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Inspection on 20/10/08 for Meadow Lodge Care Home

Also see our care home review for Meadow Lodge Care Home for more information

This inspection was carried out on 20th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People receive the healthcare they need with the help of local healthcare services and they receive their medication when required safely. Visitors are welcome to come at anytime so people can keep in contact with family and friends and routines in the home are flexible to take into account people`s wishes. There is a varied diet and people enjoy their meals. The majority of staff have obtained a professional qualification and staff receive the training they require to do their work. The manager has worked at the home for a long time and people`s health and safety are protected.

What has improved since the last inspection?

Staff have received training in medication administration and a controlled drugs cabinet has been purchased. The garden has been redesigned and a gardener is employed to maintain it. The central heating system has been updated and some electrical items have been replaced.

What the care home could do better:

People must have their needs assessed prior to coming to the home to ensure that their needs can be fully met. Care plans must describe how people`s needs are to be met and any risks to be managed. This will ensure that people receive the care they require and are not placed at any unnecessary risk. A record must be kept of the activities provided. This will show that people have the opportunity to satisfy their social and recreational needs. People should be able to go to their rooms during the day so they can collect or return their possessions or spend time there. All complaints made must be investigated through the home`s complaints procedure and a record made of the complaint to ensure that if anyone has a complaint it is properly investigated. All incidents of abuse that have occurred within the home must be reported to the Local Authority under the Safeguarding Adults procedures so people living in the home can be protected from abuse. All staff must be aware of the safeguarding procedures to follow in the event of any allegation of abuse so people living in the home are safeguarded from abuse.The keypad lock must be removed from the lounge door so people have freedom of movement around the home. A risk assessment must be prepared about when protective clothing is required to ensure people are not put at risk of infection. Consideration must be given to where staff are deployed to ensure that all people in the home are able to be supervised as required. This will ensure people are cared for by people who have proved themselves to be suitable to care for them and are readily available if required. The correct recruitment procedures must be followed at all times, including obtaining a full work history and two references. This will ensure people are cared for by people suitable to do so. There must be effective quality monitoring in place, including reviewing and updating polices and procedures. This will ensure that people are provided with appropriate care. All financial transactions made on behalf of people living in the home must be signed for and witnessed. This will ensure that people`s financial interests are safeguarded.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Meadow Lodge Care Home 21-23 Meadow Road Beeston Rylands Nottingham NG9 1JP     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: Stephen Benson     Date: 2 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 30 Information about the care home Name of care home: Address: Meadow Lodge Care Home 21-23 Meadow Road Beeston Rylands Nottingham NG9 1JP 01159228406 01159228406 meadowlodge1@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Ann Teece Type of registration: Number of places registered: Mr David Teece,Mrs Margaret Ann Teece care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is : 25 The registered provider may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Meadow Lodge is situated on a main bus route, close to a railway station and one mile from Beeston Town Centre. The home is registered to care for 25 older people, including those with Dementia, in two linked adjacent houses. Accommodation is in single and double rooms and is provided on two floors with two passenger lifts. There Care Homes for Older People Page 4 of 30 Over 65 0 25 25 0 Brief description of the care home is a large dining room and four separate lounges. The patio and gardens are pleasant and well maintained. There is an enclosed garden that is accessible for all residents. 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: The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people accommodated and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The manager said on 20 10 08 that the fees range from 295 to 348, with additional charges for hairdressing and chiropody. This was our first visit to the home since 1st April 2008. This inspection involved one inspector; it was unannounced and took place in the daytime, including lunchtime. Care Homes for Older People Page 6 of 30 Prior to the visit an analysis of the home was undertaken from information gathered over the last year including that from the Annual Quality Assurance Assessment they completed. We sent survey forms entitled Have your say about... to a sample of people and 5 of these were returned. The main method of inspection used is called case tracking which involves looking at the quality of the care received by a number of people living at the home. We also use evidence from our observations; we speak with them about their experience of living at the home; we look at records and talk with staff about their understanding of the peoples needs who they support. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: People must have their needs assessed prior to coming to the home to ensure that their needs can be fully met. Care plans must describe how peoples needs are to be met and any risks to be managed. This will ensure that people receive the care they require and are not placed at any unnecessary risk. A record must be kept of the activities provided. This will show that people have the opportunity to satisfy their social and recreational needs. People should be able to go to their rooms during the day so they can collect or return their possessions or spend time there. All complaints made must be investigated through the homes complaints procedure and a record made of the complaint to ensure that if anyone has a complaint it is properly investigated. All incidents of abuse that have occurred within the home must be reported to the Local Authority under the Safeguarding Adults procedures so people living in the home can be protected from abuse. All staff must be aware of the safeguarding procedures to follow in the event of any allegation of abuse so people living in the home are safeguarded from abuse. Care Homes for Older People Page 8 of 30 The keypad lock must be removed from the lounge door so people have freedom of movement around the home. A risk assessment must be prepared about when protective clothing is required to ensure people are not put at risk of infection. Consideration must be given to where staff are deployed to ensure that all people in the home are able to be supervised as required. This will ensure people are cared for by people who have proved themselves to be suitable to care for them and are readily available if required. The correct recruitment procedures must be followed at all times, including obtaining a full work history and two references. This will ensure people are cared for by people suitable to do so. There must be effective quality monitoring in place, including reviewing and updating polices and procedures. This will ensure that people are provided with appropriate care. All financial transactions made on behalf of people living in the home must be signed for and witnessed. This will ensure that peoples financial interests are safeguarded. 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 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be admitted into the home without having been properly assessed to establish their needs can be met. Evidence: Information provided on The Annual Quality Assurance Assessment (AQAA) stated that there have been 6 people admitted to the home in the last 12 months and there have not been any placement breakdowns. Four care files were looked at checking on information gathered as part of the pre admission process. One person admitted 28 09 08 did not have a pre admission assessment completed and the Local Authority Assessment was faxed to the home the following day, however this did not appear to be a recent assessment. Care Homes for Older People Page 11 of 30 Evidence: The manager said the person had been admitted over a weekend at the request of the family before all the information could be collected and that she normally does have the Local Authority assessment prior to admission. A file for another recently admitted person was looked at and this did have an assessment prior to the persons admission. The manager said she does go out to see some people who want to come to the home, but she does not write this up as a formal assessment. Staff said they use assessments to help them prepare care plans. No comments were received from people about the assessment process but in our survey forms 5 people said they had received enough information about the home before they moved in. The home does not offer an intermediate care service. Care Homes for Older People Page 12 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 do not provide an accurate description of the care people need and risks people face are not being identified and planned for. Peoples healthcare needs are being met. Evidence: There is a care planning and assessment booklet prepared for each person which allows for care plans to be regularly reviewed and updated. The manager said they had recently changed to a more comprehensive system but she now felt that perhaps this was not the best system for them to use because of the amount of time this took to keep up to date. It was stated on the Annual Quality Assurance Assessment that all care plans are reviewed,with relatives where possible,on a regular basis. A sample of assessments and care plans were looked at, which did not always achieve the purpose they were intended to. For example there were some totally unacceptable Care Homes for Older People Page 13 of 30 Evidence: behaviours identified but these were assessed as low and medium risk. Care plans were not being used to ensure people received the care they require, for example one plan said someone required a hearing aid but that the family could not find it, rather than guiding staff on how to ensure the person had a hearing aid. There is a separate book for daily notes, however this is only recorded in if there is anything medical or of significant note. In our survey forms 4 people said they always receive the care and support they need and 1 said they usually do. One person wrote the staff are very helpful and another said staff are very supportive. There is a form included within the care plan to record any medical appointments, however this was not always used and there was more detail about this in the daily notes. The manager said that they access a variety of community based services and some of these were seen in the home during this visit, including district and diabetic nurses and local opticians. A member of staff was concerned at the health of one person and promptly called an ambulance, then informed the manager. In our survey forms 2 people said they always receive the care and support they need and 2 said they usually do. People were asked if they got the healthcare support they wanted and all said that they did. One person wrote I need a lot of medical help. Medication was observed being given out at lunchtime and safe practices were followed. The Medicine Administration Records seen were fully completed. People were seen to be dressed individually and in the manner they preferred. Staff were aware of practices to promote peoples privacy and dignity and preventing embarrassment. There are screens available in shared bedrooms. 