Inspection on 22/10/08 for St Werburghs House

This inspection was carried out on 22nd October 2008.

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

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

Other inspections for this house

St Werburghs House 27/11/07

St Werburghs House 28/02/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Werburghs House Church Street Spondon Derby DE21 7LL     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: Helen Macukiewicz     Date: 2 2 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: St Werburghs House Church Street Spondon Derby DE21 7LL 01332280037 01332200644 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Karen Margaret Walker Type of registration: Number of places registered: European Care (Derby) Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: European Care (Derby) Limited is registered to provide nursing and personal care to service users whose primary needs fall within the categories of: Old Age, not falling within any category, (OP) - 35 The maximum number of service users to be accommodated at St Werburghs House is 35 Date of last inspection Brief description of the care home St Werburghs is a two-story detached house, which has been adapted and extended as a care home. It is a listed building and sits in its own grounds behind the local church. It is situated in Spondon close to local shops and a bus route. The home opened in 1989. The home provides nursing and personal care for persons aged 65 years and over with physical health needs. The home has 3 lounges areas and a dining area on the ground floor. The large garden is accessible to service users. The programme manager told us that the weekly fees for the home ranged between 376.00 GBP and Care Homes for Older People Page 4 of 29 Over 65 35 0 Brief description of the care home 607.00 GBP. Extra charges are made for Hairdressing, chiropody and toiletries. The most recent inspection report was available in the office at the home. 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 unannounced and lasted 7 hours during one day. Four preinspection surveys were received from people living in the home, five from their relatives, three from staff working in the home and one from a visiting professional. Findings from these surveys are included in this report. The Manager had completed a self-assessment of the home and information from this was used in the planning of this inspection. Computer held records of all contact between the Home and us since the last Inspection were also referred to in the planning of this visit. During this Inspection discussion with people who use the service and their relatives took place. Time was spent in discussion with the Manager and staff. Four care files belonging to people who live at the home were looked at in detail and their care was examined to see how well records reflect care practices within the home. Relevant records belonging to the home Care Homes for Older People Page 6 of 29 were also examined such as complaints and policy documents. A brief tour of the home took place including some bedrooms. The previous key inspection of this service took place on 27th November 2007. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given sufficient information and assessment to ensure they have a choice of home, which will meet their needs. Evidence: There was information about what services the home provided contained within two documents, the Statement of Purpose and Service Users Guide. People told us they had been able to look around the home before they moved in and relatives said they had been given a brochure and knew what to expect. There was a notice in the foyer informing people where they could see our last Inspection report, relatives told us they knew how to access this. In their completed pre-inspection surveys people told us they had been given enough information about the home before they moved in, so they could make a decision about whether it suited their needs. Relatives also told us through their surveys they Care Homes for Older People Page 10 of 29 Evidence: had enough information and that the home met their needs. In her completed self-assessment the manager recorded that the home continues to ensure that a member of the management team goes out and completes a preadmission form prior to admission to the home, prospective service users and relatives are encouraged to spend as much time in the home with staff and other residents. We saw the care files of the three people who had most recently been admitted to the home. They all contained an assessment of need and where necessary, assessments from Health care or Social Services. Assessments included relevant information to enable staff to make a decision about whether the persons needs could be met at the home. There was no space on the form to record the date of this assessment, and that would have helped establish how soon before the person was admitted that staff carried out the assessment. Care Homes for Older People Page 11 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. Administration of medicines keeps people safe. Care is planned to meet needs but gaps in care provision compromises dignity and affects wellbeing. Evidence: People living in the home and their relatives told us that they were being looked after well. One visitor said of their relative we know he is being looked after well. In their completed pre-inspection surveys people told us that they received the care and attention they needed and that staff listened to them and acted upon what they said. They also told us that they get the medical help they need. Relatives who filled in pre-inspection surveys told us that in their opinion, the care provided was good. Comments included residents treated with respect and well cared for, in all areas, cares for all (x) wellbeing and needs and overall I think St Werburghs cares well for all the residents at the home. Care Homes for Older People