Inspection on 02/04/09 for Kensington Lodge

This inspection was carried out on 2nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kensington Lodge 02/04/07

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: Kensington Lodge 53 Broadmark Lane Rustington West Sussex BN16 2HJ     The quality rating for this care home is:   zero star poor 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: Annie Taggart     Date: 0 2 0 4 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 30 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 30 Information about the care home Name of care home: Address: Kensington Lodge 53 Broadmark Lane Rustington West Sussex BN16 2HJ 01903786003 01903779160 kensingtonlodge@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr G S Nijjar,Gurkirit Kalkat Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 18 The registered person may provide the following category of service: Care home only ( PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection Brief description of the care home The home is a detached property close to the town centre in East Preston, which has bus and rail links. Care Homes for Older People Page 4 of 30 Over 65 0 0 18 18 Brief description of the care home Accommodation is provided on two floors, with passenger lift access. The home provides residential accommodation for up to 18 residents who are over the age of 65 who have suffered or suffer from mental illness or dementia. The registered manager is Ms Deborah Chant, and the registered provider is Mr Gurkirit Kalkat. Fees are approx 429 pounds to 600 pounds per week. Care Homes for Older People Page 5 of 30 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: zero star poor 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: In preparation for this inspection visit an Annual Quality Assurance Assessment (AQAA) was sent to the manager for completion and this was returned in the given timescales giving us good information about the services on offer in the home. We also read the last inspection report and any information received since the last visit. Surveys were sent to service users, staff and other professionals involved with the home. Six service user, five staff and one professional survey were returned all making positive comments about the home. All of the service user surveys had been completed by family members of behalf of service users The unannounced visit was carried out by Annie Taggart at 9.30am on Thursday 2nd April and the visit lasted for five hours. During that time we met with the people living in the home in both communal areas and in their private bedrooms, we talked to the staff on duty and were able to meet with four visitors to the home. Care Homes for Older People Page 6 of 30 We tracked four care plans and all supporting documentation such as daily records and activity plans and we assessed the system for the recording and administration of medication. We saw lunch, the main meal of the day being prepared and served and we looked at food records kept in the home. We saw the incident and accident reports, fire records, maintenance records, complaints and concerns processes and we also tracked four staff recruitment records and the staff training records. The Registered Manager of the home was on leave and the registered manager of another home in the group came in to assist with information for the visit and to receive feedback What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 Care Homes for Older People Page 8 of 30 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. There is clear information available about the services on offer in the home, people have their needs and wishes assessed before they come to live in the home and contracts of terms and conditions of residency are agreed. Evidence: There is a Statement of Purpose and Service User Guide in place that gives prospective service users and their families clear information about the services on offer in the home. A comprehensive pre- admission assessment process is carried out and documented before people come to live in the home and we saw that a sample contract had been signed by the service users representative and was dated. Kensington Lodge does not provide intermediate care. Care Homes for Older People Page 11 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and daily records do not give sufficient information to evidence the actual care being provided to service users, people are not always being treated with dignity and respect and improvements are needed to the system for the recording and administration of medication. Evidence: We tracked the care plans and supporting records for four service users and also looked at the records of three people who were being cared for in bed. The care plans had been recently reviewed but did not give clear and current information for staff to follow and did not adequately record the care actually being given to people. Examples of this were that for three people who were being cared for in bed there were food and fluid intake charts in place. The charts recorded that people were turned two hourly but no fluid intake was recorded from 6.30pm on 1/4/09 to 8.30am on 2/4/09. Food records said ate well or meal eaten but did not record what the person actually ate for their meals. People were being cared for on pressure beds with assistance from the district nurse team but there was no record of what setting the pressure beds should be set at. For one person, who was very slight in build, the pressure bed was set at Care Homes for Older People Page 12 of 30 Evidence: over 80 and felt very hard to the touch. During the visit the manager of the home was away and the manager of another home in the group came in to assist with the inspection. We pointed out the potential risk of bed settings being