to the home, key policies and working practices. They went on to complete a full twelve week programme which covered the common induction standards. The programme was mainly self study and the manager carried out a competency assessment on each topic. The central training record showed that staff had completed updated training in some of the safe working practice topics such as moving and handling and first aid. There was a training plan which included dates of mandatory topics and a few others, for example, managing behaviour that challenges and managing medication. The AQAA told us that over 50 of care staff held an NVQ at level 2. A number of staff had also completed, or were working towards, level 3. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration systems were not thorough enough to ensure that the home was run in a way that safeguarded residents health and welfare. Evidence: The acting manager has been in post for over a year but has not submitted an application for registration with the Commission. She has many years experience of caring for older people but had little management experience before taking up post. The manager had not commenced formal management training at the time of our visit. We found some of the management and administration systems were not thorough enough to ensure that the home was run in the best interests of the residents. For example, a number of records were not complete or up to date, recruitment was unsafe, and there was a lack of clear direction for the service. The AQAA did not tell us what areas of the service were in need of further development. Many of the sections asking what the service could do better were not Care Homes for Older People Page 23 of 29 Evidence: completed. There was a lack of clear information about the plans for the next year. There was a quality monitoring system in place, which involved auditing of a range of systems and processes every month but these were not up to date. Residents and visitors were invited to complete questionnaires about the service. The manager said there was no formal process for collating the results, publishing the findings or planning improvements. Any negative comments were addressed at the time. The reports of the monthly provider visits showed that residents views were sought on a regular basis. A resident also told us, At residents meetings we are asked what we would like. A number of policies and procedures had not been reviewed for six years. Some of the information was in need of updating to ensure it reflected current practice. We looked at the processes for handling money on behalf of residents. These were safe and the records were well organised. The AQAA indicated that there were a number of policies that had not been reviewed for some time. We were told that these were in the process of being updated. The AQQA showed that maintenance and servicing of installations and appliances was up to date. We looked at the fire safety records and found them to be complete and up to date. The manager and another senior member of staff had completed fire marshall training which enabled them to carry out fire safety training with the other staff. This was overdue but the staff we spoke with were aware of the procedure to follow. Fire doors in communal areas were held back by magnetic devices that were linked to the fire alarm. However, a number of bedrooms doors were wedged open and would not automatically close in the event of a fire. We were told that this had been agreed with the fire officer at one of the sister homes but there was nothing recorded to show that this was the same at Field View. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be clear care 07/07/2009 plans to support residents to monitor and meet their health and personal care needs. To promote residents health and welfare. 2 8 13 Potential risks to residents 31/07/2009 health must be assessed and plans drawn up to minimise the risk. These would include risks associated with falls. Assessments and plans must be kept under review. To promote residents health and safety. 3 9 13 There must be complete and 31/07/2009 accurate records of medicines received and administrered. To create an audit trail and ensure that residents receive their medication as it is prescribed. Care Homes for Older People Page 26 of 29 4 9 13 Assessments and risk management plans to support residents to administer their own medcation must be reviewed. To protect the health and welfare of the resident. 31/07/2009 5 18 13 The safeguarding policy and other guidance must be reviewed to ensure that all staff are clear about how to respond in the case of suspected or actual abuse. To protect residents health and welfare. 30/06/2009 6 31 9 The manager must make arrangements to enrol on the appropriate care and management courses. She must also submit an application for registration with the Commission. To ensure the manager has the appropriate knowledge and skills to fulfil her role and ensure the home is run in the best interests of the residents. 31/07/2009 7 38 13 Staff must have up to date fire safety training and the advice of the fire officer must be sought with regard to wedging open fire doors. To promote the health and safety of residents and staff. 31/07/2009 Recommendations Care Homes for Older People Page 27 of 29 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 8 19 Handwritten MAR charts should be witnessed to reduce the risk of transcribing errors. To improve the comfort and safety of people using the service the bathroom should not be used to store equipment. Quality monitoring processes should be further developed. Policies and procedures should be reviewed to ensure that they reflect current practice. 3 4 33 34 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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