Inspection on 17/02/09 for Tunstall Hall

This inspection was carried out on 17th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tunstall Hall 18/08/09

Tunstall Hall 20/04/07

Tunstall Hall 15/12/06

Tunstall Hall 20/06/06

Tunstall Hall 24/01/06

Tunstall Hall 01/11/05

Tunstall Hall 13/06/05

Tunstall Hall 25/08/04

Tunstall Hall 13/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tunstall Hall Tunstall Hall Market Drayton Shropshire TF9 4AA     The quality rating for this care home is:   zero star poor 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: Joy Hoelzel     Date: 1 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Tunstall Hall Tunstall Hall Market Drayton Shropshire TF9 4AA 01630652774 01630658270 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) : Guardian Care Homes (UK) Ltd care home 31 Number of places (if applicable): Under 65 Over 65 31 31 dementia old age, not falling within any other category Additional conditions: 0 0 The home may accommodate a maximum of Thiry-One (31) service users. The home may accommodate a service user under the age of 65 years. Date of last inspection Brief description of the care home Tunstall Hall is owned by Guardian Care Homes (UK) Ltd and provides accommodation and personal care for up to 31 people. A Georgian house, located on the outskirts of the pretty Shropshire Town of Market Drayton, it is set in three and a half acres of grounds, surrounded by mature parkland, and benefits from access to a wide range of local amenities. There are good road links to the larger towns of Shrewsbury and Telford. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have been revised and are readily available. The actual fees were not included in the Service User Guide at the time of this inspection, therefore the reader is advised to contact the home to obtain up date Care Homes for Older People Page 4 of 28 Brief description of the care home information on the fees charged. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last unannounced key inspection was conducted 19th April 2007 with an annual service review 11th April 2008. The home did not know that we would be visiting to inspect the service on this occasion. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions Care Homes for Older People Page 6 of 28 offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection a Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with the CSCI areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. We asked for our Have Your Say, surveys, to be distributed to people living in, working in and visiting the home. Four were returned from people living in the home (three people indicated that they had help to complete the form), eight were completed by members of staff, two by relatives and one by a health care professional. The responses and comments are included in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home, (except in an emergency situation), until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information on the service and what it offers is available in a statement of purpose and service users guide. Both documents are informative and contain details of the aims and objectives of the service. To comply with the regulations and to give people full information and details of the service, the service user guide should include the levels of weekly fees payable. A short colour brochure has been produced designed to give people a quick guide and overview of Tunstall Hall. The case file of the person who recently moved into the home was looked at to see if information had been sought regarding this persons needs prior to moving in. Care Homes for Older People Page 10 of 28 Evidence: Information had been gathered from the previous health care setting and the deputy confirmed that the person had been visited in the previous place of residence. No document was available to evidence this, but an assessment of the persons daily needs was completed soon after their arrival to the home. Other case files looked at included an assessment completed by staff at the home; it was not always possible to determine when the assessment had been carried out, as the date was not included on the document. The deputy confirmed that, except in emergency situations, the manager will visit the person in their current place of residence prior to offering a placement at the home. A visitor told us that they arranged for the placement, as their relative was unable to make decisions due to frailty and poor health. They were generally satisfied with the admission procedure and stated that it went well. The home does not provide an intermediate care service. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each individual has a care plan, but are not offered the opportunity to say how they would like their care to be delivered. The plan includes basic information necessary to deliver the persons care, there are some gaps in important information and does not consistently reflect the care being delivered. Medication systems do not always follow good practice or safe practice guidelines with people being placed at risk of harm by the current procedures. Evidence: Each person has a written plan of their care that is based on the assessments of their care needs. Three plans were selected to be looked at in depth with other plans looked at briefly to follow up any observations made during the day. There was no evidence in the plan that the person or their representative was included or indeed involved in the planning process. One person stated that they were unaware of any care plan and was unsure of what it actually was. It is acknowledged that some people may be unable or do not wish to be involved but people should be offered the opportunity to comment. Two of the care plans had assessments of the twelve daily living activities using a Care Homes for Older People Page 12 of 28 Evidence: person centred and individual approach. None of the plans had been fully completed to offer sufficient information of the persons individual needs. For example, we looked at the care plan of a person whose relative had completed and returned our survey. Comments made in our survey included My relative doesnt eat meat but she is very often served it. The care plan for eating and drinking and the nutritional assessment for this person did not indicate a personal preference for not eating meat. Limited records are maintained of the daily food and drinks offered to people and are completed by the catering staff. There is no record of what a person is offered for breakfast, supper, drinks or snacks during the day. It is therefore not possible to determine whether a diet suitable to a persons preference has been offered. Another care plan recorded that a person experiences episodes of distress due to a specific condition. The monitoring document for this had been completed but a specific care plan had not been developed. Without this staff may be unaware of what the possible triggers are to these periods and the action needed to reduce the distress this person may be experiencing from time to time. The Annual Quality Assurance Assessment completed by the manager acknowledges they could do better in this area and records We need to document more information than we have been doing, we are introducing new care plan documentation which