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. More could be done to meet peoples social needs and promote their autonomy and choice. Evidence: There was an activities noticeboard with posters advertising forthcoming events, including keep fit, musical entertainment and when the hairdresser visits. The manager said that at present there is not a record kept of activities people take part in and it is something she intends to start to do. Staff said they try to do something weekly such as quizzes and games, and that the entertainment quizzes are really popular. In our survey forms we asked if activities are arranged by the home you can take part in and 2 people said there always are, 1 person said there usually is, and 2 said there sometimes are. One person said that they sometimes do things. Care Homes for Older People Page 15 of 30 Evidence: Staff said there are a couple of people who go out with their families and there are plenty of visitors coming to the home. The manager said she has prepared some prompt cards for visitors to use to help visits go well. A visitor was seen assisting his relative to get ready to go out and said they were going for a walk and then going to get a haircut. Staff said they try to encourage people to make choices and gave the example of what sandwiches they wanted at tea time. The manager said she had been thinking of getting some pictures of sandwich fillings to help those with communication difficulties to make choices. A keypad lock has been fitted onto a lounge door which means that some people cannot go to their rooms during the day. One person asked why does there have to be a lock on the door as it stops people going to their room during the day and it is a lot to remember to bring everything down you may want. It is usually shut in the morning until about eight in the evening. The door was seen being closed activating the lock at 9:55 am and remained closed throughout the inspection. Some people tried to open the door but were unable to. There is a weekly menu which the manager said is varied when people make requests. Lunch today was tomato soup, a choice of chicken, fishcakes or fish fingers with chips and beans followed by rice pudding. Staff said that people prefer traditional food and there is a fish dish on Fridays and a roast dinner on Sundays. In our survey forms we asked if people like the meals in the home and all five said they did. When asked if they had enjoyed their dinner people said they had and there had been plenty. 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 poor 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 are not protected from physical and sexual abuse. Evidence: There is a complaints procedure displayed in the home and the manager showed a complaints file, which had no entires in. It was recorded on The Annual Quality Assurance Assessment that there have not been any complaints made over the last 12 months. Staff said there have not been any complaints made apart from a couple of people complaining when they had been hit by another person living in the home. An entry was seen in one persons daily notes that said other residents are complaining regularly about 2 residents behaviour. One person said he was not happy about a keypad lock having been fitted to the lounge door preventing people from going to their rooms and he had complained about this to staff. The manager was unable to locate the Nottingham and Nottinghamshire Safeguarding Adults Policy, Procedure and Guidance for Alerters and Referrers and was not familiar with these. Staff also said they did not know the procedures to follow in the event of Care Homes for Older People Page 17 of 30 Evidence: any allegation. There were entries seen in one persons daily notes showing he had been involved in several physical assaults on other people living in the home. In the persons care plan there was a behaviour assessment which judged the person to be a low risk. A monthly evaluation review said the person has had a good month and did not refer to a recent assault. Another persons case notes recorded the person being responsible for a number of sexual assaults. In the care plan the persons was judged to move from low to medium risk but then returned to low risk although it was recorded there are still problems with his sexual behaviour. None of these incidents had been reported to the Local Authority under the Safeguarding Adults procedures, and the manager said she didnt know they should have been. The manager said she thought they had been doing the right thing. The manager said they had sought assistance and had requested a referral to a local healthcare resource. 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. Peoples freedom of movement is being restricted and more could be done to prevent the spread of infection. Evidence: There was a keypad lock fitted to the door from one lounge to some bedrooms. Staff said this had been fitted a few months ago due to one person going into other peoples rooms and causing damage. Some people were seen trying to open the door and going to sit back down. The manager said she did not like having the lock fitted but was at a loss as to what else she could do to protect peoples property and the building. There was one toilet locked as it was out of order. the manager said this was currently being repaired and the floor had been taken up. Staff said the building was suitable for them to carry out their duties and repairs are attended to promptly. There are suitable laundry arrangements and one person said they thought their clothes were well laundered. Care Homes for Older People Page 19 of 30 Evidence: In our survey forms we asked if the home is always fresh and clean. Four people said that it was and one said it usually was. There was some protective clothing seen which staff said they use when providing personal care but they did not use any when serving food, although they did use an apron when cooking. Staff said they have had infection control training. 