Inspection on 26/11/08 for Lime Court

This inspection was carried out on 26th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lime Court 12/12/06

Lime Court 01/11/05

Lime Court 05/05/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lime Court Lime Avenue Dovercourt Essex CO12 4DE     The quality rating for this care home is:   two star good 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: Sara Naylor-Wild     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Lime Court Lime Avenue Dovercourt Essex CO12 4DE 01255506340 01255556805 catherine.stronach@excelcareholdings.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dovercourt Healthcare Ltd Name of registered manager (if applicable) Mrs Catherine Stronach Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 38 persons) The total number of service users accommodated in the home must not exceed 38 persons) Twenty one service user bedrooms with an area of less than 10 sq.m. will be used only following a written assessment. The essessment should include consideration of whether the facilities in the room are suitable for, and acceptable to, the service user, taking into account their mobility needs. The service user plan should reflect the assessment findings Date of last inspection 0 0 Over 65 24 38 care home 38 Care Homes for Older People Page 4 of 29 Brief description of the care home Lime Court is a large purpose built home situated in a quiet residential area at Dovercourt. The home is within easy reach of the sea front and local amenities. Accommodation is provided on the ground and first floor, which is accessed by a passenger lift. There are 30 single bedrooms and 4 shared rooms. The home has a secure central courtyard and garden with patio area that is accessible to service users. The home provides 24-hour care to older people with a wide range of dependency levels, who are generally physically and/or mentally frail. There is a large dining room on the ground floor and several lounges and small seating areas around the home on both floors. There is a visitors room for meeting relatives in private. The room can be used for an overnight stay if required by a visitor coming from a distance away. The fees charged by the service range from £352.24 and £412.16 per week. They do not include hairdressing, chiropody, optician care, toiletries, newspapers, dentistry or clothing. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 12 December 2006. This unannounced key inspection was carried out on the 26 November 2008. At the time of the inspection the previous registered manager had retired 6 weeks previously. The newly appointed manager was due to commence their post in the following week. The service was being managed by the deputy manager with support of their area manager who assisted the inspector throughout the site visit to the home. Feedback was given of findings during the inspection visit with opportunity for discussion or clarification. Care Homes for Older People Page 6 of 29 As part of the inspection we checked information received by the Commission for Social Care Inspection (CSCI) since the last inspection, looking at records and documents at the care home and talking to the area manager, deputy manager, care staff, people living at the home and their supporters. In addition the Annual Quality Assurance Assessment (AQAA) completed in August 2008, was considered as part of the inspection process and a tour of the premises was completed at the visit to the home. We would like to thank the deputy manager, area manager, staff, people living at the home and their visitors for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The risk assessment for people falling from bed and the use of bed rails requires review to ensure that staff understand the full range of options under consideration when reducing risk. The way in which people are supported to eat their meals requires further consideration to ensure that this is carried out in a manner that upholds their dignity. The provision of activities in the home require additional support to ensure there is consistent provision, especially for those people with cognitive impairments. Care Homes for Older People Page 8 of 29 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 considering moving to the home can be assured that their needs will be understood by the service before their admission. Evidence: The statement of purpose for the service is an informative document that sets out how people can expect the service to operate and what service they provide. It also sets out the assessment and admission processes that will be undertaken prior to someone moving to the home. The files of people who are living at the service were sampled and these contained documents relating to their admission and the actions taken by the service to understand their needs and how they can best support these. The documents on the file included a professional needs assessment provided by a Care Homes for Older People Page 11 of 29 Evidence: social worker, the services assessment of the persons daily living needs and an assessment form that either the person themselves or their supporters were asked to complete to provide further information about their lives from their own perspective. The questions asked in this form included what was their routine, and preferences in their day to day life, what things caused them anxiety and significant relationships. Together the documents would form a good basis for understanding the person and how their needs and wishes could be provided for. The service does not provide intermediate care. 