Inspection on 02/12/08 for Littledale Nursing Home

This inspection was carried out on 2nd December 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Littledale Nursing Home 11/01/07

Littledale Nursing Home 15/11/05

Littledale Nursing Home 07/07/05

Littledale Nursing Home 24/08/04

Littledale Nursing Home 25/05/04

Littledale Nursing Home 23/03/04

Similar services:

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Abbey The

Snydale Care Home

Hawkhills

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Littledale Nursing Home 669 Prince Of Wales Road Sheffield South Yorkshire S9 4ES     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: Stephanie Kenning     Date: 0 3 1 2 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 28 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 28 Information about the care home Name of care home: Address: Littledale Nursing Home 669 Prince Of Wales Road Sheffield South Yorkshire S9 4ES 01142611644 F/P01142611644 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Abdul Majid Khan,Mrs Tahir Majid Khan Name of registered manager (if applicable) Mrs Janet Cooper Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 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 category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Littledale is a 30 bed nursing home in a large detached property. There is a 7 bed unit accross the road that is currently closed. The main house is a spacious property; it has one lounge, one dining room and a conservatory. Only one bedroom has an en-suite. Both properties are situated on a main road and accessible to community facilities such as shops, pubs, parks and a post office. Both buildings have small gardens and a car park. Copies of the last Commission For Social care inspection report were available for Care Homes for Older People Page 4 of 28 care home 30 Over 65 30 0 Brief description of the care home service users and their families to read. The weekly fees are from £327 to £467 per week. This information was provided on the 2nd December 2008. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Care Homes for Older People Page 5 of 28 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: This was an unannounced key inspection carried out by Stephanie Kenning, Regulation Inspector. The site visit took place over two days, on the 2/12/08 and 3/12/08 and lasted for about 13 hours in total. The Registered manager Janet Cooper was present throughout the visit, and the provider Dr Khan attended for part of each day, including for feedback at the end of the visit. Prior to this visit an inspection was last carried out on the 11th January 2007. There was an Annual Service Review carried out on 5th February 2008. The outcome of that review was that the home continued to provide a good service. We have reviewed our practice when making requirements, to improve national Care Homes for Older People Page 6 of 28 consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which gave some information about what the home was doing well and plans for improvements. Information from the AQAA is included in the main body of the report. Questionnaires were sent to the home to distribute to people living and working there, and to any visiting health professionals. CSCI received three from people living at the home, and two from staff. Comments from these have been included in the main body of the report. During the site visit opportunity was taken to make a tour of the premises, including some of the bedrooms, inspect a sample of care records, check records relating to the running of the home and check some of the policies and procedures. Time was spent observing and interacting with people living at the home, and some of their comments have been included in the main body of the report. Six members of staff, three visitors, and visiting health professionals also spoke to the inspector about the home. The inspector checked all the key standards and some additional standards. The inspector wishes to thank the people at the home for their time and co-operation throughout the inspection process. 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.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 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their needs assessed prior to the home assuring them that they can meet those needs, but did not always have enough information about the home. Intermediate care is not provided at this home. Evidence: We wanted to understand peoples experiences when they decide whether to choose this care home, and what it is like for people if they did decide to move there. We spoke to some people living there, visitors, the manager, and staff working at the home. We also used information from surveys sent to people at the home and the information provided in the Annual Quality Assurance Assessment. We looked at the information the home give to people and how they assess whether they can meet peoples needs. People are assessed prior to admission by one of the registered nurses and it was Care Homes for Older People Page 10 of 28 Evidence: noted that this was predominantly whilst people were in hospital. This means that few people are well enough to make a positive choice about the home themselves and usually rely on relatives or friends to visit the home for them. One relative said that she chose the home because she felt that the staff were caring, and that it was close to her home. Someone living in the home said that although he was happy there, he didnt feel that he had any choice about where to live. The assessments carried out are recorded and kept in peoples files. They cover the required areas and identify where people have needs. These then link into the care plans in separate sections, so that people can have their identified needs met. People are given information packs before admission that tell them about the home, however some of the information was out of