knocked or changed, for example when the room was being cleaned and the manager said that they would contact the district nurses and ask them to re-assess the people for pressure care. One service user had a bruise on their forehead and we tracked the records to assess how this accident had been managed. Daily records showed that the person had fallen and hit their head on a table and following this had vomited twice. An accident form and daily records had been completed but there was no record of medical advice being sought following the fall. We were subsequently told via an email following the visit that there were paramedics in the home at the time of the incident and they had checked the person over, but as this was not recorded at the time either is the accident report or daily records it could not be verified during the visit. Records showed that people have access to their local doctor and to other professionals such as the district nurse team chiropodists and mental healthcare professionals During the visit we saw a service user being given a full wet shave at the dining room table in front of all other service users and any visitors that might come to the home. The staff member carrying out the shave said that this was custom and practice as the person in question liked to get up early and then would not go back to their room for a shave. Another service user had dried faeces under their fingernails even though people had just been helped to get up and their care plan said that they had received personal care. We pointed out to the manager and staff member that this did not provide evidence of people being treated with dignity and respect at all times. When visiting service users bedrooms we saw that some peoples beds had been made but there was soiled bed linen and in a number of rooms there was no call bell for people to use. We asked the staff on duty why this was and they told us that as people had dementia they were not all able to use a call bell. There were no risk assessments in place to evidence this or to show how people were being monitored in the night other than night staff two hourly rounds. When looking at the medication management system we saw that although staff had received training in the administration of medication there were errors in the Medication Recording Charts (MAR) and in administration records. Many of the charts had been handwritten and were very untidy and difficult to read. There are no trained nurses on the staff team who have the authority to transpose medication records by hand and the records were not signed to say who had written them, not where they Care Homes for Older People Page 13 of 30 Evidence: dated. On one occasion in the week of the visit a persons lunch time medication had been signed for but was still in the pack. On another occasion for sixteen days a persons MAR chart was signed as O (other) without an explanation of what this meant in practice. The visiting manager said that the local Pharmacist had been called to review and update all the medication procedures in the home. Care Homes for Older People Page 14 of 30 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. In order to provide regular interest and stimulation for people a programme of activities suitable for people with dementia must be provided and nutritional plans, meal planning and menus must be improved to ensure that people have a choice and are given sufficient support where needed. Evidence: From looking at an activities plan and daily records we saw that people are offered some activities in order to provide them with interest and stimulation, however there is only one activity per day being provided and sometimes this is nail care or in the case of one person had legs creamed. We asked the visiting manager if they thought that these activities should have come under the heading of personal care not social activities and he agreed that this would be more appropriate. During the day we saw that most service users sat in their chairs dozing for much of the time and some wondered about. Some people were watching the television but as this was only a small set in a rather large lounge area it was difficult for most people to see. We spoke to three visitors who told us that they were made welcome at any time and all were complimentary about the home, describing the staff as kind and caring. Care Homes for Older People Page 15 of 30 Evidence: From looking at menus and food records we saw that people are offered a range of fresh, home cooked meals but observation during the day showed that this does not always meet peoples preferences. An observation was carried out over the lunch time period and we saw that because there are a number of people who need assistance with meals, others had to wait and their meals went cold. One person pushed their meal away untouched and a staff member asked if they would like something else, the person said they would like a sandwich and this was provided. When the same thing happened with another service user, the staff member took the meal away untouched without asking if the person would like something else, later after being reminded that the person had not eaten, the meal was brought back and again refused, the staff member was taking it away again until reminded to ask the person if they wanted something else, when this was done the person said they would love a cheese sandwich and this was provided. There are nutritional assessments completed in the care plans but there is then no follow up monitoring system to record what people actually eat each meal time and if they are provided with sufficient nutrition each day. We spoke to the chef on duty who told us that although alternatives are available, people are not offered a choice of meal each day as having dementia they would not be