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Inspection on 24/09/08 for The Withens Nursing Home

Also see our care home review for The Withens Nursing Home for more information

This inspection was carried out on 24th September 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Several shortfalls were identified in all outcome areas inspected. The acting manager responded positively to our findings, and has assured the Commission that all shortfalls will be addressed and that standards will rise without delay.

What has improved since the last inspection?

The home has increased it`s budget for food and provisions. This has made a significant impact on the quality of food for residents. All residents spoke highly about the quality of the meals.

What the care home could do better:

Significant shortfalls were identified in how the home records information. Improvements must be made in pre assessment documentation, care planning, risk assessments, nutritional screening and recording of complaints. Current staff recruitment practices are poor and do not protect residents from harm. Staff have not recieved appropriate training, this must be addressed as a matter of urgency. All the above puts service users at risk. Incomplete record keeping means the home may not be aware of resident`s support needs. This could have a detrimental effect on the resident. The home must ensure that records are complete and up to date.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Withens Nursing Home Hook Green Road Southfleet Kent DA13 9NP     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: Sarah Montgomery     Date: 2 4 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Withens Nursing Home Hook Green Road Southfleet Kent DA13 9NP 01474834109 01474833082 withens@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ranc Care Homes Ltd care home 33 Number of places (if applicable): Under 65 Over 65 33 old age, not falling within any other category Additional conditions: 0 The registered perosn may provide the following category of service : Care home with Nursing( N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) The total number of service users to be accommodated is 33 Date of last inspection Brief description of the care home This care home with nursing offers 23 single and 5 shared bedrooms that are situated on the ground and first floors. Seven (single) bedrooms have en-suite facilities. A passenger lift connects the two floors. Care assistants provide the majority of care support services with a nurse on duty at all times. The manager is a registered general nurse. The home has an activities organiser, cook and kitchen assistant, domestic staff and laundry assistant and maintenance engineer. Service users, staff and visitors have the benefit of considerable lounge/conservatory Care Homes for Older People Page 4 of 28 Brief description of the care home and dining room space and they have access to a garden. The premises have some car parking spaces. The nearest train services are at Longfield and Gravesend. There is also a local bus service. Weekly fees are as follows: Contracted price (eg. Kent Social Services): £438 (plus a nursing care contribution of either £123 or £83). Privately funded: £735 (less a PCT contribution of either £123 or £83 for nursing care depending on whether the agreed banding is high or medium). Continuing care: £650 (funded by NHS primary care trusts). Additional costs charged by the home to service users are as follows: Hairdressing. Chiropody. Newspapers and Personal toiletries (service users either provide their own or contribute £7.50 a month if the care home provides these). Care Homes for Older People Page 5 of 28 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 Key inspection was conducted on 24th September 2008 by Sarah Montgomery, Regulation Inspector. All the key standards were assessed. To assess the standards we inspected documentation which included policies and procedures, service users care plans, pre assessment documentation, staff files and medication processes. We spoke with the acting manager, a relative, several members of the staff team, and to residents, both in a group and individually. By gathering all of this evidence, we have made the judgement that residents living at this home recieve an adequate service. We have requested the home provide us with an improvement plan. This will tell us how the home plans to address the shortfalls identified in the report. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 8 of 28 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 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents cannot be confident that their needs will be competently assessed prior to admission, or that should they require intermediate care, cannot be assured that their needs will be met either prior to, or following admission. Evidence: Key Standards 3 and 6 were assessed. To assess these standards, five pre admission assessments, the annual quality assurance assessment completed by the home, care plans, health care plans and risk assessments which corresponded to the five pre admission assessments were inspected. We also spoke with the acting manager, with staff members, and with residents. The pre admission assessments contained insufficient information. They lacked detail regarding assessment of need, and were blank in key areas, for example, no information regarding the hearing or eyesight being recorded. Care Homes for Older People Page 10 of 28 Evidence: On one assessment there was no indication that any healthcare professionals had been involved in the care or assessment of the service user, despite the fact the proposed move was to a nursing home. None of the assessment contained the views, wishes or aspirations of the prospective service users. The