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 living at the home can be confident that staff will understand how best to support them and that this will be documented to ensure consistency in the service delivery. Evidence: The care plans of people living at the service were sampled during the inspection. They contained instructions to staff in meeting peoples daily living needs that reflected peoples initial assessments. These included areas such as personal hygiene, continence and nutrition. The plans were generally written in a positive way that supported the focus on people as individuals with abilities and strengths that required support from staff. There was some variation in the quality of the information staff completed in the care plans, this would seem to indicate that further development through training in care planning would be beneficial. The plans also contained risk assessments that had been carried out in relation to a Care Homes for Older People Page 13 of 29 Evidence: range of issues. These included risks of falls, continence and skin integrity. They provided a clear indication of where people may have a higher risk of harm from the activity and how the service needed to react to support people in managing the risk. The risk assessments relating to the use of bed rails were discussed with the deputy manager during the inspection. The form was very comprehensive in its examination of the risks of falls from bed, however, the beginning of the assessment asked staff to determine if bed rails were the most appropriate solution and if not what would be? This required the staff member to have a full and updated understanding of the ways in which falls could be addressed, and the deputy manager and staff confirmed that this was not currently the case. This was identified as a point of development for the service. All the care plans and risk assessments were reviewed monthly and each outcome had a corresponding monthly evaluation of the plan completed by staff. The area manager said that the service was introducing a resident day where each person living at the home was allocated a date in the month where their care was reviewed and updated. Within the care plan file were also records relating to health appointments and the feedback from health professionals were included in the care planning document. The records provided a good audit trail of peoples attendance by health professionals and ensured that information was transferred to care plans for implementation. An observation of staff administering medication to people was undertaken at the midday meal. From these observances and discussions with staff it was evident that there was a good understanding of good practice in medication management. Staff were clear about the way in which records were to be maintained and how medication was received and disposed of. The assessments and care plans sampled all made reference to peoples choices at the end of their lives. On the whole the information related to their preferences for funeral arrangements, their choice of undertakers and which person had responsibility for carrying out their wishes. There is guidance available on the CSCI website to care homes in providing end of life care and the considerations they should make in supporting people at this point. Discussions with people living at the home indicated that they were very happy with the way staff conducted themselves, and how they met their needs. They told us I dont think there is anywhere as good as here, the staff are all lovely and work very hard to help us. Observations of staff interaction with people living at the service was carried out in a very positive, respectful manner which demonstrated knowledge of Care Homes for Older People Page 14 of 29 Evidence: them as an individual. A particularly good example was seen during the midday meal where the staff considered how a person with diabetes would feel about having a different sweet to the other people sitting at the table. They ensured that the persons choices were broadened so that they did not feel different from everyone else. A less positive reflection of respectful practice was also seen during the meal time. There are a number of people living at the home who cannot eat without staff support and need someone to sit with them and physically help them eat. However the ratio of people needing help was greater than staff on duty, which required each staff member to sit between two people and feed them alternately. Staff carried this out with as much sensitivity to peoples dignity as possible, they spoke to the people they were attending to and encouraged them to eat their meal. However this practice does not reflect the best practice in promoting people as individuals, who are treated with respect and dignity. Staff spoken with were aware of the shortfall and had identified from dignity training that this was not appropriate. The deputy manager and area manager were also aware and indicated that a new initiative called protected mealtimes was being introduced to address the issue. This would require all staff on duty including the manager, deputy manager and activities coordinator to attend the dining room to offer support to people who could not eat independently. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people living at the home can be assured that they will be provided with stimulation and activities that suit their preferences. However people suffering from dementia may find it difficult to engage in activities without additional support. Evidence: The service employs an activities co-ordinator to support the activities programme for people living at the home to take part in. This staff member had benefited from training in Sonas, an activity technique specifically developed to engage people with dementia. Unfortunately the staff member had experienced high levels of sickness absence and as a consequence their role had not been fully achieved or developed. The activities programme was being partially supported by a volunteer and other volunteers supported specific activities such as bingo. These people were valuable assets to the home, and were able to support people with full cognitive abilities to access the more limited programme. However they did not hold the skills in the Sonas programme and unfortunately people who experienced dementia did not gain the full benefit of the activities on offer. Care Homes for Older People Page 16 of 29 Evidence: The area manager was aware of the issues presented by the absence of the activities