Inspection on 12/10/09 for Sunrise Operations Purley Limited

This inspection was carried out on 12th October 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.

Other inspections for this house

Sunrise Operations Purley Limited 15/10/08

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Sunrise Operations Purley Limited 21 Russell Hill Road Purley Surrey CR8 2LF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth OReilly     Date: 2 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Sunrise Operations Purley Limited 21 Russell Hill Road Purley Surrey CR8 2LF 02086762300 02086762323 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sunrise Operations Purley Limited care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 80 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Sunrise Operations Purley Limited provides residential and nursing care for up to 80 older people. The home is in Purley and is a purpose built Victorian Mansion. It is situated close to local shops and transport links. A user guide is available from the home that gives good information about the services provided. Details of fees payable can also be obtained from the home on request. Care Homes for Older People Page 4 of 27 Over 65 80 0 0 5 1 1 2 0 0 8 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 unannounced inspection was carried out by two Regulation Inspectors on 12th October 2009 and one Pharmacy Inspector on 5th November 2009. The inspectors had the opportunity to speak with seventeen people who use the service, three members of staff and the service manager. The manager provided their own assessment of the service (AQAA) when we asked for this. We looked at information kept about the people who use the service and how their needs are to be met along with other records that the service must keep. We looked at the building to make sure it remains clean and comfortable. We have used information from all of the above sources to reach the judgements made in this report. A separate report will be provided by the Pharmacy Inspector. Care Homes for Older People Page 5 of 27 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 on page 4. Care Homes for Older People Page 6 of 27 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 7 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 8 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 who use this service felt they were provided with sufficient information about what they could expect before they made their decision about moving in. The needs of each person are assessed before they move in which assists in ensuring that this is the right place for them. Evidence: People who use the service told us that they had enough information about the home to help them in making the decision about moving in. Individuals informed us that they and in some instances their family had visited the service before making their decision. Comments from individuals indicated they had taken advice from others before making decisions. Individuals told us the service had been, recommended by their doctor, chosen by their family and been directed to the service from staff at a local hospital. One person told us they had booked in for one month but had now been living at the service for over six months. Care Homes for Older People Page 9 of 27 Evidence: A guide to the home is given to each person when they move in and a copy of the guide was seen to be available in the entrance area. The manager informed us that this document had been updated and was available in large print and on audio tape if needed. We looked at a sample of the records maintained for each person. Pre admission assessments were seen to be carried out. Assessments were seen to contain information on the physical needs of individuals. Good details on the likes and dislikes of individuals was seen to be recorded. Information on family links, social interests. life history and religious needs is also sought. This information is used to ensure that the service can meet the needs of the individual and also provides information from which staff can set up initial care planning. This service does not provide intermediate care. Care Homes for Older People Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using the service is provided with a plan of care. Staff have included some good information on the individual needs and wishes of the people they support. However the quality of care planning is not consistent across the service and is not always up to date. Where problems have been identified staff have not always recorded how people are to be supported or the outcomes of actions. The recording of wound care does not provide clear information on the treatment to be provided. Medication administration and monitoring needs to be improved. Evidence: People who use the service made positive comments about the way in which they are supported with their health and personal care. Comments included; I am very well looked after, I see the wellness people, lots of attention if you are unwell, I have kept my own GP but have not needed to see him and we are well looked after here We saw a wellness noticeboard where information was displayed for people on how to make appointments with the GP. Contacts within the home were also displayed. The Care Homes for Older People Page 11 of 27 Evidence: manager informed us that since the last inspection arrangements have been made for the scheduled GP visits to be increased from once to twice a week. Those people who are able to attend the GP practise are supported to do so. We looked at a sample of the care planning documents. We found some good information on individual preferences and on the equipment to be used to support people with their mobility. In one instance a new care plan was partly completed which included goals and outcomes and more detailed information on the personal needs and wishes of the individual. However we found a