assessments inspected contained insufficient information to properly inform care plans or risk assessments. The home had previously sent their annual quality assurance assessment (AQAA) to the Commission. In the homes own assessment of these standards, they state that their pre assessment processes are high quality and that the pre assessment documentation is comprehensive. Our evidenced findings do not support the information supplied by the home in their AQAA. Not only is the gathering of information poor during assessment, but the assessment tool is considered very basic, and does not fully address assessment of key areas as stated in Standard 3.3 (personal care and physical well-being; diet and weight; dietary preferences; sight, hearing and communication; oral health; foot care; mobility and dexterity; history of falls; continence; medication; mental state; social interests; religious and cultural needs; personal safety and risk; and carer and family involvement). The registered person must develop an assessment tool which enables gathering information by way of an assessment of need, and involves the prospective service user (and representative, if appropriate) to express their needs, wishes, aspirations and lifestyle expectations. The homes statement of purpose states that the home does provide an intermediate care service. However, when questioned, the acting manager advised us this is not the case, and the home was a long term placement only. We enquired further about the statement of purpose in relation to intermediate care. It became clear that the acting manager was uncertain both in terms of what intermediate care was, and whether the home provided it. The acting manager recalled a service user staying at the home for a specified amount of time following a hospital admission, and upon remembering this, agreed that the home does provide intermediate care. Further inspection of this standard (6) evidenced the home does not have a policy on intermediate care, and has no dedicated accomodation or resources. The registered person must determine the homes position on intermediate care, and take steps to address the absence of policy, resources, staff knowledge, and dedicated accomodation. Care Homes for Older People Page 11 of 28 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. Residents would benefit from a more robust system of care planning to ensure their assessed health, personal or social needs will be addressed. Evidence: Key Standards 7, 8, 9 and 10 were assessed. To assess these standards, we inspected the health and personal care files of five residents, and medication procedures and protocols. We cross referenced information that the home had told us in their annual quality assurance assessment with the evidence we gathered at this site visit. We also spoke with individual residents, the acting manager, and members of staff, and spent time observing working practice in the home. The homes annual quality assurance assessment speaks confidently of their achievements in this outcome area. It states; comprehensive and detailed care plans are allocated to key workers and are reviewed monthly or as changes occur. Service users privacy and dignity are supported and maintained. As far as possible residents Care Homes for Older People Page 12 of 28 Evidence: independence is promoted...risk assessments for pressure areas, nutritional deficits, falls and pain management are in place. The documents and care plans inspected, discussions with management and staff, and conversations with residents, all evidenced that this home has shortfalls in meeting the health and personal care needs of residents, and does not uphold the information contained within the annual quality assurance assessment. Care plans contained basic information which did not fully address the support needs of residents, or provide adequate guidance to staff regarding how to support an individual. There was no evidence that residents had been involved in planning their own care, or that their views had been sought. The home needs to address the language used on care plans. At present, the supported required is recorded as solve problem. We spoke with the acting manager about use of negative language, and was assured that this would be changed on all care plans. More care needs to be taken when recording information on health care plans. For example, entries must always be dated, and there needs to be evidence of regular nutritional screening. When speaking with nursing and support staff, it was clear that residents needs were being met regarding health and personal care, and they acknowledged shortfalls in how this is recorded. It is critical that residents are assessed for falls. Although upon speaking with staff and the acting manager, it was evident that they were knowledgable regarding individuals risks concerning falls, this was not formalised in a risk assessment. Medication administration and storage were inspected. The home stores medication appropriately. A medication round was observed, and practice was seen to be of a high standard. However, shortfalls were noted in individual care planning, in that individuals wishes regarding how they wish to take their medication is not recorded. