Inspection on 23/10/08 for Hunter Hall

This inspection was carried out on 23rd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hunter Hall 26/08/09

Hunter Hall 10/03/09

Hunter Hall 08/04/08

Hunter Hall 10/04/07

Hunter Hall 17/07/06

Hunter Hall 26/09/05

Hunter Hall 14/06/05

Hunter Hall 22/02/05

Hunter Hall 26/07/04

Hunter Hall 16/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hunter Hall Kent Avenue Wallsend Tyne & Wear NE28 0JE     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: Elaine Charlton     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Hunter Hall Kent Avenue Wallsend Tyne & Wear NE28 0JE 01912639436 01912623633 hunter.hall@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Valerie Appleby Type of registration: Number of places registered: Tamaris Healthcare (England) Ltd care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who may be accommodated is 46. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Code DE, maximum number of places: 1 Dementia, over the age of 65 years of age Code DE(E), maximum number of places: 45 Date of last inspection Brief description of the care home Hunter Hall is a care home that provides residential and nursing care for older people with mental health needs. It is located in a residential area of Wallsend close to local shops and good public transport links. The home is owned and managed by Four Seasons Healthcare Limited, a large national care provider. Care in the home is provided by Registered Mental Nurses (RMNs) supported by care staff. Forty-six single bedrooms, all with en-suite facilities, are located at ground and first floor levels. On each floor there are separate lounge areas, a dining room, bathrooms and toilets. The Care Homes for Older People Page 4 of 29 Over 65 45 1 Brief description of the care home home shares kitchen and laundry facilities with an adjacent home. There is a nice, enclosed garden and patio area at the rear of the home. Depending on the type of care provided fees are between £408 - £530. The home has a statement of purpose and service user guide that give people information to help them decide whether their needs can be met. 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: An unannounced visit was made on the 23 October 2008. A total of eight hours were spent in the home. The operations manager and deputy manager were present throughout the inspection. Before the visit we looked at Information we have received since the last inspection that took place over three days between the 8 April and the 1 May 2008. The Annual Quality Assurance Assessment (AQAA) that gives CSCI evidence to support what the service says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. The improvement plan produced following our last inspection. How Care Homes for Older People Page 6 of 29 the service has dealt with any complaints and concerns since the last visit. Any changes to how the service is run. The providers view of how well they care for people. The views of people who use the service, their relatives, staff and other professionals who visit the service. During the visit we Talked with people who use the service, staff, the operations manager and deputy manager. Arranged for an inspection of medicines and the medication administration systems to be carried out by a CSCI Pharmacist. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building/parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the managers what we found. What the care home does well: What has improved since the last inspection? A new manager has been brought into the home to manage the improvement plan making sure that people are able to live in a warm, comforable and safe place. There is now a full staff team in place to support people who live in the home. A new style and format for service user and care plans has been introduced that gives staff much better and easier to undertand information about a persons needs and how they want to be supported. Staff handover meetings have started so that people coming on duty are made aware of changes, people who are unwell and healthcare professionals that may need to be contacted for the well being of people living in the home. Staff have had access to an increased and valuable amount of training, giving them confidence and helping support them to do their job. A new round of supervision has started and named nurses know who they are responsible for supervising. This means that staff also know who they will be speaking to. New furniture, curtains and equipment has been purchased making the home a much more comfortable place to live and work. The programme of re-decoration is well underway and has made the home much lighter, brighter, fresher and comfortable. The home has won an award from North Tyneside Council for its garden. This was in Care Homes for Older People Page 8 of 29 the Residential Care - Sheltered Housing In Bloom Competition. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 are properly assessed, taking into account their differing needs and wishes, so that they can receive flexible, consistent and reliable care. Evidence: The organisation has a Dependency Assessment Rating Tool (DART) that is used in the assessment process. We saw that monthly evaluations of the assessment are being carried out. There is a copy of the healthcare professionals assessment in each of the residents files. The home has had no new recent admissions. The home does not provide intermediate care. Care Homes for Older People Page 11 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in the planning of care and support needed to meet peoples diverse needs. Privacy and dignity is promoted. Medication systems promote the safe ordering, receipt, administering and dispensing of medicine in the home helping to keep people well. Evidence: We looked at the records