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Inspection on 21/04/09 for St Quentin Nursing Home

Also see our care home review for St Quentin Nursing Home for more information

This inspection was carried out on 21st April 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 2 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

The home is a pleasant, clean and homely place to live with suitable aids and adaptation for people who live there. People have their needs assessed before they come to live at the home. Assessment of peoples` needs, gives confidence that staff are aware of their needs and will be able to meet them. People are encouraged to visit the home prior to them deciding to come and live there. The home has knowledgeable and well trained staff who are aware of people`s needs and how they should be met. Staff also have all required checks before they start working at the home. Food is described as "very nice" and a choice is always available. It is good that there is a hot meal choice each mealtime.

What has improved since the last inspection?

The home have an ongoing decoration and refurbishment plan particular areas of improvement have included a new staff call system, improved access and security to the home particularly for people with mobility difficulties and door locks to all toilets and bathrooms as this was not the situation previously for those toilets and bathrooms which had a sliding door. Findings of our random visits in October 2008 and February and March 2009 were that the homes care records and systems failed to identify sufficiently if there were any cause for concern such as unexplained injury or when additional care is needed such as additional fluids or turns. The service has updated its care records to more fully identify all people`s needs, choices and capabilities to assist staff to meet their needs. Improvements to care, and accident/ incident records have resulted in more complete records that identify any possible cause for concern and enable senior staff to report these concerns to the local authority safeguarding team to ensure all required actions are undertaken to keep people safe.

What the care home could do better:

