Inspection on 26/05/09 for Rosalyn House

This inspection was carried out on 26th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosalyn House 30/05/07

Rosalyn House 15/06/06

Rosalyn House 18/10/05

Rosalyn House 13/02/05

Rosalyn House 19/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosalyn House King Street Houghton Regis Dunstable Bedfordshire LU5 5TT     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: Louise Trainor     Date: 2 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Rosalyn House King Street Houghton Regis Dunstable Bedfordshire LU5 5TT 01582896600 01582896601 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : SAH Nursing Homes Limited care home 46 Number of places (if applicable): Under 65 Over 65 46 46 46 46 dementia learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: 16 0 0 0 Mental nursing care for Elderly people (over 65 years) Up to 16 Adults (40-64 years) Date of last inspection Brief description of the care home Rosalyn House is a purpose built Care Home (with nursing) specialising in caring for both younger and older adults with mental health and Dementia care needs. The home is in Houghton Regis very close to the town centre and in walking distance of local amenities and public transport routes. The home can accommodate up to 46 individuals in single rooms with en-suite facilities arranged over three floors. There is passenger lift access to all areas of the home. Care Homes for Older People Page 4 of 29 Brief description of the care home The home has a secure courtyard area at the rear and a designated parking area. The fees for this home vary from £786.38 to £2000.00 per week, depending on the needs of the resident and funding source. If a higher staff ratio is required due to the assessed needs of the resident, fee levels will be above this figure based on the additional staffing costs. These fees are negotiable and the home takes a number of service users at social services rates. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of the key standards for the provision of a care home for older people that takes account of service users views and information received about the service since the last inspection Evidence used and judgements made within the main body of the report include information from this visit. This was a two star home and had therefore not recieved a Key Inspection since May 2007. This inspection was carried out on the 26th of May 2009 by Regulatory Inspector Mrs Louise Trainor, between the hours of 08:15 and 16:45 hours. During this inspection we picked two residents to case track in detail, and looked Care Homes for Older People Page 6 of 29 more briefly at the documentation relating to another. We spent time observing care practices and informally chatting with staff, residents and visitors. We examined three staff files, all doumentation relating to their recruitment, and other records relating to staff training and supervision. A full tour of the premises was carried out, and documentation relating to health and safety checking procedures, medication administration, complaints, accident and incident reporting and residents finances were also inspected. The home manager was present to assist throughout this inspection, and the Responsible Individual was present for the final feedback session. Feedback was given periodically throughout, and at the end of the inspection. We would like to thank everyone involved for their assistance and support. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 29 There is presently some refurbishment work in progress in the main dining / therapy area on the ground floor of this home. This work is nearing completion and will enhance the environment in general. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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. This home understands the importance of having sufficient information when choosing a care home. The information documents clearly set out the objectives and philosophy of the home, and identifies the specialist services that the home provides. Evidence: During this inspection we looked at the information documents for this service. These had been reviewed to reflect the recent changes in management and staffing in the home. Documents were detailed and contained all the appropriate information including facilities available, a copy of the most recent inspection report, terms and conditions of the service and fees. A summary of the complaints procedure was also incorporated into this documentation. Recent changes relating to The Care Quality Commission should be ammended. Care Homes for Older People Page 11 of 29 Evidence: We looked at the pre admission documentation for an expected admission to the home. This had been fully completed by the new home manager, and included detailed information relating to the individuals needs and how they should be managed. It also identified past medical and psychiatric conditions, and included an overview assessment from the present care provider of this individual. Prospective residents and / or their representatives are encouraged to view the home and its facilities prior to admissions taking place. This home does not provide an intermediate care service. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health care services in the home and within the local community. People are generally happy with the care they recieve, however records of the care delivered are not always reflective of the care plans. Medication systems are not always followed by all staff, however the manager has responded to this efficiently. Evidence: During this inspection we case tracked three residents presently in the home. Two of which had very complex needs. Each resident had risk assessments in place for mobility, falls, nutrition, skin integrity and behaviour. These had been used to generate care plans, which were writen in a descriptive way, however did not always give detailed instructions to staff to ensure care was delivered with continuity and in a way that was preferable and safe for the individual. For example moving and handling Care Homes for Older People Page 13 of 29 Evidence: sling sizes. Our main concern in reviewing individuals documentation was that daily records were not always reflective of the care prescribed in the care plan, therefore we were unaware if the care had been carried out. For example one residents care plan instructed wound care / dressing changes every other day. It was not identified in the daily records whether this was always done or not. Another residents care plan instructed staff to carry out passive upper arm exercises three times a day. This was not specific and not reflected in the daily records. It is essential that daily records are written in conjuction with specific care delivery. We would like to acknowledge at this point that there is presently a qualified member of staff working in the home, solely concentrating on reviewing all care plans, however this is a major task and there is still some way to go to complete the task. Observations of care throughout this inspection, reflected a relaxed and unhurried atmosphere, where the residents were being treated in a respectful and dignified way by staff who were confident in their roles. During this inspection we looked at the Medication Administration Record (MAR) sheets for residents on the ground floor and first floor of this home. All residents had a photograph attached to their MAR sheet, and a profile which identifies any allergies / conditions etc. MAR sheets were generally neat and tidy, and medication was being signed in correctly. The manager had been away from the home for the week preceeding this inspection, and we found that over this past week several anomilies had occurred and not been identified until this inspection. In particular one residents medication had been altered in dosage. The original prescription had a line through it, however there was no signature or discontinued date, and a second prescription for this medication handwritten on another sheet. This was rather confusing and could have resulted in missed doses or double doses being administered. Where doses were not being administered codes were not always being applied correctly to the record sheet, variable doses were not always identified, and the reverse of the MAR was not beng used appropriately. Medication that was being carried forward from month to month was not being recorded, therefore reconcilliation for many of the drugs was not possible. There was an audit process in place for the MAR sheets, however since this inspection, both the format and the scope of this audit have been revised. Care Homes for Older People Page 14 of 29 Evidence: We looked at the Controlled Drugs for this service. These were stored appropriately and the register was completed in line with policies. We were informed by the manager that she had called a meeting for qualified staff to address all these issues as a matter of urgency, and further training with their Pharmacy Provider has been arranged. 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. Residents in this home are involved in meaningful activities, and are encouraged and supported to make individual choices whenever practicable. Evidence: This home has a large dining / therapy room on the ground floor, which provides an extensive area for activities such as games, exercise sessions, religious services and crafts. There is also a kitchenette for residents to participate in baking sessions to maintain / develope new skills, and a hairdressing salon where residents can recieve beauty treatments and pampering. On the day of this inspection residents were not accessing the main activity area due to building work in progress. This will provide an additional small, more private lounge area for residents to relax or meet with their visitors. This is nearing completion, and contingency plans have been in place during this work to ensure residents still have access to a variety of activities. For example a craft session was ongoing during the day on the top floor of the home, and residents from the other floors were being encouraged and assisted to join in these activities. Care Homes for Older People Page 16 of 29 Evidence: For those that did not wish to participate in these structured sessions, there was television / music / and one to one interactions with the staff initiated in all areas. Alternatively some residents prefer to spend more time in their bedrooms. The new manager in this home was passionate and enthusiatic about how this area of care can be improved upon and was keen to share some of her ideas. We look forward to seeing some of these implemented, particularly the sensory garden and outdoor activities. There is an open visiting policy in this home and friends and families are always made welcome. We spoke to one relative, whose loved one has been in Rosalyn House for seven years. They said they felt their loved one was well cared for and they had no complaints. We briefly visited the kitchen area and viewed the menus for the next two weeks. There is a wide variety of choices available daily, which includes vegetarian options and lite bite alternatives. The midday meal each day consists of a starter, choice of main course and a dessert. Supper options included dishes such as spanish omelettes, quiches and pasties as well as soups and sandwiches. Cooked breakfasts are also available on request. There is a picture menu book which is used to assist those residents with more severe cognitive impairment to make choices. This includes pictures of plated meals and samples of well known food brand packaging, such as weetabix. 