Page 12 of 29 Evidence: We looked at peoples care files. These all contained a plan of care that was written in a personalised way and updated. These plans gave staff clear directions about how to meet peoples care needs. However, we found that the care that was planned was not always the care that people were receiving, as our observations found that some people had not had some basic needs attended to (see later observations made in this section). Care files showed that people regularly had visits from their Doctor, showed liaison with health professionals in the community and included sections to record G.P. visits, chiropody and attendance for other health related appointments. People had their needs risk assessed in areas such as skin care, continence and falls. Such assessments had been regularly updated. In her completed self-assessment the manager wrote the home needs to encourage people to share access to our documentation, although we are moving forward this we would still like for more residents / relatives to agree to this. There was evidence in some care files that relatives had given their input, and signatures were found to support this in some sections. The managers self-assessment also told us that new equipment had been provided since the last inspection such as wheelchairs and pressure cushions. It also recorded that new profiling beds were to be purchased so that people were more comfortable. People told us that staff upheld their need for privacy and that they maintained their dignity, relatives also confirmed this was the case. Peoples care plans made reference to the need for staff to promote peoples dignity. However, we observed some aspects of care that did not fully maintain peoples dignity. Some peoples personal hygiene had not been maintained, some clothes were creased or stained and in bedrooms, some were not presented in a manner that showed respect for peoples dignity due to state of bedding, cleanliness and odours. Due to the fact there were a high level of people who were unable to communicate and required total care, staff will need to ensure a more person- centered focus when anticipating and meeting peoples needs. We looked at the storage of medications, storage of prescribed medications was accurate. Staff were also signing for the medications they had given each time. Some topical preparations were either not labeled correctly or needed destroying and one homely remedy needed adding to the homely remedy protocol. Where changes to prescriptions occurred, these were not always being dated and signed for to enable a complete audit trail should a query arise. The manager and registered nurses were completing regular audits of medication, but the audit form did not cover all matters for improvement raised through this inspection. Care Homes for Older People Page 13 of 29 Care Homes for Older People Page 14 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. People are supported to lead a varied lifestyle of their choosing, within their capabilities. Evidence: On the day of this visit, a relatives/residents meeting was being held, during this time people were given information about forthcoming events and given the opportunity to have their say in what events should be scheduled. Through completed pre-inspection surveys people told us there were usually enough activities they could participate in. In their survey one relative wrote try to provide activities, singers etc. on a regular basis. One care professional told us that staff treat individuals as individuals and give people the chance to lead as fulfilling a life as possible. In her completed selfassessment the manager told us we have increased staffing levels and now have more one to one activities and care with residents, our new activities co-ordinator has recently started and is putting together a weekly activity programme to be displayed on the notice board. We saw that events were being displayed, we also looked at what activities had been recorded in care files. We saw that people were being given one to one time with the activities person, and she told us this happened every day, but we did not see all of this recorded in peoples care files. The activities person said she was Care Homes for Older People Page 15 of 29 Evidence: working her way through files and that these records would be completed in more detail in future. Each care file contained a social profile, where people had been able to tell staff what things they liked to do. Care plans made reference to peoples preferred routines and people told us they could come and go as they pleased throughout the day. Through their pre-inspection surveys people told us they usually liked the meals. One relative wrote provide excellent food and snacks for residents. During the inspection we were told by various people and their visitors that the food was good. Comments included the food is outstanding. People were offered regular food and drinks throughout the day, the cook confirmed that snacks were offered in between meals. The manager told us they had recently increased the amount of snacks offered. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are kept safe through effective complaints procedures and staff training. Evidence: When we spoke to people they told us that they knew how to complain and found the senior staff to be approachable and responsive to concerns that they raise. In their completed pre-inspection surveys people also told us they knew who to speak to if they had any complaints. Staff who completed these surveys told us that they knew how to respond to concerns raised. One wrote the matron and deputy are very good at dealing with complaints and get it resolved as soon as possible. In the managers pre-inspection self-assessment she told us that they had now started to record both formal and informal concerns as they arose within their documentation. They recorded seven complaints received in the past 12 months. The records of complaints seen at the time of the Inspection did show that concerns were being recorded and dealt with, which showed that the manager was upholding peoples rights in this area. People were given the right information about how to contact us should they need to, and this was available in both the information about the home and the complaints procedure that was displayed in the foyer. There had been no safeguarding incidents at the home in the past 12 months, although one potential incident had been reported to us at the time of this inspection. Staff at the home took appropriate action when dealing with this. Some safeguarding Care Homes for Older People Page 17 of 29 Evidence: procedures, including the Governments No Secrets document were seen in the office. Staff were provided with safeguarding training as part of the routine training programme, and future courses were on display in the office. When asked, staff provided safe responses in regard to the action they would take if they suspected abuse, this ensured that people living in the home were kept safe. The manager had attended some training on deprivation of liberty and both she and the deputy were due to attend training on the mental capacity act. Equipment in use, that provided a degree of mechanical restraint was consented for within peoples care files. Equipment was also subject to regular recorded risk assessments and there was evidence that these had been reviewed also within peoples care files. Care Homes for Older People Page 18 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 physical layout of the home enables people to live in a comfortable environment. Some general standards of hygiene and equipment had the potential to compromise infection control. Evidence: We conducted a brief tour of most parts of the home. In their completed preinspection surveys people told us they found the home to be fresh and clean. One relative described the home as friendly, cosy and homely. One area where a relative felt there could be some improvements was better disabled access outside the home, for example fitting of ramps to improve access in and out of the conservatory. On the day of our visit the home was without their usual cleaning arrangements due to an unforeseen personal event, but evidence suggested this was not usually the case. As a result some parts of the home were not as clean as their usual standards. However, we also saw that some commodes and bed tables were not clean. we were told that this fell within the responsibility of care staff, who were working to planned levels that day. One bedroom had a urine odour. This compromised the overall control of infection. Although the senior domestic monitored cleanliness and ancillary staff functions, this responsibility did not extend to ensuring that care staff carried out their functions in relation to general hygiene. It was suggested that a system to regularly audit cleanliness and general tidiness of rooms would be a useful way to promote good Care Homes for Older People Page 19 of 29 Evidence: practice in this area. We also found that there was quite a lot of furniture including commodes that required replacement. In particular the wooden commodes which had lost their protective varnish and could therefore not be effectively cleaned due to the porous of the wood. We did however, observe several items of new furniture had been provided and we saw evidence that the management were undertaking a refurbishment programme. In her completed self assessment the manager wrote We have refurbished several bedrooms with new furniture and carpets. We have provided some residents with fridges in their bedrooms. The dining room has been redecorated and the carpet has been replaced with new flooring (easier to clean) and new tables and chairs have been purchased. an additional maintenance person had also been appointed to speed up the refurbishment and the outstanding areas of maintenance. There was equipment in place for the laundering of soiled linen and which was appropriate for maintaining infection control. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are looked after by well trained and experienced staff although gaps in recruitment means that peoples wellbeing is not fully safeguarded. Evidence: Staffing rotas showed that there were qualified nurses provided at all times. There were mainly 2 nurses during the morning and additional qualified support from the manager. Rotas showed 4 or 5 care staff during the day although there had been occasions recorded when staffing fell short of this figure due to sickness. The manager told us that she is expected to monitor staff sickness within European Care procedures and had evidence to support that she was recruiting new staff. Relatives who completed pre-inspection surveys were happy with the staffing of the home. One wrote we only have praise for the care and attention given by the staff. Surveys also indicated that people were happy that staff were available when needed. On the day of the visit people also confirmed their satisfaction with the overall staffing arrangements. Their comments included staff are excellent and if I want to talk to a member of staff they will always talk to me. The fact that we found that some peoples basic care needs had not been met and that attention to cleanliness in bedrooms was an issue suggests that staffing levels may not be adequate at their current level, or that staff were not fulfilling their roles effectively. The manager will need to consider whether changes to staffing are needed when making improvements Care Homes for Older People Page 21 of 29 Evidence: in those areas. New staff told us that they had received an induction when they first started. In their completed pre-inspection surveys staff told us that they had undergone the necessary pre-employment checks before they commenced their employment and had received a good induction. They also told us they had a good level of training and support. In