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. People are not fully protected by the homes recruitment procedures or in the way staff are deployed on shift. Evidence: The manager said that there are three staff on duty during the day with an additional person for the first part of the morning. There are 2 staff awake at night. During a period of observation in one of the lounges staff were only seen passing through and serving hot drinks despite there being people know to be at risk from others in the home. It was stated on The Annual Quality Assurance Assessment that there are eight staff who have completed their National Vocational Qualification level 2 and two currently enrolled on the course. A file of a recently appointed member of staff was seen which contained an application form, medical questionnaire, a Criminal Records Bureau check reference number and one reference. The work history section of the application form was not fully completed and the manager said they have not yet got the second reference. Care Homes for Older People Page 21 of 30 Evidence: The staff training records showed that the majority of staff have received the required training, though in a number of cases these are about to expire and updates will be required shortly. The manager said she had applied for a training grant and was aware that some staff will require training updates. Some staff have attended training on The Mental Capacity Act. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current management arrangements are not in the best interests of people living in the home. Evidence: The manager, who is also one of the registered providers, has held the post for 27 years. The manager has not undertaken a professional qualification but said she is considering doing so. Staff said the manager is hands on and supportive. The Annual Quality Assurance Assessment was returned but this did not give an accurate picture of what is happening in the home. It was stated the policies and procedures have been reviewed, however they were considerably out of date and did not give the guidance staff require. Care Homes for Older People Page 23 of 30 Evidence: There is a system for helping people manage their personal allowances, however records seen only had one signature so any transaction made is not witnessed. It was stated on the Annual Quality Assurance Assessment that equipment is tested or serviced as recommended by the manufacturers or other regulatory body. 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 1 18 12 All incidents of abuse that 20/10/2008 have occurred within the home must be reported to the Local authority under the Safeguarding Adults procedures. So people living in the home can be protected from abuse 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 3 14 People must have their needs assessed prior to coming to the home To ensure that their needs can be fully met 01/12/2008 2 7 15 Care plans must describe how peoples needs are to be met and any risks to be managed This will ensure that people receive the care they require and are not placed at any unnecessary risk 01/02/2009 3 12 16 A record must be kept of the 01/12/2008 activities provided Care Homes for Older People Page 26 of 30 This will show that people have the opportunity to satisfy their social and recreational needs 4 14 12 People should be able to go to their rooms during the day. So they can collect or return their possessions or spend time there. 5 16 22 All complaints made must be 10/11/2008 investigated through the homes complaints procedure and a record made of the complaint To ensure that if anyone has a complaint it is properly investigated 6 18 12 All staff must be aware of 10/11/2008 the safeguarding procedures to follow in the event of any allegation of abuse So people living in the home are safeguarded from abuse 7 19 23 The keypad lock must be removed from the lounge door. So people have freedom of movement around the home 8 26 13 A risk assessment must be prepared about when protective clothing is required. To ensure people are not put at risk of infection 01/11/2008 21/11/2008 24/11/2008 Care Homes for Older People Page 27 of 30 9 27 18 Consideration must be given 23/11/2008 to where staff are deployed to ensure that all people in the home are able to be supervised as required. This will ensure people are cared for by people who have proved themselves to be suitable to care for them and are readily available if required 10 29 19 The correct recruitment 21/11/2008 procedures must be followed at all times, including obtaining a full work history and two references This will ensure people are cared for by people suitable to do so 11 33 24 There must be effective quality monitoring in place, including reviewing and updating polices and procedures This will ensure that people are provided with appropriate care 01/02/2009 12 35 17 All financial transactions made on behalf of people living in the home must be signed for and witnessed This will ensure that peoples financial interests are safeguarded 01/11/2008 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. Care Homes for Older People Page 28 of 30 No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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 © (2008) 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. 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!