To enable improvement to continue and be maintained a permanent manager needs to be appointed. Records of all complaints need to more fully detail how the complaint was investigated and whether this was within required timescales. More comprehensive records will give greater assurance that all concerns are fully and comprehensively investigated and when appropriate required actions have been put into place.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 0LZ     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: Amanda Hennessy     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 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 27 Information about the care home Name of care home: Address: St Quentin Nursing Home Sandy Lane Newcastle Staffordshire ST5 0LZ 01782662911 01782620255 st.q@virgin.net 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) : St. Quentin Residential Homes Limited care home 33 Number of places (if applicable): Under 65 Over 65 0 33 0 dementia old age, not falling within any other category physical disability Additional conditions: 2 DE(E) 33 PD over 60 years Date of last inspection Brief description of the care home 2 0 4 3 0 1 0 2 0 0 8 St Quentin Nursing Home provides accommodation for up to 33 older people who may require 24 hour nursing care. The home is a large detached property that has been extended to provide comfortable accommodation on two floors. A passenger lift provides access between the floors. There are two lounges and a dining room situated on the ground floor. The home is set in approximately one acre of very pleasant gardens, a mile or so from the wide range of community facilities provided in the town of Newcastle-under-Lyme. There are adequate parking facilities. As no information is included in this report in relation to fees charged by the home, Care Homes for Older People Page 4 of 27 Brief description of the care home readers of this report are advised to contact the service directly for this information. Care Homes for Older People Page 5 of 27 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: The quality rating for this service is 1 star. The means that people who use this service experience adequate quality outcomes. This unannounced inspection was carried out on in two days with a second inspector also present on day two. As it was unannounced neither the home nor the provider knew we were going. The Acting Manager was present throughout the inspection. Information for the report was gathered from a number of sources: A questionnaire called an Annual Quality Assessment (AQAA) was completed by the homes proprietor and was sent to us before the inspection. We looked at the premises. We had discussions with the Acting manager and care staff plus visitors and people who live at the home to gain their views on what it is like to live in and receive care from this service. Some people were unable to communicate their views verbally to us Care Homes for Older People Page 6 of 27 so we used direct and indirect observation to inform the inspection process. Three people who live in the home were case tracked this process involves establishing peoples experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes of the care that they receive. Tracking peoples care helps us understand the experience of people who use the service. We looked at how the service has responded to any concerns, how it protects people from abuse and how staff are recruited and trained. We also looked at how the service manages peoples medicines. We have also visited the home on the 30th October 2008 following concerns initially highlighted by the home that two people had sustained fractures during personal care. We also visited the home on the 10th, 11th and 23rd of February and the 2nd March 2009. following a number of concerns highlighted about unexplained bruising to people living at the home. Random inspection reports for the visit on 30/10/08 and the visits between the 10th February 2009 and the 2 March 2009. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed and have the required information about the home to enable them to make the decision that the home will be suitable for them. Evidence: The home provides required information about the services they offer. The service user guide and statement of purpose have both recently been updated to reflect recent management changes and the change from the previous regulatory body the Commission for Social Care Inspection to new regulatory body The Care Quality Commission. The service has not had any admissions since the beginning of February 2009 when Social Services would not fund any new people. People admitted to the service do have an assessment of their needs carried out by a senior nurse. We looked at these assessments and found that they provided good information about the person and their care needs. We did advise that whenever possible staff record peoples feet and Care Homes for Older People Page 10 of 27 Evidence: oral care needs though. People are invited to visit the home, although sometimes due to their frailty this is not possible and their relatives visit on their behalf. Relatives that we spoke to confirmed that they had in deed visited the home and made the decision that the home would be suitable for their relative. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs recognised and met by the home the ongoing improvements in the care planning system will also add to this giving assurance that the home manages and meets all health and personal care needs. Evidence: The home is in the process of updating and improving its care planing system. We found that the new care planning system identifies peoples needs on an individual basis detailing their needs, choices and capabilities and giving staff information on how they should be met. The Acting Manager told us that he is also further developing person centred care planning this will more fully reflect their interests, choices, needs and capabilities. Those care plans we looked at had all been recently updated and although we had previously found care plans were not reviewed regularly we found that this is no longer the situation. We saw that people have access to other health professionals such as doctors, dentists, chiropodists, opticians and dietitians dependent on their clinical need. It was positive to see that staff had identified that one person had lost a small amount of Care Homes for Older People Page 12 of 27 Evidence: weight as they had been unwell, records showed that the person had been seen by a doctor and a dietitian and their plan of care had been updated to reflect the dietary advice and a need for additional dietary supplements given by the Dietitian. We found that there are risk assessments in place to identify problems with nutrition, risk of pressure sores, continence, moving and handling, use of a wheelchair and the use of bed rails. People are also weighed at least monthly and more frequently if this is identified by their risk assessment. We have previously highlighted records of drinks that people receive or the frequency that they are turned was not always recorded. We found that the there are now good records in place to show when people have had a drink or have been turned. It is also positive that people have their blood pressure and