co-ordinator and indicated how the provision of activities would be supported to greater effect in the future. This included the appointment and training of more than one post holder. People spoken with during the inspection were appreciative of the opportunities for activities and said that there was plenty to do if you liked to take part. They were enthusiastic participants in the bingo on offer on the day of the inspection and spoke about the entertainment and outings that had recently taken place. People were receiving visitors throughout the day of the inspection, and those spoken with told us how much they liked the home and the staff working there. One person told us I dont think there is anything else like it in the area the staff are very good they show a lot of patience and respect to the people living here. The midday meal was observed being served and eaten during the inspection visit. There is a planned menu with a variety of choices for each meal. People living at the home are consulted each day about their choice from the menu on offer. Those people with cognitive impairments that affect their being able to make a choice in advance of the meal are shown the choices on offer as the meal is served. Staff were observed supporting people in a patient and dignified manner. They gave thought to the way people made their choices and supported them to do so. The way in which people were supported to eat their meal has already been detailed earlier in this report with relevant recommendations for improvements in the quality of the meal experience. People spoken with during the meal were fulsome in their praise of the meal. they felt the menu was broad enough to please peoples tastes and that the cooking was of a good standard. They said it is really tasty, and cooked well and I always like everything that is cooked, but it would be fine to ask for something else if you dont like it, they dont make a fuss about it. 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 living at the home can be confident that they will be listened to and their concerns acted upon. Evidence: The service has a complaints policy that is open and has clear guidance of the processes that would be followed if a complaint was raised. The policy is included in the service users guide provided to people before they move to the home and advertised within the premises. There had not been any complaints recorded since the last inspection and the Commission has not been made aware of any concerns relating to the service. The safeguarding of vulnerable adults policy set out how the service responded to allegations of abuse and included the expectations of staff to report incidences. The procedures reflected the guidance provided by the Local Authority, who have lead responsibility in safeguarding issues. There was evidence in the staff files that safeguarding is covered during their induction and further annual training sessions are given to keep staff updated. Staff spoken with during the inspection gave a good account of the whistle blowing policy of the home and how they expected reports of alleged abuse to be responded to by the service. The home has a whistle blowing policy to protect staff if they report any concerns. Care Homes for Older People Page 18 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can be confident that the premises will be suitable to meet their needs. Evidence: A tour of the premises was undertaken at this inspection visit. They were clean, well decorated and comfortable. There are a number of communal spaces available for people to use as well as their own personal space provided by their rooms. The dining rooms provide opportunity for people to eat in smaller groups and ensure that people who require support have sufficient space for staff to assist them with dignity. Peoples bedrooms were viewed with their permission, and the deputy manager was careful to knock on all doors before entering. The rooms were bright and comfortably furnished with many personal items brought in at their admission by the person themselves. There is ongoing redecoration planned for the home and a maintenance plan for refurbishment of equipment and the materials. Care Homes for Older People Page 20 of 29 Evidence: The laundry facilities provide suitable levels of infection control to meet the management of soiled linen. There is dedicated laundry staff and a system of alginate bags are used to reduce the risk of cross contamination from soiled linen. 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 living at the home can be confident that there are staff with skills to meet their basic needs. They would benefit further from staff who had received a more varied training programme. People are supported by staff in sufficient numbers to meet their needs, however they would benefit from an increase in staff availability at mealtimes and to support them in activities. Evidence: The staff duty rota demonstrated that there were five care staff and a senior care staff working during the waking day. This number had been increased from five care staff in the morning and four care staff in the afternoon in response to feedback from staff and assessments of peoples needs carried out in recent weeks. The assessments were used to inform a staffing calculation tool and copies of this seen during the inspection demonstrated that the staffing levels for the service was above the recommendations of the tool. Staff were supported by ancillary roles of a housekeeper, laundry staff and servery staff (who supported the delivery of meals during the lunchtime period), as well as the cook. Feedback from staff was, however, overwhelmingly negative about the shortfalls in the Care Homes for Older People Page 22 of 29 Evidence: availability of care staff and the impact they felt this had on the support they provided to people who lived at the home. Although neither the people living at the home or the relatives spoken with felt this had affected the quality of the service, there was also awareness that staff were hard pushed to do everything. This was discussed