Inspection on 28/07/09 for The Manor Care Home

This inspection was carried out on 28th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Manor Care Home 03/12/09

The Manor Care Home 07/08/08

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Manor Care Home The Manor Care Home Greendale Drive Manor Park Middlewich Cheshire CW10 0PH Lead Inspector Joan Adam Key Unannounced Inspection 10:00 28th July 2009 DS0000071371.V376880.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 2 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 The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor Care Home Address The Manor Care Home Greendale Drive Manor Park Middlewich Cheshire CW10 0PH 01606 833 236 01606 833 324 ahussa22@googlemail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manor Care Home Ltd Manager post vacant Care Home 44 Category(ies) of Dementia (11), Old age, not falling within any registration, with number other category (44) of places The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people 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 Dementia - Code DE The maximum number of people who can be accommodated is: 44 Date of last inspection 7th August 2008 Brief Description of the Service: The Manor is a privately owned 44 bedded care home, providing personal care, to residents over the age of sixty five years set in four and a half acres of land close to the town of Middlewich. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is no stars. This means that the people who use the service experience poor quality outcomes. We made an unannounced visit to the Manor on 28th July 2009. During the visit we spoke to the proprietor, manager some staff members and some residents and relatives. Before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) to provide us with up to date information about the home. Some of the comments we received and the information is detailed in this report. What the service does well: The Manor has a warm homely atmosphere and people spoken with said the staff are very kind and caring. “ the staff are lovely. The food on offer is good and wholesome and people spoken with said “just like mother used to make” A good standard of hygiene was seen throughout the home and the standard of decor was good so that people live in a comfortable environment. Staff were seen to be patient and caring with the people in their care. Recruitment procedures are robust so that people who are employed at the home are safe to work with elderly people. What has improved since the last inspection? The staff have received up to date fire safety training so that they know what to do in case of fire. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 6 Recruitment procedures are more robust so that the manager knows that staff are safe to work with elderly people. 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. 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. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training needs to be undertaken and the documents need to be more robust so that a full assessment of people’s needs is carried out before they move into the home to make sure their needs can be met there. EVIDENCE: The AQAA states that assessments are carried out by the manager of the home. We looked at the admission details of two residents who had recently come to live at the home. The documentation is a checklist which was completed, however, this does not give much information to enable the needs of the person to be fully assessed so that the home was sure their needs could be met there. The senior staff lack some experience, training and knowledge to The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 9 assess people with dementia care needs. This was fully discussed with the manager and proprietor at the time of the visit. There was evidence that information had been obtained from social services prior to admission. The home does not provide intermediate care so standard 6 was not assessed The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of people who live in the home and the receipt of medicines are not sufficiently well documented so that we are unable to ascertain if care needs are being fully met. EVIDENCE: The AQAA told us that routines at the home can be flexible to suit peoples’ needs. When speaking with people who live at the home they said they could make choices about where they could sit, what they had to eat and what they wanted to wear each day. All of the people living in The Manor had a care plan which was written in every day. We looked at the care plans for four people who lived at the home. Daily records were very detailed and were well written. The care plans were mainly The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 11 type written and were not sufficiently personalised. They did not give sufficient guidance for care staff to know how to care for the person. Some older type care plans were in place which did give guidance. Some plans were not signed or dated so it was not clear who had written them and when. The plans had been reviewed on a monthly basis, however, these needed to be more detailed so staff know what has happened and what changes have been seen. Visits by other health professionals was recorded so staff would know when these visits had taken place and why. One person who had a pressure sore had not had their position changed as directed by the district nurse. This was recorded on a chart but this showed that some hours had gone past without the person being turned over. This means that the condition of the sore may deteriorate. Staff spoken with said that this is because of a shortage of staff. The person had an air flow mattress on their bed provided by the home to help to alleviate pressure. Medication management was looked at. The AQAA states that “we have a clear medication policy and staff are appropriately trained to manage medications safely. A number of residents self manage their medication, a risk assessment of which is recorded on the personal care file. Medication audits are currently being carried out monthly by the manager. This is all evidenced on the medication audit file.” When we visited the home we found that in some instances’ the staff are not recording when drugs are being received in to the home. This means that the management is unaware of how many medicines are in the home and if the drugs delivered are the correct amount that have been ordered. Some medication administration sheets (MAR) did have medicines recorded when they arrived at the home. One person had not had their medication recorded on the MAR sheet but the blister pack was empty, it was not possible to know for sure that this person had received their medication. Some MAR sheets had been handwritten by staff but they had not signed and dated these entries. Two staff must sign the MAR sheet if they need