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident they will be supported and encouraged to maintain relationships with family and friends, and can be equally confident they will be offered a variety of activities that they have told staff at the home they enjoy. Evidence: Key Standards 12, 13, 14 and 15 were inspected. To assess these standards we looked at lifestyle choices offered to residents, how residents are supported to maintain family links and friendships, what support is offered to enable residents to maintain choice and control over their lives, and inspected documents that told us how residents nutritional needs are met. We spoke with a number of residents about life at the home, and asked them if their lifestyle expectations were being met. Several of the residents were in the main lounge participating in a planned exercise activity. Without exception, all the residents spoken with during this activity told us they were happy with the home, and said that they alwayslooked forward to participating in the varied activities on offer, and there was something different to do most days. The residents spoke highly of staff, and of the care they recieve. They mentioned how nice the food was, and told us that relatives and friends could visit at anytime. Discussion with the activities coordinator and inspection of activity records evidenced a planned, Care Homes for Older People Page 14 of 28 Evidence: competent and enthusiastic approach to providing meaningful and varied activities for residents, this included consulting with residents about the type of activity they prefer. Some residents chose not to join in any activity. These residents are offered one to one time. There are shortfalls in recording activities. This means that the home cannot properly evidence when residents have made a decision to participate or not. The acting manager stated that an additional activities coordinator is to be recruited, and this should enable better planning and recording of activities, and increase the choice and number of activities on offer. All residents spoken with praised the quality of the food served. Inspection of menus and discussion with the chef further evidenced that meals are balanced, healthy and nutritious. However, shortfalls in recording individuals nutritional needs, including lack of regular recorded weight monitoring, means that the home is not fully aware of the nutritional needs of individuals. The home must ensure that all residents nutritional needs are assessed regularly. While at the home we spoke with a relative. They expressed confidence in the home, and felt their relative was recieving a good service, was cared for and supported. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident their concerns and complaints will be listened to. Residents would benefit from a more robust complaints recording system. Evidence: Key standards 16 and 18 were assessed. To assess these standards we looked at the homes policies and procedures regarding complaints and adult protection. We spoke with residents about making complaints, and with staff and management regarding their management of complaints, and understanding of adult protection protocols. We also looked at information we had recieved about the home or from the home regarding complaints investigations or any safeguarding concerns. We spoke with residents about what they do and who they speak with when they are unhappy with the service and have a concern or complaint. It was clear from the answers that people are confident about who they can speak with, and all residents spoken with indicated that they felt comfortable speaking about concerns. However, on inspection of complaint documentation, it was evident there are shortfalls in recording complaints. The manager confirmed that most complaints are made verbally, and these are not recorded. It was also clear that some outcomes were unsatisfactory, and that appropriate action to resolve the complaint had not been taken. The manager agreed that by not recording complaints, following up on actions taken and ensuring good outcomes was difficult, as sometimes information was lost or forgotten. Although the home has a complaints procedure which clearly states processes to follow upon Care Homes for Older People Page 16 of 28 Evidence: receiving a complaint, evidence gathered during inspection demonstrated that the home is not following this procedure. This issue was raised with the manager who gave assurances this would improve and all complaints would be recorded with a record made of action taken, timescales, and outcomes. We spoke with the manager and staff members regarding safeguarding adults protocols. All staff gave confident responses, which indicated they had sufficient knowledge to ensure understanding of their own and multidisciplinary procedures, including recognising signs of abusive practice. However, staff are trained in adult protection by an internal trainer. The trainer had received the most recent training in 2004. This is now out of date and staff at the home are not benefiting from current training which is reflective of recent legislation and changes in safeguarding protocols. Care Homes for Older People Page 17 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a comfortable and safe environment, but would benefit from consideration being given to eliminating unpleasant odours. Evidence: Standards 19, 25 and 26 were assessed. To assess these standards we looked at communal areas of the home, and inspected some bedrooms. We spoke with residents about their home, and asked whether they liked the decor and furnishings, and if they were happy with their rooms. We also spoke with the manager about how the home is maintained. A tour of the homes communal and bedroom areas evidenced that residents live in a comfortable, clean, homely and safe environment. Inspection of maintenance records demonstrated that the home is regularly maintained. Residents told us they were happy with the furniture and decor, and bedrooms were personalised and contained all necessary furniture. Although the physical environment was pleasant, this was let down by the overwhelming odour of urine. This was addressed with the home manager who acknowledged the problem and gave assurances that all flooring in the home was due to be replaced. Most areas of the home also felt quite cold. The