her completed self-assessment the manager wrote the home has a rigorous selection policy and staff are pova checked and have CRB checks completed before commencing employment. All staff have an induction and are sent on adult protection training. All staff have supervisions every two months. We checked the recruitment files of three newly appointed staff. All had been subject to satisfactory police clearance before they started work. All had references obtained although one did not have a last employer reference. Most files did not have recorded verification why they had left previous employment that involved working with vulnerable adults. This information would ensure that all possible safeguards had been put into place through pre-employment checks. Staff told us they received regular training and there was a systematic approach towards ensuring that all staff received their mandatory training. An external training provider was being used to assist with this. Any training gaps identified within the staff training matrix had been covered through planned future training events that were advertised in the office. Most staff had completed national vocational qualifications in care to level 2 or above. This ensured that people were being looked after by well trained and experienced staff. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home ensures that care is user-focused. Evidence: The manager is a experienced registered nurse who has completed her registered managers award and undertaken various professional courses. Her deputy has also completed the registered managers award and a national vocational qualification to level 4. This means that care is managed by experienced and well qualified staff. There were various quality assurance systems in place, many of which used a personcentered approach, particularly the residents/relatives meetings, one of which we attended on the day of this visit. This gave people who used the service the opportunity to have a say in the running of the home and in the planning of future events, as well as providing them with the opportunity to raise concerns. In their completed pre-inspection surveys people told us that communication was good within the home. Relatives in particular said that they were kept well informed about events Care Homes for Older People Page 23 of 29 Evidence: and about the residents and relatives committee. In her completed self-assessment the manager told us that The Home uses bi-annual service users questionnaires and audit these to see how we could do better. We hold regular minuted residents and relatives meetings. The quality assurance systems included audits of cleanliness and medications but had not been effective in reducing gaps in care and recruitment noted during this Inspection. These are areas that management will need to give attention to in future developments. Thr programme manager showed us the systems he was putting in place to address the shortfalls, and he has worked well with us in the past to bring about improvements. People told us they were happy with the way that staff handled money on their behalf. The system for storing and handling money for people included the keeping of receipts for purchases and two signatures obtained for withdrawals. Money was kept securely in individual wallets to prevent pooling of monies. Most equipment had service records to support this was being safely and regularly maintained. The water system was due for maintenance work, but staff had this in hand. Care Homes for Older People Page 24 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 25 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 10 12 4a) Staff must ensure the personal cleanliness and appearance of people. Nails, hair, glasses, shoes and clothes must be kept clean and tidy. This is so that peoples dignity is maintained through their personal appearance. 30/11/2008 2 26 16 2 k) The bedroom identified during this Inspection must be kept free from urine odour. This is to ensure the dignity of the person occupying the room. 05/01/2009 3 26 16 2 j) k) All parts of the home 31/12/2009 must be kept free from infection control hazards through effective cleaning of commodes, toilets and bedtables. Care Homes for Older People Page 26 of 29 This is to ensure people are not put at risk of infection due to inadequate standards of hygiene. 4 29 19 Written verification of the 31/12/2008 reason why in previous employment the staff member ceased to work with vulnerable adults must be obtained. This is to ensure people are kept safe from unsuitable workers. 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 9 Topical preparations should be correctly labelled and discarded within recommended timescales to promote infection control. Changes to prescriptions on medication records should contain a signature and date so queries can be followed up. Homely remedies provided should be consistent with the homely remedy policy to avoid errors in administration. The programme for refurbishing the home should be completed to ensure that peoples dignity is not compromised and to reduce infection control risks. A system should be introduced to monitor standards of general housekeeping within bedroom areas, this will ensure a more person centered approach to care and generally promote the dignity of people. Increased staffing, or re-training should be considered as a way to achieve better hygiene and housekeeping standards within the home. Wherever possible a last employer reference should be obtained prior to appointing staff to ensure people are kept safe from unsuitable workers. Systems for monitoring the quality of care, medication and recruitment should be put in place/improved to provide better safeguards for people. Page 27 of 29 2 19 3 26 4 27 5 29 6 33 Care Homes for Older People Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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. 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