to be handwritten. One person had run out of some medicines and had not received them for four days. One person who was self medicating had a risk assessment in place but this was not adequate and did not fully assess the risk to the person. One person had their medication stopped by the manager before discussing this with the GP. We did not see any evidence of medication audits taking place. The atmosphere in the home was warm and welcoming and all staff were seen to be friendly and appeared to have good relationships with the people in their care. When spoken with staff were aware of peoples needs and their likes and dislikes. Residents spoken with said it is a lovely place to live” the staff are lovely the staff work hard The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the 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 who live at The Manor are not always able to take part in a range of activities, mealtimes were a positive experience EVIDENCE: When we looked at the AQAA it told us that “we provide a varied activity programme which is pre planned but flexible to the needs for change within the home. relatives and visitors are encouraged to join us for activities.” We saw that the home has an activities programme but no activities coordinator is employed at the home and care staff are expected to provide this service during the afternoons. Staff spoken with said that they are able to do this some days but not on others depending on the staff numbers. As the home has had staff shortages for some weeks and regular activities were not taking place. People who live in the home said that” theres not much going on in the way of activities” A survey received by a relative said “. We believe that activities are not offered to a level that stimulates residents” The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 13 The menu is on a notice board in the dining room downstairs. The menu looked varied and people spoken with said “ the food is lovely” “Food is alright, we don’t get a choice but if it was something we couldn’t eat we could have something else,” For sweet it was rice pudding and one person said “just like my mother used to make” The menus were printed in small letters and this made it difficult for people to read. It was discussed with the manager that perhaps these should be written in large print or menus could be put on the tables. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the 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 who live at The Manor are confident that their complaints are listened to however, staff training needs to improve so that they know what to do to protect people. EVIDENCE: We looked at the AQAA which told us that one complaint had been made to the home. When we looked at the complaints record the complaint had been fully logged and action taken was recorded. People spoken with said that they knew how to make a complaint. The home had policies and procedures on the prevention of abuse and whistle blowing. The safeguarding procedure is how the local council and other agencies respond to allegations of abuse against vulnerable people. The AQAA said that “all staff are protection of vulnerable adults (pova) trained and are made aware of our whistle blowing policy on induction.” However when we visited we found that only fourteen of the total number of thirty three staff employed by the home has received training with regard to safeguarding adults so that they know what to do to protect people. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 15 This was a requirement at the last visit. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the 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 comfortable place to live, visit and work. EVIDENCE: We walked round the home and looked in all communal areas, bathrooms and some bedrooms. People who live at the home were spoken with and they said that the home is comfortable and clean. The decor of the home was of a good standard and each bedroom was well personalised. The home was cleaned to a good standard and there were no unpleasant odours. There were one area of the garden outside the lounge areas that required cutting and weeding. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 17 The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are not sufficient to meet the needs of people living in the home. Training needs to improve so that people are kept safe. EVIDENCE: The AQAA told us that “staffing numbers are sufficient to meet the assessed needs of the service users. Staffing is organised in order to ensure a mix of skill, experience and qualification. The ratio of care staff to service user is determined in accordance with guidance recommended by the department of health and additional staff are provided at peak times.” When we visited we looked at the duty rotas and found that the numbers of staff on duty was not sufficient to meet the assessed needs of the people living at the home. There were thirty three people living at the home on the day of the visit. The rota for the week of the visit (Sunday 26/07/09 to Saturday 1/08/09) showed that on Sunday 26/07/09 there were only three staff on duty from 8am with another staff member coming on duty at 10am. There were five staff on duty for only two days that week, Tuesday and Thursday. This means The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 19 that three staff are working on the main downstairs unit and two staff work on the upstairs dementia care unit which the manager feels is sufficient to meet the needs of the people living in the home. For three days there were only four care staff on duty and on Saturday 1/08/09 only two staff were on the rota to work. During the night for three nights only two staff were on duty. Rotas show some staff working excessive hours to cover shortfalls. This situation has been ongoing for some weeks with the main shortfall at night due mainly to staff taking annual leave and an increase in the amount of people living at the home. We discussed with the manager and proprietor that agency staff should be used to increase staffing levels and copies of duty rotas be sent to CQC until further notice. Staff must take their days off. One person was not having their position changed as directed by the district nurse care plan to prevent pressure relief and staff felt that they were not giving the care they would like. Survey forms received by the home state” Sometimes the staff seem very overstretched” “We feel that staffing levels in recent weeks may not have been adequate.” The AQAA told us that “our recruitment process is thorough and based on equal opportunities and the protection of the service user.” We found this to be true. Staff files looked at had all relevant safety checks in place so that the manager was aware that the staff were safe to work with elderly people. We saw that some of the staff