temperature registered at 20 degrees (69F). Many windows were open because of the odour. The manager was advised to maintain adequate temperatures in line with guidance from the Care Homes for Older People Page 18 of 28 Evidence: department of health for residential homes for older people. Care Homes for Older People Page 19 of 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be confident they are protected by the homes recruitment practice, and cannot be sure staff are adequately trained to ensure their assessed needs are met. Evidence: Key Standards 27, 28, 29 and 30 were assessed. To assess these standards we looked at the staff rota, qualifications of staff, recruitment practices and staff training. We also spoke with staff about work practices at the home. We looked at seven staff files. None of these files were complete, with documentation concerning identity confirmation, employment references, and application forms missing. One file had two emloyment references, five files had one reference, and one file had no references at all. The registered person has not ensured appropriate checks are made on individual staff prior to commencing employment at the home. This means that residents are potentially at risk from harm, and have not been protected by correct recruitment procedures. The registered person must ensure that appropriate checks are carried out on all staff prior to employment. Shortfalls were identified in staff training. The manager informed us that staff training had fallen behind, and currently staff did not have up to date training in key areas such as fire, manual handling, food hygeine, the mental capacity act, and person centred care. The manager was hoping to arrange training within the next two months Care Homes for Older People Page 20 of 28 Evidence: for all staff, but no dates had been arranged. We informed the manager that a more proactive approach towards training must be adopted to ensure staff are appropriately trained to meet the needs of residents. The home employs seven nurses and twenty three carers. All the nurses are registered general nurses. Evidence regarding the NVQ status of the carers could not be found. Observations of staff throughout the inspection evidenced that interactions between staff and residents were good. Staff were observed treating residents with respect and dignity. It was clear from conversations with staff that the needs of individuals are well known. Staff feel confident they are meeting the needs of residents, but acknowledge that record keeping could be improved, and increased detail in care planning and risk assessments is necessary. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from more robust record keeping. Evidence: Key Standards 31 and 33 were assessed. To assess these standards we looked at the competency and experience of the acting manager, the annual quality assurance assessment written by the acting manager, and inspected records which told us how quality assurance is measured at the home. The acting manager is new to the home. Throughout the inspection many shortfalls were identified. In particular, shortfalls in pre assessment, health care planning, staff training and staff recruitment. In each area of identified shortfall, the acting manager gave assurances that each one would be addressed, and that standards would improve. The acting manager had sent the annual quality assurance assessment (AQAA) to the Commission prior to this inspection. Information contained within the AQAA differs greatly to our evidenced findings. The acting manager recognised that many statements made in the AQAA regarding the home were examples of what the Care Homes for Older People Page 22 of 28 Evidence: home is working towards, and are not examples of current practice in the home. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 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 3 14 The registered person must develop a robust pre assessment tool. The pre assessment tool will enable the home to accurately assess prospective residents. 27/04/2009 2 6 4 The registered person must ensure that the services which are stated in the statement of purpose are offered at the home. The registered person must clarify to prospective service users whether a intermediate care service is offered at the home. 27/04/2009 3 15 16 The registered person must ensure that the nutritional needs of all residents are regularly assessed. This will ensure the nutrional needs of residents are met. 27/04/2009 4 16 22 The registered person must ensure that all complaints, 27/04/2009 Care Homes for Older People Page 25 of 28 including actions and outcomes recorded, within timescales stated in the homes complaints procedure. This will ensure residents complaints are responded to appropriately. 5 18 13 The registered person must 27/04/2009 ensure that staff recieve adult protection training from a trainer who has up to date training. This will ensure staff recieve relevant and up to date training. 6 25 23 The registered person must ensure that heating at the home is suitable. This will ensure that residents are warm. 7 26 16 The registered person must 27/04/2009 ensure the home is kept free from offensive odours. This will ensure residents live in a hygenic environment. 8 29 19 The registered person must ensure that all staff at the home undergo a thorough recruitment process which ensures the protection of service users. This will protect service users from risk of harm. 22/05/2009 27/04/2009 Care Homes for Older People Page 26 of 28 9 30 18 The registered person must ensure that staff recieve appropriate training for them to carry out their duties. This will ensure service users needs are met. 22/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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