able to make a choice. There was no list of peoples likes, dislikes and nutritional needs in place in the kitchen and everyone was given the same meal. Care Homes for Older People Page 16 of 30 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. Although complaints are recorded and acted upon and the staff team have received safeguarding training there needs to be more awareness of how some service users can impact on the well being of others. Evidence: The home has a complaints procedure, a copy of which is included in the Statement of Purpose and also displayed in the home. From looking at records we saw that complaints are recorded and acted upon in a timely manner and outcomes are fed back to complainants. Complaints are currently recorded on loose sheets and are not numbered and we suggested that for safety and monitoring purposes they should be kept in a numbered book. From looking at staff training records we saw that the staff team attends safeguarding training and the staff on duty at the time of the visit were aware of their responsibilities to report any suspected abuse. Observation during the day identified one service user who was acting in a sarcastic, bullying overbearing and unkind way in their dealings with another service user who appeared to have more advanced dementia that they did. This was pointed out to the visiting manager as a cause for concern as when the person came to speak to the inspector they were told by the other person to keep walking or I will deal with you later, which sounded quite threatening. The manager said that there was an Care Homes for Older People Page 17 of 30 Evidence: awareness of the issues and that he would ensure that the situation was reviewed. One safeguarding referral made by the home has been investigated by the West Sussex Safeguarding team and has now been resolved. Care Homes for Older People Page 18 of 30 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. To ensure that the home is clean, hygienic and well maintained, improvements are needed to the environment, peoples bedding should be of a good quality kept clean at all times and records must be kept up to date. Evidence: Observation on the day of the visit showed us that although there have been improvements made to the environment there are other areas that need to be addressed. Recently some bedrooms have been redecorated, some new equipment and furniture has been purchased and new carpets laid in communal areas. People told us that they were happy with their private bedrooms and visiting families told us that they thought that the home always looked bright and clean. As previously stated in this report, several beds had been made with unclean and stained bedding in place and we saw that the quality of bedding was not good with nylon bed covers being old and having ripped lining that was in holes. This was brought to the attention of the visiting manager who asked the staff to strip and remake the beds, discarding the ripped bed covers. Also as previously stated a number of rooms did not have a call bell in place and there were no risk assessments to evidence why this was the case. The downstairs bathroom was in a poor state of repair and decor and some of the upstairs bedrooms are also in need of redecoration. The visiting manager told us that this was because the home had been awaiting Care Homes for Older People Page 19 of 30 Evidence: planning permission to extend and improve the downstairs bathroom and as this had now been granted a new specialist bath would be fitted and other areas of the home refurbished. We looked at fire records and saw that regular checks are undertaken and staff receive fire training. Maintenance records were in place and were generally up to date but in the downstairs bathroom, where there were guidelines and charts in place to record water temperatures each time someone was bathed, these had not been completed since 21/02/09. Care Homes for Older People Page 20 of 30 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. Records show that the home carried out a robust recruitment procedure and the staff team receive an induction and training suitable to their role. Further guidance must be provided to the staff team to ensure that they are fully aware of their roles and responsibilities. Evidence: From looking at staffing rotas and staff records we saw that there are three staff members on duty both on the early and late shift and there was also a cook and a cleaner. Two waking staff are on duty during the night. The manager of the home is usually available during the working day but at the time of the visit was away on leave. One of the staff members on duty was designated as a senior carer. In the AQAA we were told that this staffing ratio meets the needs of the people currently living in the home and we are told that of twelve full time staff, seven have NVQ in Care at level 2 or above. We looked at the recruitment records for four members of staff and saw evidence of an interview process having been carried out, references were in place as were current Criminal Bureau Checks (CRB). In all we checked the records for eight members of staff and CRBs were in place for all of them. New staff receive a structured induction and we saw evidence of work books kept on file in the home. There is a programme of training and development in place and as well as statutory training such as infection control and first aid we saw that people Care Homes for Older People Page 21 of 30 Evidence: also attend safeguarding training, mental health awareness, dementia awareness and medication management. Observation during the day showed us that the staff on duty were kind and caring in their dealings with service users and families and service users were complimentary about the staff team. However as previously