pulse checked every month.We found that staff have been concerned that peoples skin has broken down when they sat them out of bed. We advised that specialist alternating cushions should be available to minimise the risk of pressure sores alongside staff providing regular turns and regular inspection of peoples skin. The ordering, storage and administration of medicines is the responsibility of qualified nurses and is done both safely and with appropriate safeguards in place. We did advise staff that minor improvements may be made to further improve and reduce the risk of potential errors. For example when there is a need to handwrite the medication record two staff should confirm the accuracy of the entry and when there is a variable dose of medicine ( for example give one or two tablets) the amount of medicine actually given should be recorded. The homes induction programmer includes a section on treating people with respect. We observed staff to interact in a friendly way with people living at the home, although we have been told that some staff can be loud or a bit brisk. Other people told us the staff here are very good to everyone. The proprietor has told us how the home respects peoples privacy and dignity : Everyone wears their own clothes- there are no communal clothing and people choose what they would like to wear if they are able to. People are addressed by their preferred form of address and this information is passed on to staff at handover following their admission to the home and also recorded in their plan of care. Care Homes for Older People Page 13 of 27 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. Improvements that are being made mean that the daily life of the home more fully represents peoples individual interests and choices. Evidence: The home has told us that they do their best to meet individuals needs by providing plenty of choice at mealtimes, flexible timescales, a broad range of varied daily activities and trips out. Information about activities is available on the Residents noticeboard. We found that peoples interests and choices are mostly recorded within their care records. As already identified within this report the Acting Manager has told us that the home is developing its care records to ensure that it more fully details peoples interests and choices. The Acting Manager and the Proprietor are ensuring that the home is run in the interests of people who live at the home rather than the staff, which may not previously have been the situation. They have told us that they enable people to get up and go to bed when they choose to. We spoke to people in the lounge and found them to be smartly dressed, and it was positive to see that all the ladies had either stockings or tights on, and everyone was wearing either shoes or slippers. Activities within the home are undertaken by care staff. Care staff told us about Care Homes for Older People Page 14 of 27 Evidence: activities that take place: We have recently helped people make easter bonnets and and an easter tree, they all seem to like the music and movement especially when we use the balloons it makes them laugh and I think we are getting better. People are able to worship according to their faith and a Church of England service is held monthly. Visitors are welcome at any reasonable time and a several visitors visited during the two days of our visit. People told us: I cant fault them. People living at the home are offered three full meals each day. Breakfast and tea always include a hot option as well as the usual such as toast, cereal etc and sandwiches at tea time. In addition at tea time soup is offered as a starter every day to those that want it. Lunch is a two course meal, of which there is always a choice of two hot dishes plus a salad option. The home offers a six week menu which is then repeated. We were told that staff ask people on a daily basis what they would like to eat and this is recorded. The menu is displayed in the dining room, but staff also read out the menu individually as well. Liquidised meals are available for those people who are unable to eat solid food and are presented in the same way as a solid meals with each foodstuff kept separately. All diets are catered for if required, including vegetarian and diabetic, also therapeutic supplements when prescribed and specials feeds for those people who are unable to eat anything orally. Staff assist people when needed to eat and drink. We spoke to one lady and asked her about the food, she said its very nice, there is lots of choice and they make us whatever we want. Care Homes for Older People Page 15 of 27 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. Improvements made give greater assurance that people who use this service will listened to, any concerns will be acted upon and the home will act in their best interests and protect them from abuse. Evidence: The complaints procedure is included in the service user guide and is also displayed in the home. The home has told us that they have had six complaints in the last twelve months of which they have told us three were substantiated. We have received six complaints about the home of which three were anonymous, all complaints have been forwarded to the home for investigation and information. Complaints are recorded in the complaints log, although we were unable to see whether the home had concluded their investigation within the required timescale or any records of feedback to the complainant, or how the complaint had been investigated. In addition we also saw concerns highlighted by a member of staff in relation to poor moving and handling but there was no record of this complaint within the complaints log. Another person also told us that she had raised concern about the care given to their relative but there was no record of her concerns either. We have advised the homes management that more comprehensive records should be available of all concerns raised to give assurance that all concerns are listened to and addressed. We have also visited the home on the 30th October 2008 following concerns initially Care Homes for Older People Page 16 of 27 Evidence: highlighted by the home that two people had sustained fractures during personal care. We also visited the home on the 10th, 11th and 23rd of February and the 2nd March 2009, following a number of concerns highlighted about unexplained bruising/ injury to people living at the home highlighted to us both by the home and Staffordshire Council. Random inspection reports for the visit on 30/10/08 and the visits between the 10th February 2009 and the 2 March 2009 are available separately. The home have told us in the last twelve months they have made thirteen safeguarding referrals to the local council. The home have fully supported and assisted in the current adult protection investigation. We had previously found that the home had failed to make safeguarding referrals when required such as incidents of unexplained bruising due to the homes poor record keeping. We issued the home with a statutory requirement notice as they had failed to make these referrals, this requirement notice has since been met. We found at this inspection that there are much improved records available of all injuries or bruising enabling senior staff to more clearly identify any