Inspection on 10/03/09 for Guardian House Nursing & Residential Home

This inspection was carried out on 10th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Guardian House Nursing &... 17/12/07

Guardian House Nursing &... 20/07/06

Guardian House Nursing &... 11/02/06

Guardian House Nursing &... 13/09/05

Guardian House Nursing &... 29/01/05

Guardian House Nursing &... 23/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Guardian House Nursing & Residential Home Cobden Street Dresden Stoke-on-trent Staffordshire ST3 4EL     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: Yvonne Allen     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Guardian House Nursing & Residential Home Cobden Street Dresden Stoke-on-trent Staffordshire ST3 4EL 01782598330 01782644950 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Guardian Care Nursing Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 3 24 3 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Guardian House is a purpose built home that provides nursing care for up to 24 older people. It is part of the Nightingale Group Ltd, Guardian Care Centre, Longton Road, Trentham, and Stoke on Trent. Guardian House is situated in Dresden, a residential area between Trentham and Longton and is close to local amenities. The home is set back from the main road and has its own small garden for people to enjoy. There is a small car park to the side of the home that is accessed from the drive. Accommodation is provided on two floors that are accessible by stairs or passenger lift. There are 16 rooms and four companion rooms available and 30 per cent have en-suite Care Homes for Older People Page 4 of 29 Brief description of the care home facilities. The home has a large open plan lounge that has three distinct areas, one social area where service users can enjoy participating in tivities, a quieter sitting area and the dining area. The home meets the needs of older people with general nursing requirments and can accommodate up to three people with dementia care needs. The home has been adpated to meet the needs of people with limited physical abilities. The home has adapted bathing and toileting facilities on both floors. Catering and laundry facilities are also provided at the home. The fees charged range from 521.00 to 600.00 pounds and then increase according to any one to one care required. There are additional charges for hairdressing. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 Quality Rating for this service is ONE STAR. This means that the people who use this service experience ADEQUATE quality outcomes. This unannounced Key Inspection was carried out by one inspector over one day. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under take a self assessment, which focuses on how well outcomes are met for people using the service. We also sent out surveys for people who live at the home, relatives and staff to complete. A number of these were returned to us and comments have been included in this report. Care Homes for Older People Page 6 of 29 All of the Key minimum standards were assessed and for each outcome a judgment has been made, based on the evidence gathered. These judgments tell us what life is like for the people who live in the home. The ways in which we gathered evidence to make our judgments are as a follows - We looked at any information we had received about the home since the last Key inspection. We spoke with some of the people who live in the home and some visitors. We spoke with some of the staff who work in the home. Discussions were held with the acting manager. We examined relevant records and documentation. We walked around the home. Following the inspection visit we spoke with a health care professional who visits the home regularly. At the end of the inspection visit we discussed our findings with the acting manager. As a result of this Key Inspection we have made some recommendations for improvement. What the care home does well: What has improved since the last inspection? What they could do better: There have been a number of different managers for this home over recent years. When we arrived for this inspection visit we were met by yet another acting manager. This has not been helpful in overall management of the home. Relatives feel that there now needs to be some consistency of management. A visiting professional also feels that this needs to improve as she has to keep dealing with different managers. We made a requirement for this to improve at the last Key Inspection and this has only been stable for 12 months. The overall decor and presentation of the home is poor. There has been no significant recedoration and refurbishment to this home for several years. The environment needs to improve so as to provide the people who live there with pleasant well presented surroundings. We received the following comments from people who live at the home and their relatives - Care Homes for Older People Page 8 of 29 Home could be cleaner. The carpets are particularly dirty. General care sometimes good but not always consistent. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo an assessment of their needs prior to being offered a place at the home and can be assured that their assessed needs will be met. Evidence: In their AQAA the Providers tell us that they offer new people the opportunity to visit the home before deciding to come and stay wherever possible. They say that they provide brochures and information and engage people in conversation. We looked at some individual care plans and saw copies of pre admission assessments which had been carried out by the previous manager and current acting manager of the home. We held discussions with the acting manager and he confirmed that, following a referral or an enquiry for a place at the home, he goes out to meet people in their own homes or hospital, depending on their current placement, and carries out Care Homes for Older People Page 11 of 29 Evidence: an assessment of their needs. These assessments are important as they provide the manager with vital information about the person. There are usually other people involved in these assessments, such as Social Services, doctors, health care professionals and other funders of care. We saw records of these assessments contained in care plans. The manager told us that he then makes a decision, based on the information, as to whether the home would be an appropriate placement for the person, and whether the staff will be able to meet the persons assessed needs. The surveys we had sent out prior to this inspection visit indicated that people and their families had felt included and informed during this initial assessment process. We spoke with two visitors during the inspection visit and they told us that they had come to have a look around before their relative was admitted and that they had been given information about the home by the manager and by social services. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal and nursing care which is planned and individual health care needs are monitored. Professional advice and support is actively sought as and when required. Evidence: In their AQAA the Providers tell us that they ensure that all personal care is delivered by kind, caring, skilled and experienced staff. They tell us that all staff are given the opportunity to complete the common induction standards and National Vocational Qualification (NVQ) training. They say that they have weekly visits from the Community Matron and rapid access to specialized nursing services. They say that they have an excellent relationship with the doctors practices who cover the home. They cover all activities of daily living within the care plans. During our inspection visit we looked at some of the care plans. Each person has their needs assessed, risk assessments produced and plans of care developed. These plans consider personal and nursing care needs of people including monitoring individual Care Homes for Older People Page 13 of 29 Evidence: health care needs. Psychological health care needs are also assessed where this is identified as a problem. People receive advice and support from health care professionals and plans contain documented evidence of visits by doctors, chiropodists, opticians, geriatricians, physiotherapist and occupational therapist. People are also supported to attend specialist departments and clinic appointments. We saw that a person had been supported to attend the Orthotics department and the audiology clinic. We also noted that people have their risk of developing tissue damage risk assessed and monitored. We saw that a person who is at high risk of developing pressure ulcers has a care plan in place for this and specialist equipment provided including an alternating pressure mattress. We were informed that there was currently no one accommodated in the home who has a pressure ulcer. The manager explained that the Tissue Viability Specialist Nurse is available for advice and support should the staff need this and she will come out to the home to see people. The home also has the benefit from a Community Matron who will come in and offer support and advice to staff. We spoke to her following this inspection visit and she told us that she visits the home regularly to assess people who staff have concerns about. She told us that she does not have any concerns about the care which people receive in the home and that staff are quick to refer to her should they have any concerns about people. She confirmed that staff listen and act on her advice. People also have their nutritional needs risk assessed and anyone who is at risk of malnutrition is monitored and referred to a dietitian via the doctor. People are also weighed regularly. We saw staff helping people with their lunch and drinks were given regularly throughout the day. People who had not eaten much for their lunch were being offered and helped with nutritional supplements, prescribed by the doctor. Staff are aware of peoples eating habits and they monitor peoples dietary intake. Care plans do not contain much information about what people like and dislike and their choices and preferences surrounding activities of daily life. These plans would be improved by being made more person centered. The following comments were received from surveys, I am happy with the care my mother is receiving. All staff are friendly and helpful. All the staff do their utmost to look after the residents. They are all hard working and caring which is most important in this kind of work as all their needs are different. Care is good generally but not always consistent Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and entertainment are provided for people who live in the home but it cannot be guaranteed that individual social and therapeutic needs will be met. Seating arrangements for some people do not provide an atmosphere conducive to dining and should be reviewed. Evidence: The Providers told us in their AQAA that they arrange outings and have a trained activity coordinator who provides activities. They say that they encourage contact with family and friends, and respect individual wishes and requirements as far as social activities are concerned. They make full use of mealtimes as opportunities to socialize with seating around tables encouraging conversations. We spoke with the care assistant who is responsible for overseeing and delivering the activities programme in the home. She told us that people come in from outside to entertain and that she has the forthcoming years entertainment planned and booked up. She also told us that trips out are arranged to local places of interest. We observed a quiz taking place in the lounge during the inspection visit which some of the people Care Homes for Older People Page 16 of 29 Evidence: who live in the home were