during the inspection with the area manager, who recognised that there had previously been some staff shortages. They stated that high sickness levels had been a factor in this, as well as a reluctance to use agency staff to cover absences. In addition the assessment of needs carried out for each person living at the home gave an up to date understanding of the requirements for staffing to meet these. On the day of the inspection staff were generally attentive to people, although the cover of both the meal time and the afternoon planned activity were affected by the staff availability. Measures being taken by the provider to address these areas had already been highlighted in this report. The files relating to the employment records of four staff were considered at this inspection visit. The records contained relevant employment checks such as a full application form, full account of employment history, two written references and checks made against the Criminal Records Bureau (CRB) and the Department of Healths Protection of Vulnerable adults (POVA) list . These checks support the service in ensuring that the applicants are suitable to work with vulnerable adults and reduce the risk to people living at the home from abuse. New staff are inducted using a format that meets the Skills for Care induction standards. This is a competency based process where staffs knowledge and skills are established and signed off in a workbook during their initial period of employment. This provides a good basis of understanding for the employee in their role and what the service expects of them. Staff training already undertaken for the current year included health and safety matters such as food hygiene, fire safety, first aid, moving and handling. There was also training in Safeguarding vulnerable adults, loss and bereavement and continence management. The annual training programme was already booked with a local training company for 2009. The subjects covered included all the areas required by health and safety legislation as well as some topics such as dementia care that supported staff in meeting the needs of people living at the home, although there would be benefits to both staff and people they support if there was a greater range of topics relating to their assessments of need. Care Homes for Older People Page 23 of 29 Evidence: There was not a matrix of staff training needs or subjects they had already been trained in. This document would assist the manager to understand where the staff teams strengths and shortfalls were in their skill base to meet the assessed needs of people living at the home. Care Homes for Older People Page 24 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 living at the home can be assured that they will be consulted and their views taken into account in the day to day operation of the home. Evidence: At the time of the inspection the previous registered manager had retired and the newly appointed manager was due to commence their post the following week. During the 6 week interlude between the post being filled the deputy manager had with support from the organisation carried out the role of manager of the service. There are quality assurance systems operated in the service with annual surveys and action plans created to report on the progress the service had made in responding to comments. The organisation has also carried out a telephone survey shortly before the inspection to determine how relatives viewed the service, following issues that had arisen in another service owned by the organisation and local newspaper reports. The feedback from the relatives were generally very positive saying things like the home Care Homes for Older People Page 25 of 29 Evidence: is superb, the staff work their fingers to the bone, it is a very clean home, no complaints at all it is such a welcoming home and all are very pleasant. There were a few comments relating to perceived staffing turnover and shortages that affected the activities in particular, however the service had already begun to address these issues at the time of the inspection. Staff meetings and communication between the management and staff was stated by staff to have been very good in the past and this was planned to continue with the new manager, who was attending the home prior to commencing her post to meet all the stakeholders involved with the service. The maintenance and safety checks of equipment and systems operated in the home were in place and evidence was seen in safety certificates and maintenance records of the most recent checks. These included passenger lift maintenance, gas and electrical safety certificates, fire safety systems and moving and handling equipment. Care Homes for Older People Page 26 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 27 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 7 How risks are assessed for bed rails should be reviewed to ensure that staff carrying out the assessment have the best information to make their decision about the most suitable equipment to be used. The way in which people are supported to eat their meal should be reviewed to ensure that this is carried out in a manner that provides the most dignity and respect to the individual. The service should ensure that their is a variety of opportunities for activity that suit a range of interests and abilities. specifically this relates to the consistent provision of activities for people with dementia and other cognitive impairments. The service should ensure that they support people to eat meals in a way that maintains and upholds their dignity. The deployment of staff during mealtimes and when people are participating in activities should be developed to ensure sufficient support to individuals during these periods. The training programme for care staff should reflect the skills required to meet the assessed needs of people living at the service. Page 28 of 29 2 10 3 12 4 5 15 27 6 30 Care Homes for Older People Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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