lack of consistency across the plans we looked at. Discussion with staff showed a good understanding of the individual needs of people they support. However this was not always reflected in the care planning. Care planning was not always updated following assessments. In one instance the plan did not provide clear information on mobility and did not match with the most recent assessment. In another instance staff had noted a person as not having challenging behaviour but later statements clearly indicated that staff were challenged in providing support for this person. Care planning did not provide staff with clear information on how to approach individuals whom they found to be challenging other than to administer medication. Discussions with staff indicated that this information on medication was out of date. The evaluations of care planning seen did not give clear information on outcomes. In one instance staff had noted that one person was in pain all the time and that they should see their GP. However we could find no information as to whether this person had seen their GP or how their pain was to be managed. These discrepancies could lead to a lack of consistency in meeting the needs and wishes of individuals. We found a lack of information on the strengths and abilities of individuals which could assist staff in supporting individuals to maintain their independence. The recording of wound care was not satisfactory. We found staff were recording the treatment they had provided but no care plans for individual wounds were available which set out the treatment to be given, any changes, or the frequency of treatment. In one instance information on file indicated that staff had not followed the advice given by the Tissue Viability Nurse. This was discussed with the manager of the service who stated that the nursing staff had made their own decisions about how to treat this wound. However staff had not produced a plan of care for this wound and we found no recording by staff on what they were basing their treatment on. In one instance it was noted that a wound had doubled in size between one change of Care Homes for Older People Page 12 of 27 Evidence: dressing and another but there was no information as to what action had been taken. We looked at the medication held in the service. We found one instance where tablets were still in a dosset on two separate days but had been signed for as given. One instance was found where staff had signed the record seventeen times to say an antibiotic had been given. The course prescribed was only fifteen capsules. The information for on giving medication as required was not sufficient. In one instance staff had noted that the GP said to give the medication for challenging behaviour, but no further information was recorded. One instance was found where the quantity of boxed medication did not match the administration records. This appeared to indicate that the record had been signed for but the medication not actually given. On two consecutive days staff had not given the prescribed antibiotics to three people. The monitoring system used by the service recorded that three omissions had been made on both days. This suggest that the monitoring had been retrospective as it had not prevented the same mistakes being made on the second day. The daily monitoring tool showed that 11 medication omissions had been made between the 5 and the 12 October 2009. The lack of accuracy in recording and administering of medication along with the failure of the monitoring system to prevent further errors is of concern. A requirements, which had to be actioned immediately, was left with the service manager on the first day of the inspection. This was to ensure that medication was administered as prescribed with full and accurate records kept. A request was made for a further examination of the management and administration of medication to be carried out by a pharmacist inspector from the Care Quality Commission. This inspection was carried out on the 5th November. Information from the pharmacist indicated that some improvements had been made in the management of the medication however these improvements need to be continued and the immediate requirement had not been fully complied with. We observed staff providing support and advice in a respectful and discreet manner. The privacy and dignity of individuals was seen to be respected by the staff group. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have the opportunity to take part in a varied activities programme. Overall people generally enjoy the meals provided. Evidence: We asked people who use the service about the food provided. Individuals told us; the food is wonderful, the food is very good, they have everything, whatever you want, the food is nothing thrilling but quite good, its gone down a bit in the last few months but pretty good. One person told us I dont care much for the food and another person said they felt the meat was of poor quality. Overall comments about the food were positive. The manager informed us through their own assessment of the service that there was a continuous review of the dining service and changes had been made to the menus and suppliers of meat and fish after listening to the views of people who use the service. Two sittings for lunch and dinner have also been introduced to allow more choice for individuals as to when they take their meals. Monthly dining service meetings are held to gain the views of people who use the service and review the menus. These meetings are minuted and included in a monthly newsletter. Care Homes for Older People Page 14 of 27 Evidence: People told us they could have visitors at any time and that their families felt welcome in the home. One person told us; I had a friend to stay, they were made very welcome and they rented a room. A separate dining room is available where individuals can meet with and share a meal with