date and needs to be corrected. People living in the home did not remember having this information, and three people said that they did not have sufficient information about the home before moving there. Care Homes for Older People Page 11 of 28 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. People had their basic care needs met regarding health and personal care, including medications, but good management of these areas would improve the standards. Evidence: We wanted to understand how people had their health and personal care needs met. We spoke to people in the home, observed practices in communal areas, and looked at records and medication systems. People said positive things about the care given and about the staff. One relative said, I always feel that my mum is being cared for here, and she likes the staff, who are good to her. Another person said, I get well looked after, and the meals are nice. A GP commented that the home was caring, with no ongoing issues. People have access to health care services both within the home and and the local community. The manager has obtained the services of a dentist with the help of the PCT, so that people can have dental care more easily. The staff monitor the health Care Homes for Older People Page 12 of 28 Evidence: needs and take appropriate action themselves or get other health care professionals to help and advise. There are care plans for individuals based on the needs assessed on admission, and these give a record of some of the care given. They are not clear about specific things that happened to each individual giving more general statements such as care as plan. Only registered nurses regularly contribute to these records and care staff rarely even read them, though they were able to describe the care required by individuals. It was unclear whether people were involved in their own reviews, or if relatives were involved, or neither. Some sections in the records were uncompleted, such as the social profile, the section on death and dying, and the record of belongings, limiting the knowledge about that person, and not protecting their property. Not all people using wheelchairs had footplates in use, which can harm people. This had been identified by the local authority contracts monitoring team who had required the home to complete risk assessments and signed agreements where not in use. Medication was administered by the Registered Nurses at the home, and generally followed good practice, with one example of poor practice corrected during the visit. No one has responsibility overall for managing medicines, and the practices are not observed or audited, which means that poor practices can go on undiscovered. Staff were careful to care for people in private, but people could be seen using one bathroom, with a toilet, on the ground floor when the individual was unable to close the door properly themselves. During the visit a curtain was put on an existing pole in this bathroom to try to screen people from the corridor, but the situation requires constant staff vigilance to protect peoples dignity. Care Homes for Older People Page 13 of 28 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. People do not have many opportunities for social activities and other stimulation, though food provided was of a good quality. Evidence: We wanted to understand peoples daily experiences and opportunities for social contact and leisure. We observed the routines, the meals, and the activities taking place and spoke to people living in the home. We looked at the records of activities, routines and meals. People living in the home made the following comments: There are no activities or outings. Its the same things over again. We get taken on shopping trips often. This I like, something I could no longer do by myself. We get fed well. Despite a chart displayed in the hall detailing activities each morning and afternoon the manager admitted that these did not happen. There is no one employed to organise and carry out activities so the care staff do what they can when they have Care Homes for Older People Page 14 of 28 Evidence: time, meaning that in reality very little stimulation to people in the home is provided. During the visit the manager put on a video tape of songs from the war. The lounge has two televisions, both of which were on all day and often on different programmes causing a distraction. Many people were sat watching the screens or asleep in their chairs. A row of people sat in the hallway said that it was an interesting place to sit and watch people, in the absence of anything else happening. One care plan recorded no interests in that section, and others were not very detailed in respect of social activities and preferences, showing that it is not an area that is given very much priority. Notices and noticeboards intended to give people information, such as which staff are on duty that day, were of poor quality and difficult to read even with good eyesight. The menus for four weeks were stuck on the dining room doors, but they were small print, and people did not know which menu was current for the week. People generally liked the food and it looked appetising and well cooked. The main cooked meal was served to everyone on small plates regardless of appetite, and whilst people could have more, most did not. Staff assisting people with meals were not communicating very much, and the dining room was fairly quiet and sombre. Care Homes for Older People Page 15 of 28 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. People are not being fully protected by the homes policies and procedures, however the provider has taken action towards rectifying this. Evidence: We wanted to understand how people were protected from abuse or neglect and how the service responds to complaints. We looked at records, policies and procedures and spoke with people living and working at the home. We also spoke to social workers involved in