working in the home have achieved a national vocational qualification in care. This shows that some staff have had formal training to carry out their roles. We saw staff training is on-going but not all staff have received mandatory training in key subjects. All staff have received training in fire safety so that they will know what to do in case of a fire. Only twelve staff have received moving and handling training so all staff may not know what to do to move people safely. Fourteen of the total number of thirty three staff employed by the home has received training with regard to safeguarding adults so that they know what to do to protect people. These were requirements at the last visit. The home has a unit which has people with memory problems, only eight staff have received some training with regard to dementia so they can look after this type of resident appropriately. A dedicated staff team has not been put on this unit and staff move from one area of the home to another. It is important for people with dementia to have consistency and for staff to build up relationships with people in their care. The new staff employed at the home are not receiving structured induction and at present are “shadowing” a more experienced staff member. Some new staff have been in post fro some months and have not had formal moving and handling or safeguarding training. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of management need to improve to ensure people are cared for safely. EVIDENCE: The manager has been in post since November 2008 and has not been registered with CQC. She is a qualified social worker. Some staff meetings had taken place, however, the minutes did not appear to record staff comments and views. One staff meeting in April was discussing staff shortages but this problem does not appear to have been addressed. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 21 Relative meetings had taken place which discussed improvements in staff training and improvements to the garden. We did not see any evidence of residents meetings. The AQAA said” there are systems in place to monitor quality assurance in order to ensure the aims and objectives of the statement of purpose of the home are met.” We were shown an accident audit but this was a detailed list of accidents that had taken place. It did not inform the manager who had fallen, when and how often. No other internal audits were seen. The fire safety file was up to date and checks on fire alarm points and emergency lighting was recorded. A full health and safety audit had been completed on the home by an outside company and areas had been risk assessed. The proprietor stated that most of these areas had now been dealt with. The home should have quality assurance systems in place designed to identify strengths and areas of improvements. Some survey forms had been sent out to relatives by the home to gain their views. The staff spoken with felt that the manager was supportive. Survey forms received by CQC and the home were positive about the home, management and care given. They did however say that “activities were lacking” and” that although staff were very good they felt that more training was needed with regard to dementia care.” It was observed that the manager had a good relationship with people who live at the home and their relatives present on the day of the visit. Regular fire drills and staff training sessions are held to make sure staff know what to do in case of fire and there was a record of the names of staff attending. The AQAA gave us details of when equipment in the home had been checked and serviced to make sure that it continues to be safe and effective. There is a robust recruitment system in place so that all staff employed have the correct safety checks so that the manager knows they are safe to work with elderly people. The numbers of staff on duty is not sufficient to meet the assessed needs of the people living at the home. Staff training needs to improve with regard to moving and handling so that all staff are aware of how to move people safely. Training also needs to be improved with regard to safeguarding of people who live in the home so that staff know what to do and how to recognise if abuse was taking place. These were requirements at the last visit. Medication management needs to improve so that people who live at the home are confident that they receive medications as they are prescribed. Issues regarding medication was highlighted at the last visit. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 31/08/09 2 OP7 15 3 OP7 15 4 OP9 13 Pre-admission assessments for people with dementia must be carried out by a suitably qualified person. So that they know their needs can be met at the home. Care plans must reflect each 31/10/09 person’s individual needs and give guidance to care staff to enable them to meet their needs. Care plans must be signed and 31/10/09 dated by the person writing the plan so the home is aware of who is writing the plan and when. Medicines must be administered 31/08/09 as prescribed and in accordance with the home’s policy and procedures. This means that people living in the home can be confident they will receive their medicines as prescribed. Unmet requirement 31/08/08 All medicines that are being received in to the home must be recorded so that the DS0000071371.V376880.R01.S.doc 5 OP9 13 30/09/09 The Manor Care Home Version 5.2 Page 24 6 OP38 18 management know how many drugs are in the home at all times. All staff must receive up to date moving and handling training so people living in the home are not placed at risk of possible injury. Unmet requirement 30/09/08 All staff must receive up to date training regarding safeguarding of adults so they know how to recognise abuse. Unmet requirement 30/09/08 Activities must improve so that people are kept stimulated. Adequate numbers and skill mix of staff must be provided to enable the needs of people living at the home to be met. A copy of duty rotas with all staff names and names of agency staff must be sent to CQC on a weekly basis until further notice. All new staff employed by the home must have a structured induction including moving and handling and safeguarding training so that they are aware of how to work and are aware of the homes policies and procedures. A quality assurance system must be in place so that areas of concern can be highlighted and acted upon quickly. 30/09/09 7 OP18 18 30/09/09 8 9 OP12 OP27 16 18 30/09/09 31/08/09 10 OP30 18 30/09/09 11 OP38 24 30/09/09 The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations Ensure that all areas of the grounds of the home are maintained to provide a pleasant environment for the people who live there. The Manor Care Home DS0000071371.V376880.R01.S.doc Version 5.2 Page 26 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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