for four people living in the home. One of them was in the new format and included an updated, and increased range of care plans. The new care plans we saw were written in a sensitive yet informative way. How the care and support was to be provided was written in one long paragraph and this may deter people from using them properly. Evaluation of the older style care plans had not been carried out since July or August, which could mean that the care and support people are receiving is not being reviewed. Care Homes for Older People Page 13 of 29 Evidence: For one person who had a history of suicide attempts their care records noted that staff should liaise with family about the previous attempts. We could find no evidence of this happening but were later told that the resident concerned does not have any family. The same person had also displayed some behaviour that had challenged staff. Monitoring charts had been introduced, with the involvement of a Consultant Psychiatrist, but we also saw from the daily records that one of these incidents had been when staff had woken the person to take their medication. We did see some good evaluations linked to the hygiene and dressing needs of the same person. Some staff still need additional training on record keeping to help them understand how they should record events in a sensitive and non-judgemental way. For example she was taken away to her room, and woke resident for her medication, she lashed out. Peoples allergies were clearly noted so that everyone was aware about things they should not take or use. We also saw information for staff reminding them that bathing routines should be flexible and the different needs of residents should be accommodated. Personal care records for people living in the home clearly showed whether one or two staff should be involved in assisting them with this area of care, and with moving and transferring. Throughout the inspection we heard and saw staff talking to, encouraging and giving people choice. Conversation was sensitive and time was taken to explain what was happening in the home and outside. Policies and procedures for the safe administration of medication have not changed since our last inspection, although they were dated for review in March 2008. These are Four Seasons Health Care generic documents but lack some details to support local procedures. We saw an additional procedure on the nurses station that provides good guidance on how to order, receive, check medication orders and dispose of waste. This should be incorporated into the main policy document. Care Homes for Older People Page 14 of 29 Evidence: Copies of the Royal Pharmaceutical Society of Great Britain guidance on handling medicines in social care and the latest British National Formulary (BNF) were available in the home. We observed part of the morning medication round being carried out on the ground floor. There was only one nurse available to carry out the administration of medicines over two floors and this took almost two hours. We were told that there were usually two nurses carrying out this responsibility. One on each floor. The systems we observed were fine. Checks were carried out to make sure it was the right resident getting the medication, plenty of fluids and encouragement were given and a no touch technique was in use. We spoke to the nurse about signing the medication administration record (MAR) before the resident had taken their medicine. MAR sheets are pre-printed by the pharmacy, including dates, and are kept securely in a divided ring binder. We identified the following issues. A prescription for flucloxacillin not being obained promptly, a dose of perindopril not recorded as administered with no explanation, lansoprazole supplied for one resident with a discrepancy between what had been received, administered and was left in the blister pack, limited life medication and eye drops not dated when they had been opened, staff had changed the time for the administration of trimethoprim with no identified authorisation, three handwritten entries on the MAR for one resident with no amount of medication recorded, no entries on the MAR for one resident for amisulpiride between the 10 and 14 October (it was unclear whether this had been administered, missed or refused), and we were unable to reconcile the stock balance for a residents supply of simvastatin. A robust system is in place to manage and document the ordering of regular medication. Prescriptions come to the home first to facilitate checking prior to dispensing. Copies of prescriptions are kept in a file and it is easy to check up on a particular residents medication to see what was prescribed, ordered from the pharmacy and received into the the home. All records were dated and signed. We were told that the treatment room was about to be refurbished. The room was rather congested but this could be resolved by using the storage cupboards more appropriately. A check of controlled drugs held in the home was carried. No discrepancies were found. All entries were legible and countersigned but there was no evidence of any regular controlled drugs checks. Care Homes for Older People Page 15 of 29 Evidence: We saw evidence of monthly audits being carried out by the manager, using a pre printed form for each residents medication. Any issues identified are recorded on the audit sheet and left in the file for a month to help raise awareness and change practice. The manager has recently issued all nursing staff and carers handling medicines with a personal copy of the medication policy. This is being followed up with one to one observation of each person involved in medication administration, by the manager, who then completes an assessment record. We were told that changes have taken place following the arrival of a new manager in the home. Staff felt that