the monitoring visits to the home. People living at the home were generally satisfied with their care and stated that they would talk to the manager about any concerns. They were not aware of the complaints procedure nor did they recall having any written information about it. People did feel that the staff listened to their concerns and acted upon them. A recent safeguarding investigation highlighted the lack of knowledge about safeguarding people by the manager and staff of the home. During the investigation a further incident was revealed requiring investigation, and Sheffield Social Services conducted a monitoring visit to the home where they identified many areas for improvement on an action plan. These included procedures for handling peoples monies, staff training, review of policies and procedures, including safeguarding people. Care Homes for Older People Page 16 of 28 Evidence: The manager had obtained a copy of the local safeguarding procedures, but was still not familiar with them. She was awaiting attendance at a training course to help her to understand them more fully. At the same time as the visit the provider was meeting with Social Services to show how he would meet the requirements of the action plan. He had obtained the support of another provider to help him to achieve this, and had enlisted the help of his son to support the manager of the home. These improvements were already being put in place. Care Homes for Older People Page 17 of 28 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 poor 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 home that is warm and mainly safe, but is need of improvement and organisation. Evidence: We wanted to understand what it was like to live in the premises and whether they were appropriate for the lifestyles of the individuals living there. We were shown around the premises including some of the bedrooms. We talked to people about their experiences of the home. We also walked around the building with the provider at the end of the visit to explain our findings. We identified many areas for improvement that affect the lives of people living there including: Saggy chairs with no or stained cushions. Rusty bed rails, wheels and bedtables. Missing curtain hooks including on privacy screens. Dishwasher solution stored in a sluice (dirty) area. Damaged decor especially to paintwork. Dirty bins, and bins with no lids. Bathrooms with dirty and stained decor, worn toilet seats, damaged flooring, mould, storage of incontinence products, and one used permanently as a store. Staff wash hand basin, and some bedrooms with a trickle of warm water. Smoking in the entrance conservatory so that people had to walk through smoke and it drifted in to the home. Some of the lockable facilities in bedrooms did not work. Care Homes for Older People Page 18 of 28 Evidence: The provider, during the visit, agreed to purchase new furniture, address problems and redecorate. There were other areas of concern such as two different televisions on in the same lounge, causing difficulties particularly when different programmes were showing. Notice boards were out of date and contained some staff information, with little thought given to making clearly read and appropriate notices for people living in the home. The white boards in use were too damaged to write anything clearly, and so they could not be useful to the people in the home either. The previously mentioned privacy problem when using the ground floor bathroom. These show a lack of organisation and management for the best interests of people using the service. Care Homes for Older People Page 19 of 28 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 felt well cared for by staff that they liked, but there had been some slippage on procedures in regard to recruitment and training that could have put people at risk. Evidence: We wanted to understand how staff were recruited and trained to ensure that they could carry out their jobs well. We talked to people living at the home, visitors and staff, including the manager and the owner. We checked the recruitment files and the training records to see if procedures had been followed. We looked at the questionnaires returned and noted the comments they had made. People were complimentary about the staff and the manager of the home and felt well cared for generally. A relative said the home may look shabby but I feel that I can trust the staff to care well for my mother. A person living at the home said If we have any problems they help to sort them out. Another person at the home said the staff are angels, I could not manage without them. In discussions with the staff they were very familiar with the needs of people in their care. Some staff were familiar with care plans, but not all, meaning that they relied on information being passed on verbally and may miss something. They worked from task to task, the routines determined by the time of day rather than by peoples needs. Care Homes for Older People Page 20 of 28 Evidence: They wanted better facilities for people, such as nice furniture and decoration, but were also very concerned about people sharing the six double rooms, and the lack of en-suite facilities. Minimum staffing levels were usually met with many staff being employed for several years. To prevent the use of agency staff the manager and other staff covered a variety of jobs within the home, which helped with continuity for people, but resulted in tired staff and a lack of management. Staff did not individually have areas of responsibility, that would improve the organisation and running of the home on a day to day basis. The recruitment files sampled showed that generally safe recruitment procedures had been followed , but on occasion had not, putting people at risk. A local authority contracts monitoring visit had had identified these problems and there had been improvements made to safeguard people at the home. The monitoring visit had also identified gaps in training and plans had been made to update these areas. There is a high proportion of staff trained to level 2 or 3 NVQ in Care, according to their Annual Quality Assurance Assessment, showing that there has been a commitment to training previously. Some of the registered nurses have received training in catheterisation and taking bloods, and several staff had attended sessions on pressure relief, infection control and diabetic diets. The manager acknowledged a difficulty in arranging training at suitable times for night staff and planned to address this within the forthcoming training. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home has been affected recently and now has additional support to improve it. Evidence: We wanted to understand how the home was managed and ensured a quality service for the people living there. We talked to people in the home, visitors and staff, including the owner and manager. We looked at some records, policies and procedures of the home. The Registered Manager is Janet Cooper, an experienced nurse and manager who has been at the home for many years. The home is owned by Dr Khan who admitted to rarely getting involved with the running of the home, and was not always up to date with the reports of his monthly visits. Following an investigation into a serious incident at the home and the identification of many areas in need of urgent improvement, Dr Khan has provided some additional support on a daily basis, via his son Rashid Khan, Care Homes for Older People Page 22 of 28 Evidence: consulted another provider for advice, and agreed to a programme of improvements. This had just started at the time of our visit, but we were shown changes and planned changes that would improve the lives of people living there. We talked to people in the home and found that generally they liked living there. They felt that they had choices in some areas such as food, but did not really get to express their concerns about the lack of activities, and other issues. They did not like to complain because they liked the staff and the manager and could see how hard they were working. Relatives felt that people were cared for and safe and therefore that was their priority, but would like improvements to activities and the building. Responses from the questionnaires were very mixed, with peoples individual experiences being different, showing that perhaps things are not always going as well as planned. Staff were not being individually supervised sufficiently, and had no areas of responsibility, with the result that their personal development was being restricted, and the organisation within the home was affected. Plans to improve this were discussed by the provider and manager. Records kept at the home were sometimes lacking in detail, which did not always reflect the care given in reality, and did not give a clear picture of how that individual was at that time. Records of accidents and incidents were kept as required, and the maintenance of the building and equipment was up to date, protecting peoples safety. Care Homes for Older People Page 23 of 28 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 24 of 28 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 Ensure that all care carried out is recorded in sufficient detail. This will enable the care plan to be reviewed accurately. 02/04/2009 2 18 13 The manager should undertake training in safeguarding people and ensure that all staff at the home are also trained in the correct procedures. To ensure that people are protected from abuse and neglect. 01/03/2009 3 19 23 The provider must improve the environment as agreed at the visit and send the action plan to CSCI. To improve the surroundings of the people living at the home. 01/06/2009 4 31 24 Provide clear lines of accountability within the home and for the manager. 01/04/2009 Care Homes for Older People Page 25 of 28 People should know what is expected of them and be accountable. 5 31 26 The Provider must send copies of his monthly visit reports to CSCI. To demonstrate that he is monitoring the progress. 6 33 24 set up effective quality assurance and quality monotoring systems, including using the views of people using the service. To check that the home is run in the best interests of those that live there. 01/04/2009 01/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 1 The information provided in the statement of purpose and service user guide should be updated. The service users guide should be given to people as soon as possible so that they can make a decision about whether to live there or not. Incorporate the views and comments of people living at the home in their reviews, and where possible their relatives and staff at the home. Medication practices should be audited to ensure that they are safe. The privacy and dignity of people using the ground floor bathroom with toilet should be maintained at all times. Up to date information about activities should be circulated to all people in formats suited to their capacities. People should have opportunities for stimulation through leisure and recreational activities that suit their needs, 3 7 4 5 6 7 9 10 12 12 Care Homes for Older People Page 26 of 28 preferences, and capacities. 8 9 15 16 The menu offering a choice of meals should be given, read or explained to service users. People should be familiar with the complaints procedure and have written information about who to contact if they are not satisfied. Review the recruitment procedures to ensure that people are protected. Review the training for all staff and plan future training so that it does not become out of date. Establish staff supervision on a one to one basis that meets the required frequency and covers appropriate areas. 10 11 12 29 30 36 Care Homes for Older People Page 27 of 28 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 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!