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. The complaints policy is easily accessible to everyone entering the home. The home has an open culture and encourages opinions from residents and their relatives. The manager was able to demonstrate her understanding of the safeguarding procedures, and was mindful that training on the Mental Capacity Act and Deprivation of Liberty safeguarding is a high agenda subject. Evidence: This home has a complaints policy that is summarised in the service information documents and easily accessible to residents and visitors to the home. We did notice some minor ammendments were required to this document, such as details of the Care Quality Commission. We looked at the complaints file, however only focused on complaints recieved since the new manager came into post and how she had managed them. Documentation showed that all complaints had been addressed in a timely manner, letters of response were sent to complainants and clearly explained what actions were being taken to resolve the concerns raised. For one resident this involved altering her mealtime, reviewing her medication and ensuring the identified areas of care affected were introduced to the care plan. The responses that we looked at were very Care Homes for Older People Page 18 of 29 Evidence: thorough. Safeguarding is addressed with staff in this home through the induction process, and is also included in the mandatory training schedule. The training matrix indicated that all staff have attended this training. We are aware through involvement with this service over recent weeks, that they liaise closely with the safeguarding team and the CQC when appropriate. The manager also advised us that the Mental Capacity Act (MCA) and the Deprivation of Liberty, are also being address through managers training, and is consequently being cascaded to all staff and integrated into the care plans. 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. The home provides a physical environment that is appropriate for the specific needs of the people who live there. It allows people to live together in small clutsers in a non institutional way. The home is clean, comfortable and well maintained. Evidence: We undertook a full tour of the premises during this inspection. This is a large home that caters for residents with an array of both physical and mental health needs. The home is well maintained and boasts a high standard of cleanliness throughout. Communal areas are spacious and comfortable, and provide a homely environment for the people who live here. They are well decorated and details of forthcoming social events and menus are displayed and accessible to all. There is presently some refurbishment work in progress in the main dining / therapy area on the ground floor of this home. This work is nearing completion and will enhance the environment in general. The layout of the home provides ample corridor space for residents to wander, and their safety is promoted by coded doors which limit their access to areas where risks may be increased for them. The manager in this home is familiar with, and has an Care Homes for Older People Page 20 of 29 Evidence: understanding of the legislation relating to the Deprivation of Liberty, and any eventuality where residents wish to enter restricted areas is considered and managed with this in mind. Similarly where residents do not have the capacity to make an informed choice about keeping their room locked and secure from others, the precaution of locking the bedrooms is implemented, and addressed on an individual basis where residents wish to enter and spend time in their rooms. Some residents have possession of their own door keys where capacity allows. We visited several of the bedrooms in this home.These varied greatly, in that some were clearly decorated and furnished to personal taste with photographs and other indicators reflecting personal life histories. Whereas others were more clinical in decor and furnishings. We appreciate that this maybe due to personal choice or the medical conditions of some residents, where this may be impractical and may cause increased risk to the health and well being of the individual, where there is an inability to recognise basic environmental safety. There are however ways that some of these rooms could be made more homely in a safe way. All rooms have en suite facilities. Photographs were in place on some doors, to assist residents with orientation and recognition of their own rooms. Others had opted not to have their photographs on display. The external grounds are well maintained and provide a pleasant area for relaxing outdoors weather permitting. The manager discussed some ideas that she hopes to introduce in the future, such as raised sensory flower beds. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are consistently enough staff to meet the needs of the people who live here. The recruitment procedure is robust and the induction and probationary periods ensure that staff are suitably matched to their role. Evidence: The staffing levels in this home are good. There are eight care staff plus two qualified nurses on duty during the day. This does not include the home manager, who also spends some time involved in clinical practice. The night shift is covered by four care staff and one qualified nurse, and one carer working a twilight shift between 19:30 hours and 22:00 hours The care staff are supported by kitchen staff, cleaning staff, an activity organiser, an administrater and a maintenance man. Over the past few months there has been numerous new staff appointments made, and twelve staff have left the service