family or friends. Discussions with staff indicated that they supported people to maintain contacts with family and friends when needed. The future activities programme was seen to be available throughout the home and the activities on offer for that day were seen to be well advertised. People told us there were; bags of activities and that I like the entertainment, I have done flower arranging, knitting and crosswords, the activities are good. We observed a large number of people involved in activities throughout the day. The manager informed us that a minimum of two mini bus trips are on offer each week, and live entertainers are booked regularly. The Bistro area on the ground floor was seen to be well used for socialising and entertainment. One person we spoke to felt that weekends could be boring and that more entertainment should be provided. Two people told us they would like to go out more with one person wanting more shopping trips. One person felt the activities available did not suit them. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service know how to make a complaint or raise concerns. The organisation has a complaints procedure which is on display and appropriate records are kept of any complaint. Staff have received training on safeguarding people which assists in protecting people who use the service from abuse. Evidence: People who use the service told us they knew who to speak to if they had any complaints or concerns about the service. Responses from individuals indicated they were confident that staff would listen to them and act on their concerns. People told us I would speak to whoever was in charge, I would go to the senior staff and I would speak to the manager. The complaints procedure was seen to be on display in the home. The organisation has provided a list of advocacy services which individuals can contact should they wish. We saw that the home is keeping a record of all complaints along with actions taken and outcomes. Records showed that the manager had met with the people who have raised complaints to assist in resolving issues. Staff were found to be aware of their responsibilities in ensuring appropriate assessments are carried out in relation to the deprivation of liberty of any one using Care Homes for Older People Page 16 of 27 Evidence: the service. Staff confirmed that they had been provided with training on safeguarding people which assists in ensuring that they understand their roles and responsibilities in reporting any allegations or suspicions of abuse. During this visit one issue was raised with the inspectors which the service reported to the appropriate agency for investigation. Following our visit to the service a number of issues were raised by health care professionals which have been passed on to the local authority safeguarding team for investigation. These issues had not been raised with the service for investigation. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are provided with a very high standard of accommodation. Evidence: Individuals we spoke to made positive comments about the environment. Comments included; the rooms are very nice, you can walk in the grounds and I have everything I need in my room. All of the areas of the service we saw were well maintained and decorated to a high standard. People have access to a variety of communal areas. Each person is provided with their own single room with en suite facilities or can choose a companion room which consists of two single rooms side by side with a shared bathroom. We saw that people can and do bring to the home items of their own such as furniture, photographs. pictures and possessions which assist in personalising their own space. All areas of the service we saw were clean and odour free. People who use the service told us; they clean the rooms beautifully and the sheets are changed regularly. At the time of the last inspection concerns were raised with the inspector about the management of the laundry service. Since then changes have been made and a full time laundry assistant has been employed. Comments received indicated that the service has improved. Care Homes for Older People Page 18 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. Feedback from people who use the service indicates high levels of satisfaction with the way in which staff provide care and support. Staff are provided with good opportunities for training which assists in ensuring that people who use the service are supported by a knowledgeable and skillful staff team. The number of staff available at meal times needs to be reviewed. Evidence: All of the comments received about the staff were positive. People told us; the staff are very good, they are nice and polite, lovely, quite nice, quite pleasant, pretty good and the best. The staff we spoke to felt that the numbers of staff on duty were sufficient when they were fully staffed but that at times in the past they have not always had the full staff complement and that made their work difficult. Three people who use the service raised concerns about shortages of staff at meal times. One person told us they had to wait a very long time at breakfast that morning. The manager informed us that staff recruitment had improved over the last year and we observed two new nurses were working as part of their induction at the time of this visit. The manager also informed us that the recruitment drive would be continuing to ensure the service employs twenty percent more than requirements. Care Homes for Older People Page 19 of 27 Evidence: The management should review the arrangements for staff at meal times to make sure that sufficient staff are available. We looked at a sample of staff files and these were found to be in good order. Evidence of pre employment checks on staff were seen to be available including Criminal Records Bureau checks. The application forms completed by staff requested a list of employment over