detailed in this report it also showed that some of the basic needs of service users were not being met, this was especially true at peak periods such as mealtimes. There was a process in place for the supervision of the staff team, some supervisions were recorded but these were not all regular or up to date. Care Homes for Older People Page 22 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is evidence to show that the standards of management of the home have deteriorated since the last inspection visit and improvements are needed to health and safety monitoring Evidence: The registered manager has worked at the home for sixteen years and has the qualifications and experience to manage a care home. Although the staff team and families speak highly of the managers approach and personality, both in surveys and in person during the visit, this inspection has identified that standards of care within the home have fallen since the last inspection visit. There are regular Regulation 26, Registered Providers visits carried out and outcomes are recorded but these records are very brief and do not address all areas of management of the home. The visiting manager told us that the format is currently under review and in future will be much more comprehensive with an action plan included. Regulation 37 reports concerning incidents and accidents in the home are Care Homes for Older People Page 23 of 30 Evidence: sent to the Commission as required. We are told that the home does not handle monies on behalf of service users and that the process is for personal expenditure is for this to be invoiced to families or personal representatives. A quality assurance process is in place that elicits the views of families and professionals involved with the home and outcomes have been collated. Evidence during the visits show us that records and health and safety monitoring need to be improved to ensure the safety of both service user and the people working in the home and this includes improvements to the care planning and risk assessment process, incident and accident recording, medication management records, improvement to the environmental standards, re-assessing the numbers of staff on duty during peak period and staff supervision records. Care Homes for Older People Page 24 of 30 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 30 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 Care plans must be kept under review and give current information to guide the staff team This is so that the people living in the home receive care in the way they wish and need to meet their assessed needs. 20/05/2009 2 8 12 Care plans must ensure that they clearly guide the staff team to the the correct use of pressure relieving equipment. this is to ensure that service users are safely cared for when staff are caring for people in bed. 20/05/2009 3 9 13 There should be a full review 20/05/2009 of the system for recording and administering medication within the home. This is to ensure that service users received the Care Homes for Older People Page 26 of 30 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 medication they need and to ensure that records are safely managed. 4 10 12 People should receive personal care in a way that protects their dignity, privacy and healthcare. This is because observed staff practice showed that people were not always being treated with dignity and respect. 5 12 16 A programme of activities and outings must be provided that are designed for people with dementia This is to ensure that people are offered stimulation and interest on a regular basis. 6 15 16 Advice must be sought from a nutritional professional to ensure that assessment and monitoring plans are put in place and people must be offered a choice at each meal time. This is to ensure that there is a clear record of what people are eating and drinking to ensure that their nutritional needs are met and that they are being given a choice. 20/05/2009 20/05/2009 20/05/2009 Care Homes for Older People Page 27 of 30 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 7 26 13 The people living in the 20/05/2009 home must be provided with suitable quality bedding that is kept clean at all times, water temperatures must be recorded where there are charts in place to record this and where people do not have a call bell in place the reasons must be recorded and risk assessed. This is to ensure that people are being safely cared for, that they have the equipment they need and that infection control is managed. 8 27 18 There should be sufficient staff to meet peoples assessed needs at all times. This is to ensure that during peak periods such as when people are receiving personal care, being cared for in bed and at mealtimes there are sufficient staff to meet peoples needs without them having to wait for care. 20/05/2009 9 36 18 Staff must receive supervision and this should be recorded at least six times a year This is to ensure that the 20/05/2009 Care Homes for Older People Page 28 of 30 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 staff team have the skills, knowledge and support they need to safely support the service users in their care. 10 38 13 Records such as care plans, medication records, hot water temperatures and incident and accidents must be kept up to date and in good order This is to ensure that service users are being safely supported, that health and safety issues are addressed and records are in place to evidence the care people receive. 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 20/05/2009 Care Homes for Older People Page 29 of 30 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. 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 30 of 30 - 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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