for a variety of reasons, some personal and some work related. However the manager informed us that the team now only have one part time vacancy. There is still some dependence on agency staff, however this is becoming less. During this inspection we looked at the files of three staff who have been recently appointed. All the files that we looked at contained appropriate documentation that included, fully Care Homes for Older People Page 22 of 29 Evidence: completed application forms, Criminal Record Bureau / POVA first checks, at least two references from appropriate sources, home office documentation where necessary, various forms of identifiaction, Nursing Midwifery Council checks for qualified staff, health questionnaires, interview notes and letters offering posts and detailing individuals dates for induction. Training for staff in this home is provided both in house, and by an external training provider. Mandatory training for all staff includes; fire, moving and handling and safeguarding, and the training matrix identified that generally, staff attend sessions in a timely way and are up to date. Other training that staff are expected to attend, depending on their roles include subjects such as, food hygiene, infection control, person centred care, wound care, dementia, diabetes awareness and non abusive psychological and physical intervention (NAPPI). Observations of care throughout this inspection, identified staff that were competent and confident in their roles. Interactions with residents were spontaneous and unhurried and carried out in a respectful manner. The manager has attended a training event / conference relating to the Deprivation of Liberty, and this is being integrated into the residents care plans. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is qualified and experienced in care home management. The service is focused on the residents as individuals, and attempts to work with residents and their families whenever possible. Records are generally up to date, however some entries were unspecific and insufficient in detail. Evidence: Since the last inspection there have been several changes in management of this home, and it has been without a registered manager for more than two years. The manager of the home at the time of this inspection, left her post during the period of time between this report being written and published. We discussed this matter with the company Director who told us she has decided to transfer the manager from a sister home into Rosalyn House for an indefinite period until a suitable candidate can be recruited. Care Homes for Older People Page 24 of 29 Evidence: As discussed in the Staffing Outcome Area of this report there have been numerous staff departures over recent months, and staffing has been addressed as a priority. Consequently there has been a considerable number of new appointments and staffing levels overall have been increased. A new senior carer role was introduced in December 2008, as was an additional carer on the day shifts. Quality assurance is addressed through an array of weekly and monthly audits in place, including documentation and environmental checks. We found that some of the documentation was not always specific in its content or reflective of the care required or being delivered. However this is in the process of being addressed through the auditing process. Periodic resident / visitors meetings are in place to gauge feedback from those who use the service. We looked at minutes from the most recent resident meeting, relatives meeting and staff meeting. All had taken place within the last month. The minutes from all of these meetings indicated that everyone is kept fully informed about any changes in the home, and all opinions are listened to, valued and considered when changes are planned. This management team has a very clear understanding of both Regulation 37 reporting processes and those relating to safeguarding issues, they remain transparent and open with The Care Quality Commission and the safeguarding team. Appropriate health and safety checks are in place to include, water temperatures, fire call points, smoke detectors and lifts. The home has just had a fire risk assessment completed - 15/04/09. This home holds a limited amount of personal money for most of the residents in this home. We checked the account documentation for six individuals. These all balanced correctly with the funds present in the accounts. There is evidence that some supervision is taking place for staff, however the Company Director, who is the Responsible Individual, told us that due to the frequent changes in managers at this home, this process has not always been followed diligently. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that care plans are kept under review to reflect individuals changing needs as they occur. People who live in this home must have care plans that correctly reflect their needs as they change. 31/07/2009 2 9 13 The registered person must 15/06/2009 make arrangements to ensure the recording, handling and safe administration of medication in the home. People who live in this home must be protected by the medication procedures being adhered to by all staff 3 36 18 The registered person must 31/07/2009 ensure that all staff recieve appropriate supervision from a line manager. Care Homes for Older People Page 27 of 29 People who live in this home must be cared for by staff that are appropriately supervised. 4 37 17 The registered person must ensure that all documentation is kept up to date. People who live in this home must have clear records that reflect their care needs and the care that has been delivered. 31/07/2009 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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