participating in. For the remainder of the visit people were sitting watching television and we observed visitors coming and going. There was a lack of newspapers, and other reading material for people to read or look at in the lounge and most people were not engaged in any activity for most of the time other than the quiz and eating lunch. The televisions were on but most people did not appear interested in watching the programmes. Staff were observed talking to people as they came in and out of the lounge but for most of the time people were not engaged in meaningful activities. The care staff did tell us that regular video afternoons are arranged and we saw the availability of these videos. The following comments were received on surveys prior to the inspection visit Mum is unable to take part because of her physical disabilities and her partial sight. Hearing is sometimes limited. Would there be any way any form of stimulation be instigated. I feel because of mums condition this would not be possible. Surveys indicate that people and their relatives have mixed feelings about whether there are enough suitable activities for people who live in the home. Some links with local community are maintained and Church services are held monthly. People have access to local clergy. We observed people eating lunch. There was a considerable number of people who were not moved to the dining tables at lunchtime and ate their meal from an overbed or occasional table from their easy chairs. This is not conducive to pleasant dining and it was obvious that some of these people were disinterested in eating their meal. It is recommended that everyone accommodated in the home is given the opportunity and encouraged to sit at the dining table for meals. Staff did try and encourage people to eat their lunch and were observed assisting people to eat and were giving some people a nutritional food supplement after lunch. We observed a choice of main meal and spoke to the Cook about meals. We also saw the menus which are four weekly rotational and offer variety and choice. In care plans we noted that people have their nutritional needs assessed and monitored. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be assured that any concerns they may have will be taken seriously and acted upon. The systems in place help to safeguard people from harm or abuse. Evidence: In their AQAA the Providers tell us that they deal with all concerns and complaints at an early stage so that people or relatives do not feel the need to take their concerns higher. We spoke to the acting manager about the way in which concerns and complaints are dealt with. He commented that he has only been in post a very short time and that the previous manager dealt with complaints. However we did receive some poitive comments about how people feel able to approach him and that any concerns are dealt with promptly. We observed the acting manager talking to people who live in the home and visitors and he told us that he makes himself accessible and runs and open door policy seeing people on a one to one basis. We noted that there is a clear and accessible complaints procedure displayed in the home. Care Homes for Older People Page 18 of 29 Evidence: The home has a policy in place for safeguarding people who live there. The acting manager is aware of the procedure for reporting abuse. Staff told us that they would raise any concerns about poor care practice or abuse with the nurse in charge or the acting manager of the home. They also confirmed that they had received training in this area. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe comfortable environment but would benefit from a total refurbishment and redecoration programme. Evidence: In their AQAA the Providers tell us that they have a fully adapted clean, pleasant, light, and homely environment with outdoor, secure access. We walked around the home and looked in some of the bedrooms and all of the communal areas. Previous requirements have been met but the home is still in need of redecoration and refurbishment. Furniture and fitments are looking worn and in need of replacement. Carpets are badly stained in areas and these too are in need of deep cleaning or replacement. Otherwise the home was clean. There has been the addition of some more television sets in the lounge enabling everyone to be able to view a television from wherever they are sitting in the lounge area. Activities and entertainment take place in this main lounge and this was noted at the time of the inspection visit. As previously highlighted, the seating arrangements for taking meals is not conducive to eating and will need to be reviewed and improved. This might involve the provision of more dining tables and chairs. Care Homes for Older People Page 20 of 29 Evidence: The home has a policy in place for infection control and staff have access to the nurse specialists from the Health protection Agency for advice and support. The kitchen is inspected by the Environmental Health department. There is an accessible outdoor garden area available for people to enjoy. It was noted that the cover over the radiator located in the corridor area outside room 7 was broken. This must be fixed and made safe. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are cared for by a staff team who have the skills and expertise to be able to meet their needs. Evidence: In their AQAA the Providers tell us that they appreciate staff and respect them and provide opportunities for their development through training. They allow staff to support themselves psychologically and offer support with individual review. At the time of the inspection visit there was a total of 15 people accommodated in the home with nursing needs. The acting manager who is a nurse, was on duty together with three care assistants, one of whom was a senior carer. There was also a cook and a domestic assistant on duty. We were told that maintenance support for the home is available as and when required. We spoke with the care staff who all felt happy and supported at the home. They told us that there is a good staff team and that they are supported by the acting manager who is approachable. They also confirmed that the training is good and that they have regular updates of mandatory training. We looked at the records of Care Homes for Older People Page 22 of 29 Evidence: staff training which confirmed that above. All of the care staff spoken to had obtained National Vocational Qualification (NVQ) in care to at least level two and two of the care staff were now doing NVQ level three. We looked at the staff recruitment procedure and found this to be robust. Staff are carefully selected to work at the home and undergo the required checks of Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA). Also the usual references and employment history checks are obtained. New staff then undergo a programme of induction training. As previously highlighted the Community Matron visits this home regularly and told us that she offers support advice and training for staff in the home. We noted that some of the people accommodated in the home have a degree of dementia care needs and although some staff have received training in this area, others have not. It is therefore recommended that all staff giving care and support to people with dementia care needs receive training in this area so that they are able to understand and meet individual needs. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The changes in manager of this home over recent years has not been helpful for the people who live there in establishing a consistency of management approach. Evidence: In their AQAA the Providers tell us that they have regular staff meetings and have started to have more frequent relatives meetings. We met with the new acting manager who was in charge of the home at the time of the visit. We had not been informed of the change of management by the Providers prior to the inspection visit but have now received this in writing. This home has had a few different managers over the last few years and has therefore lacked consistent management. Health care professionals have also found this difficult as they get used to a manager and then this changes. People who live at the home, their families and staff who work there will benefit from a more settled consistent management. Care Homes for Older People Page 24 of 29 Evidence: The current acting manager is a qualified general nurse with experience of care of the elderly. He has also worked in other areas of nursing. He told us that he has completed mental health training and Crisis Control Intervention (CCI) and is now undertaking a Leadership Management Course funded by the Providers. People we spoke with were complimentary about the acting manager telling us that he is very approachable and has lifted the place. The home does have a Quality Assurance programme in place where areas and services are audited and improvements made. This should now be further developed to include obtaining the views of the people who live at the home so that they have a say in the services offered to them and are encouraged to be involved in the running of the home. We looked at the maintenance of personal allowances in the home and these are managed in an open and translucent way where an audit trail can be carried out if required. People are encouraged to manage their own monies and finances wherever possible. No one at the home is acting as agent or appointee for any of the people who live there. There is a Health and Safety policy statement in place at the home and records are in place to confirm that Health and Safety at the home is well managed. Individual risk assessments are in place in care plans and are regularly reviewed. Generic risk assessments are also in place and updated. Equipment used at the home is checked and serviced regularly by people who are trained to do so. Staff receive regular training updates in all areas of Health and Safety. Care Homes for Older People Page 25 of 29 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 31 8 and 9 The Provider must ensure 04/02/2008 consistency of management at the home in order to help improve all the outcomes for the people who live there Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 12 Care plans should be made more person centered to help ensure that personal choices and preferences are upheld. The provision of interesting reading material should be made available for people such as daily newspapers and magazines in order to provide people with more meaningful stimulation and help meet individual social needs. Each person should be given the opportunity and encouraged to sit at the dining table to eat their meals. This will provide a more suitable environment for eating and an opportunity for socializing. The cover over the radiator located in the corridor outside room 7 should be made safe. The home is now looking very worn and is in need of refurbishment and redecoration in order to offer a good standard of accommodation. Stained carpets should be deep cleaned or replaced. It is recommended that all staff giving care and support to people with dementia care needs receive training in this area so that they are able to understand and meet individual needs. 3 15 4 5 19 19 6 7 26 30 Care Homes for Older People Page 27 of 29 8 31 There should be less changes in manager for this home so that the people who live there can benefit from a more consistent management approach. The Quality Assurance system should be further developed to include obtaining the views of the people who live at the home so that they have a say in the services offered to them and are encouraged to be involved in the running of the home. 9 33 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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