the new medication guidance, a review by the local pharmacist and the introduction of the audit tool had made a big impact on the control of medication in the home and had helped to develop better team working. Care Homes for Older People Page 16 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. People who live in the home are being encouraged and helped to be more independent and make choices for themselves. Social opportunities are still limited but improving. Evidence: The activities organiser who had been appointed at the last inspection left the home but a new person had just started work. She told us that she was spending time getting to know people so that she could introduce activities and social events that they would enjoy and benefit from. The regional manager has started monthly meetings for activities organisers in the homes she oversees as a means of support and an opportunity to share good practice and ideas. We saw notes in a care plan that said a resident should have the right to refuse to particiate in activities and this should be respected. This was a sensitive reminder to staff that choice should be promoted. Throughout the inspection we observed that the atmosphere in the home was much Care Homes for Older People Page 17 of 29 Evidence: brighter, lighter and inclusive. Staff were engaging with residents and were keen to tell us how they felt the home had improved since the new manager arrived. Staff recently held a surprise 80th birthday party for the husband of a lady who lives in the home. He is a daily visitor and was treated to a buffet tea and received a small gift and card from the staff. This was a very thoughtful gesture. The kitchen is shared with the adjacent home. We sampled all the menu choices for lunch. Food was hot, well cooked and nicely presented. Home made chocolate cake was served with the afternoon drinks. In the records for one person we saw an entry that said watching diet carefully as we have run out of thick and easy. A new supply was not ordered until two days after the entry had been made. Care Homes for Older People Page 18 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. Systems and procedures are in place to support and encourage people to raise concerns and complaints. Staff are getting training in safeguarding adults that will help them to understand their responsiblities and keep people who live in the home safe. Evidence: Policies and procedures are in place to support the receipt, recording and investigaiton of complaints and concerns. The regional manager monitors complaints and concerns and the actions taken as part of her regular visits to the home. We were told that a programme of delivering and updating staff training in safeguarding adults was well underway. Staff told us that they had enjoyed doing the training. They appeared more confident and keen to take part in the inspection. 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. People live in a homely environment that keeps them safe and gives them the chance to spend time privately. Areas of the home are more comfortable and pleasant for the people who live there and adapted equipment is provided when necessary. Evidence: A major refurbishment of the premises is underway and we saw that good progress is being made. Hallways, dining rooms and lounges are being re-organised and decorated. Some bedrooms have also been involved in this process. New equipment, beds, draws, wardrobes, chairs, tables and carpets have been bought and more are on order. The home has taken on a much brighter atmosphere and is welcoming to visitors. We saw one bedroom that had been set up for a new resident. It was warm, homely, well furnished, and included a welcome pack of toiletries and a card. Bedding was of a good quality. A large number of profile beds have been purchased to meet the needs of people living in the home and staff told us that this had made a huge difference to them when they are looking after people and delivering personal care. Care Homes for Older People Page 20 of 29 Evidence: One resident had been shown the new bedroom furniture and asked if she would like some. She told staff to give it to someone who needed it. We met the lady during our walk around the home and she showed us her bedroom. It was cosy and homely and set out in a way she likes. She enjoys spending time in her room. There is still an odour in the entrance to the home despite the attempts of staff to clean carpets and other areas. It thought to be from the carpets. The entrance and hallways have been measured for replacement carpets and this should resolve the problem. The laundry is now working to capacity, the problems with the water supply having been resolved. This is a very busy laundry as it supports both homes on the site. 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 adequate 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 protected through recruitment and selection procedures that are properly followed and staff training. Staff are supported to do their job and to understand about peoples differing needs and how to meet them. Evidence: The organisation has policies and procedures in place to make sure that people are properly recruited. We have previously seen that these have not always been followed. We looked at the records for three people recently recruited to work in the home. The staff files are now being kept in a more organised way and we saw that each file contained an application, references, criminal records bureau responses and interview assessment sheets. The new manager has introduced staff handover meetings. This means that people who are just coming on duty can be told about the well being of residents and any checks that need to be carried out or healthcare professionals who need to be spoken to. We spoke to a number of staff during the