the last ten years. This should be amended in future to request a full employment history which will comply with more recent amendments to the regulations and further assist in safeguarding people who use the service. Induction for new staff includes training and shadowing established staff until assessed as competent. Appraisals are carried out after one month, then at three months and following this annually. NVQ training is offered on a rolling basis after six months satisfactory employment. We looked at a sample of training records. In one instance the records showed only one training session over the last year however the manager informed us after our visit that this person had completed NVQ level 3 in care and had completed a number of training sessions over the last twelve months. The training record for one nurse showed a significant amount of training in 2008 but very little in 2009. One person was seen to have taken part in training on sensory deprivation, manual handling and medication in 2009 and to also have completed NVQ level 3. Staff spoken to told us that they had good opportunities for training which keeps them up to date with good practise. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are satisfied with the way it is managed. Opportunities are available to people who use the service, their relatives or representatives and staff to influence the way in which the service is provided. Certain record keeping needs to be improved and monitoring systems need to be used to make sure that any errors that do occur are not repeated. Evidence: We asked people how well they felt the service was managed. Individuals told us its quite well run, all in all its quite good and from what I can see it seems pretty good. One person felt the service could be run more efficiently. The majority of people we spoke to felt satisfied with the way the service was run. Since the last inspection of the service there has been a change in manager. The new manager informed us that an application had been made for their registration with the Care Quality Commission. Care Homes for Older People Page 21 of 27 Evidence: Systems are in place to consult with people who use the service through a Residents Council and a Dining Service Committee. Meetings for relatives are planned to be carried out on a regular basis. In addition the organisation carries out regular quality monitoring which is fed back to people who use the service. Staff meetings and individual staff supervision assist in ensuring that staff are all working in line with the aims and objectives of the service. Records showed that staff supervision and appraisals were being carried out. However one member of staff spoken to told us they had not received one to one supervision. The standard of record keeping particularly in relation to care planning, medication and wound care needs to be improved. The monitoring systems in place should be reviewed to make sure that when problems are identified action is taken to prevent any further errors or omissions. The organisation should also ensure that there are clear lines of responsibility and reporting for those staff monitoring areas of the service. People who use the service can deposit small amounts of cash for safekeeping. We looked at a sample of the records kept for these accounts. The records were found to be clear, accurate and up to date. Care Homes for Older People Page 22 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 23 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 1 9 13 PRN protocols must be 13/01/2010 available for all medicine given on an as required basis which provide information on when these should be used, the maximum dose in 24 hours and the time interval between doses to ensure appropriate use and avoid overuse. To ensure the health and welfare of people who use the service. 2 9 13 There must be a robust system for the order and supply of medicines to ensure that people do not miss doses of medicines. To ensure the health and welfare of people who use the service. 13/01/2010 3 9 13 Medication must be 19/10/2009 administered as prescribed with full and accurate records kept. To ensure the health and welfare of people who use the service. Care Homes for Older People Page 24 of 27 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 Care plans must be kept up to date and include clear information of any changes in individual needs. To make sure that people who use the service receive the support they need in the way they wish. 13/01/2010 2 8 12 Wound care records must 18/12/2009 include a plan of treatment including clear, up to date information on the treatment to be provided, the frequency of treatment and actions taken to address any changes. To ensure that people who use the service receive consistent treatment in line with good practise. 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 Where staff have sought the advice of other health care professionals but have not followed this advice there should be a clear record of the reasons for this along with details of the current evidence based practise being followed. The organisation should review the number of staff available to support people during meal times including breakfast. To further safeguard people who use the service all new staff should be required to supply a full employment history Page 25 of 27 2 27 3 29 Care Homes for Older People 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 with a satisfactory explanation of any gaps in employment. 4 36 The management should carry out regular checks to make sure that all staff are provided with regular one to one supervision. The monitoring systems in place should be reviewed to make sure that when errors or problems are identified prompt action is taken to ensure these are resolved or not repeated. 5 37 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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