unexplained injury and make required referrals to highlight any concern. We found that all staff have had safeguarding training and were clear of what constitutes abuse and actions they would take if they had any concerns about potential abuse. The home have told us that they have made one referral to the Protection of Vulnerable Adults list (POVA). Care Homes for Older People Page 17 of 27 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 is a clean, pleasant and homely place to live and has suitable aids and adaptations for people who live there. Evidence: The home is a large, extended, detached property that is clean and homely. It is set in large and pleasant grounds, which have both grassed and paved areas with garden furniture where people can sit if they wish to. There are steep steps to the front entrance, although the Proprietor told us that there is level access at the back of the home. One gentleman we spoke to said it would be helpful if arrangements could be made to stop people parking near the front entrance as it limited his access to the building. The home is well maintained and there is an ongoing refurbishment plan. The hallway has recently been decorated and had a new floor. There are two large lounges and a separate dining room, which are suitably furnished and decorated. Bedrooms are on the both the ground and first floor, with two passenger lifts to access the first floor. There are now only two double rooms. The double bedrooms have mobile privacy screens available to preserve peoples privacy. One bedroom has en-suite facilities. Bedrooms have been personalised with ornaments, small items of furniture and family photographs. Bedroom doors are not lockable although the home owner did tell us that people can have a door lock fitted if they ask for one. Care Homes for Older People Page 18 of 27 Evidence: There are bathing and toilet facilities suitable for dependent people throughout the home. Locks are now fitted to all toilets and bathroom- included those with sliding doors which were not previously lockable. The home provides people with a range of equipment to support them to be as independent as possible. The baths are fitted with hoists and there is a range of grab and hand rails around the building. Hoists are available for moving people safely. There is a new staff call system is available throughout the home. The home is clean and there are good arrangements to minimise the risk of cross infection. Staff were observed to use gloves and aprons to complete personal care tasks. Care Homes for Older People Page 19 of 27 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. Staff are knowledgeable and well-trained staff to meet peoples needs. Recruitment practices minimise the risk of unsuitable people working at the home. Evidence: The home is staffed with appropriate numbers and skill mix to meet peoples needs. Staff we met spoke positively about support and training they receive and were knowledgeable about peoples needs. We also observed good interaction between staff and people living at the home. People were very complementary about the staff and told us: They are very good. The home supports staff to undertake a care qualification (minimum of National Vocational Qualification level 2) with 50 of care staff having a care qualification. This gives confidence that staff are knowledgeable and understand peoples care needs. Staff recruitment and selection is completed to the required standard with all required checks undertaken before staff start working at the home. We were told that new staff have, induction training with an external training provider that meets the Skills for Care standards and we saw evidence of this in those staff files we looked at. All staff we spoke to said that they had an induction and they were initially additional to normal staff numbers and as a new member of staff they felt supported. One member of staff we spoke to said: Care Homes for Older People Page 20 of 27 Evidence: my induction was very good and was like a mini NVQ. Care Homes for Older People Page 21 of 27 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. Changes to management arrangements give greater confidence that the home will be run within an ethos of openess and respect and peoples health and safety will be safeguarded. Evidence: The home manager left at the end of March 2009. The homes owner has told us that she will manage the home until a suitable Manager can be appointed. We have highlighted that previous management arrangements and records available did not highlight concerns which meant that required actions could not be made to safeguard people. The home completed it Annual Quality Assurance Assessment (AQAA) when we asked for it. The AQAA was comprehensively completed and gave us a good picture of the service that is provided and also included areas that the service has identified for improvement. The home has a quality assurance system to monitor quality and improve the service Care Homes for Older People Page 22 of 27 Evidence: provided to the people that live there. We were told that surveys are sent to people living at the home and their relatives every six months to seek their views on what it is like to receive the service. No report is undertaken of the findings of the surveys. The service has also reviewed its record keeping as a result of the current adult protection investigation and improvements have been made to highlight any concerns. Staff do not manage any persons personal allowance but look after small amounts of money on their behalf. Sampling showed that suitable records were being kept with receipts supporting expenditure. Balances we checked were all found to be correct. We looked at staff training in health and safety and other required areas. The home ensures that all staff receive training as and when they need it. The service has confirmed that all maintenance contracts and records are up to date. Care Homes for Older People Page 23 of 27 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 27 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 16 22 There must be a 20/05/2009 comprehensive record of complaints that are made about the service including a record of the investigation made and timescales in which the complaint is investigated. This will give confidence that any concerns raised are fully investigated by the service within required timescales. 2 31 9 The home must appoint a manager and an application for this person to be the registered manager sent to the Care Quality Commission. The home has a suitably qualified and experienced manager and will be managed in a way to protect the health and safety of people who live there. 28/07/2010 Care Homes for Older People Page 25 of 27 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 8 Alternating pressure relieving cushions are available to enable people who are at high risk of developing pressure sores an opportunity to sit out of bed and as advised by the Tissue Viability Nurse Specialist. Staff should have training in the prevention and management of pressure sores. The amount of medication given when a variable dose (one or two tablets) is prescribed should be recorded. Two staff confirm the accuracy of hand written medication records. 2 3 4 8 9 9 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!