inspection and all were keen to tell us about the amount of training they had recently attended. Care Homes for Older People Page 22 of 29 Evidence: They also told us it was much nicer to work in the home now and they were getting training and equipment that helped them to do their job safely. Two nurses and six carers are on duty between the hours of 08:00 and 20:00, and one nurse and three carers overnight. The care team are supported by two domestic assistants. The improvement plan submitted after our last inspection told us that a Named Nurse and Key Worker system was being introduced to support staff with their job. Everyone has also completed Customer Care training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in a home that is now being run in their best interests, in an open and inclusive way. Policies, procedures and safe working practices are followed, helping to keep people safe and well. Evidence: The new manager has worked for the organisation for a number of years. She is qualified and experienced to run the home and has adopted a very pro-active approach to improving the physical standards and the care and support that people receive. We received a copy of the homes Annual Quality Assurance Assessment (AQAA) that told us about what was happening in the home, what they felt they did well, and areas that needed to improve. As well as the AQAA we received the homes Improvement Plan that tells us how they are going to meet the requirements we made at the last inspection. Care Homes for Older People Page 24 of 29 Evidence: All the requirements and recommendations we made in April this year have been met or work is well on the way to meeting them. Four Seasons Health Care have identified, agreed and signed off the homes refurbishment budget and have supported the manager to make sure work started quickly. As well as our last key inspection we carried out a random inspection in August to check that work we had told was starting was underway. This was a positive visit. We saw evidence of staff supervision and meetings taking place. The improvement plan also told us that nursing staff were going to be allocated supervision teams. This will clearly identify roles, responsiblities and support arrangements for people working in the home. We spoke to the handyman about maintenance and servicing arrangements. These are all up to date. Regular fire safety and water temperature checks are carried out and recorded. Tasks are set out on daily, weekly and monthly audit sheets. The nurse call system is also checked on a monthly basis to make sure it is working properly. Four Seasons are working with Royal College of Nursing to promote the Dignity in Care campaign. All Four Seasons homes in the North Eastern regiona are involved in this challenge. It is called Defending Dignity - Challenges and opportunties for Nursing. The organisation has clear policies, procedures and systems to support the safe handling of residents monies and the acceptance of fees. Regular audits are carried out to make sure that procedures are being followed. Care Homes for Older People Page 25 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 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 1 7 14 Care plans for people living 23/01/2009 in the home must be evaluated on a regular basis. This will mean that their health and wellbeing is kept under review and care plans are changed to meet any new or different needs. 2 9 13 The providers policies, 23/12/2008 procedures and best practice guidance must be followed when staff are dealing with medication. This will help to keep people who live in the home safe and well. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Better quality recording in daily records should be promoted, encouraging people to pay more attention to writing in a sensitive and non-judgemental way. Care Homes for Older People Page 27 of 29 2 7 Information recorded in care plans to help staff deliver care and support should be written in smaller paragraphs to encourage people to read the guidance. Staff delivering care and support to people living in the home should be helped to have a better understanding of how their actions might trigger behaviour that challenges normal routines. Medication, eye and ear drops, and inhalers with a limited life should be dated when opened so that staff know when they should stop using them. This will help to keep people who live in the home safe and well. The local guidance on how to order, receive, check medication orders and dispose of waste should be incorporated into the main policy document. This will help to support staff who are involved in the dispensing of medication and keep people who live in the home safe. The programme of activities and social opportunities should continue to be assesed and improved to make sure that people living in the home lead a stimulating and interesting life. Better control should be exercised over the ordering of products that people need to improve their diet. This will ensure that people are receiving all the nutrition they need to keep them well. The programme of training in safeguarding adults should be completed so that everyone is sure of their responsibilities and what to do if they are told about a concern, or observe poor practice. This will help to keep people who live in the home safe. Work should continue to meet the schedule of planned refurbishment and redecoration to make the home more comfortable and pleasant for the people who live there. People working in the home should continue to have the chance to obtain new qualifications and attend training. This will supported them to do their job and help to keep people who live in the home safe and well. 3 8 4 9 5 9 6 12 7 15 8 18 9 19 10 28 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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