is more comprehensive than we are using at the moment and staff are having training on the importance of documentation/care planning There are plans for the next twelve months for- All staff are to have training on documentation and care planning. Medication is administered to people by the care staff, using a monitored dose system with additional boxes and bottles of medicines. On inspection of the storage of the medications we found that external and internal preparations are being stored together in the medicine trolleys. Eye drops and other medicines (creams/ointments) that had short shelf lives upon opening were not being dated so there was a risk that some people may be given out of date medication. Strips of tablets had not been replaced in their original packaging after use and as such it was not possible to establish for whom the medications had been prescribed. There is a high risk in this practice that someone may be given medications prescribed for another person. An accurate recording of the temperature of the fridge for medications that require cold storage conditions is not being recorded. A minimum/maximum thermometer is required to ensure that the fridge is maintained at between 2 and 8 degree Celsius. A selection of the Medication Administration Records were seen, there were some gaps indicating that medications had not been given, no reason for this was documented, the deputy was unable to offer an explanation. These concerns were discussed with Care Homes for Older People Page 13 of 28 Evidence: the deputy at the time of the inspection they offered an assurance that a review of practice and procedure would be undertaken. Observations during the day indicated that generally staff are respectful and considerate. Staff were observed to be knocking on the doors of private rooms before entering and privacy screens are provided in the shared rooms. Most people appeared to be dressed appropriately, however one person was not and we had to request additional clothing for them. A response was made in our survey of The cleanliness of some of the individuals clothing could be improved. Care Homes for Older People Page 14 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. Generally staff are aware of the need to support people but are limited by time and workload constraints. Some people are consulted or listened to regarding the choice of daily activity, but this process could be improved. Evidence: During the morning of this inspection there appeared to be very little structured social activity available, as the care staff seemed to be very busy attending to the personal care needs of people. They had very little time for anything else. People sitting in the lounge areas were either asleep, watching other people or waiting for staff assistance. Except for when staff were offering refreshments there were very little interactions or conversations occurring. The deputy manager stated that a variety of organised activity is available each afternoon during the week. A person has been recruited to assist with this. A small group of six people were in the dining room during the afternoon participating in some craftwork. Some people in the lounge areas became quite restless as the afternoon progressed there appeared to be very little for them to do. The statement of purpose includes a section on social and leisure pursuits and states the activity organiser is Care Homes for Older People Page 15 of 28 Evidence: trained in delivering activities for service users with dementia. A visitor to the home spoke of the very limited social and recreational stimulation available especially for the people with dementia and felt that this was sadly lacking in an otherwise satisfactory home. One person told us that they very rarely leave their bedroom as they prefer their own company and are perfectly happy with this. A member of staff completed our survey and commented in the What could be done better section - more activities especially at weekends. Visitors to the home expressed a general satisfaction with the visiting arrangements, and commented that they welcomed the time they are able to spend with their relatives. The main front door is kept locked for security reasons staff answer the door and allow entry, a push button device is used for exiting the building. Stair guards have been installed in areas where there is a potential risk to people, and the door leading to the kitchen and laundry area is fitted with a locking device. People have free access to the communal areas and were seen to be using all areas. Meals are prepared by the catering staff and served by the care staff mainly in the dining area, but people are able to have their meals in their preferred place. People commented that they have a choice of food and that generally they are satisfied with the menu. Mealtimes and when drinks are available seem to be very regimented and restricted to certain times. People were heard to be requesting drinks during the afternoon only to be told by staff that they had another half hour before afternoon tea would be served. Staff were instructed to provide drinks immediately. The statement of purpose states You may have tea, coffee or juice at any time you wish. Care Homes for Older People Page 16 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. The service has a complaints procedure that meets the National Minimum Standards and regulations. The procedure is up to date and is displayed around the home. Some people say they know how to make a complaint but others do not. Evidence: The statement of purpose and service user guide both offer details of how to raise a concern or complaint about the service. Our contact details in the service user guide are incorrect and will need to be amended so that a person can contact us if they so wish. The complaints log was unavailable at this inspection, information recorded in the AQAA indicates - Our complaints folder is well organised and all documentation is placed within. Three people spoken with stated that they would see the manager if they had any concerns or worries and they were certain that the manager would be able to help sort it out. Two out of the four people who completed our survey indicated that they did not know how or to whom to make a complaint. A person added an additional comment in our survey I speak with the manager if I have concerns but this does always resolve things. The AQAA informs that the home has received one complaint and at the time of completing the AQAA this was still to reach a satisfactory conclusion. Four referrals have been made to the Safeguarding adults multi agency team for consideration following some allegations. One of the investigations has yet to reach a satisfactory Care Homes for Older People Page 17 of 28 Evidence: conclusion. The manager is aware of the referrals and has offered their cooperation with the process. The deputy told us that All staff have had basic protection of vulnerable adults training and abuse awareness is included in the induction programme training. Additional training for two members of the senior staff has been arranged for March 2009. Staff spoken with described the actions they would take if they had any suspicions of any wrong doings. The home offers a facility for residents to deposit personal monies and valuables for safekeeping; records relating to this were seen. All transactions are recorded on individual balance sheets with invoices and receipts kept. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate for the people who live there. Evidence: Tunstall Hall is a large country house set in its own grounds on the outskirts of Market Drayton. All areas of the home are very well furnished and decorated and there is a programme for ensuring the upkeep of the premises remains at a high standard. People spoken with stated they are satisfied with their accommodation with one person stating This is now my home and I shall be happy to stay here for the rest of my days. The gardens are well tended, with one person enjoying their daily walks in the grounds. During the tour of the home many of the bedrooms we looked at were highly personalised, all very different and diverse as the inhabitant. There are one or two areas that pose a potential risk to people. To reduce the risk of injury to people, wardrobes should be fitted and secured so that they are stable and do not have the potential to topple over. Freestanding electric radiators should be secured and covered or removed and rubber coverings should be fitted to the bottom of the legs of commodes. Care Homes for Older People Page 19 of 28 Evidence: All areas of the home were clean, the people responsible for the cleanliness of the home work hard to maintain a good standard. Hand wash facilities have been provided for the control of the spread of infections. Staff discussed the actions they take on a daily basis and their working practices to ensure people are as safe as they can be. Responses made on our survey indicated that people thought the home was always kept clean. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally satisfied that the care they receive meets their needs, but there are times when they may need to wait for staff support and attention. Evidence: A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. During the morning of the inspection the deputy manager was on the premises supported by three care staff. Ancillary staff were also on the premises. The deputy stated that these are the usual staffing levels for the day with a reduction overnight to three care staff. The deputy confirmed that twenty seven people are currently residing at the home of which twenty one people have cognitive impairment with a dementia related illness. Observations of the dependency needs of people and staff working practice suggest that the staffing levels are insufficient to provide anything but the basic care to people. Staff stated they were always very busy, with people living at the home commenting the same. They say they will see me later, sometimes they come, sometimes they dont, they do not always do what they say. Care Homes for Older People Page 21 of 28 Evidence: I understand that they cannot do what I ask when they are busy. Staff completing our survey indicated that More staff are required,and Additional staff needed at busy times of the day. Relatives completing our survey - Sometimes the staff dont check things, sometimes our expectations are not met. Other people, visitors and residents, expressed a satisfaction with the staff and service - Staff are very good, No complaints very good to my relative. They always meet my mothers wishes and needs. The Annual Quality Assurance Assessment indicates that of the 19 care staff, 13 hold a National Vocational Qualification. Staff commented that they have either completed the course or are thinking about starting one. Three staff files were selected for inspection and included different grade staff. All files were well presented and contained the information required to safeguard the people living at Tunstall Hall. The deputy was advised to ensure a full employment history is obtained and any gaps in the information to be discussed with the person. Some concerns were raised with us about the younger members of staff and on occasions (when the manager is not on the premises) of them messing about. One of the personnel files looked at included documentary evidence of disciplinary action taken when this had occurred. Staff spoken with considered they are provided with good training opportunities to include mandatory and service specific topics such as infection control, moving and handling, protection of vulnerable adults and medication administration. Training certificates and accreditations for training were in the staff files we sampled and leaflets advertising future courses and dates were seen displayed in the office. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is qualified and has the necessary experience to run the home. The manager understands person centred planning and thinking but there are one or two areas that require attention to ensure effective outcomes are achieved for people using the service. Evidence: Ms Marita Williams is the registered manager of the service and has held the position since October 2007. Ms Williams was not on the premises during this inspection. The deputy manager was in charge of the home and offered her fullest cooperation with the inspection. The deputy confirmed that both senior staff have gained the Registered Managers Award, with plans for further training in specific areas relating to the service. People offered positive comments about the management arrangements - Ms Williams is a very good manager, works with the carers on the floor and shows a good example. Visitors stated the manager is very good but that they have certain reservations of the staff group when she is not about. People living at the home told us Care Homes for Older People Page 23 of 28 Evidence: The manager is good and will listen to us, equally there are some very good staff and some not so good. The quality assurance and monitoring of the service continues with satisfaction surveys distributed to people involved with the service. An audit of the last survey was produced in July 2008 and any suggestions for improvements have been actioned. The AQAA informs us that - We also hold Residents Meetings on a two monthly basis and we have regular reviews with Social Workers, Residents & Families to ensure that our service is meeting all their needs. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. Transactions are recorded on individual balance sheets with regular audits of the account conducted. Records, documents and certificates are available for inspection to ensure that the weekly, monthly and annual health and safety checks are being carried out. Care Homes for Older People Page 24 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 25 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 8 12 The service must make 27/03/2009 proper provision for the health and welfare of people who live at Tunstall Hall To ensure that people receive the nursing, personal care and monitoring that their conditions require. 2 9 13 Amendments must be made to the medication procedures. To ensure that the potential risk of medication errors is reduced. 27/03/2009 3 27 18 Staffing levels must be determined according to the assessed needs of the people living at the home This will ensure that the health, personal and social care needs of people are fully met. 27/03/2009 Care Homes for Older People Page 26 of 28 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 1 The service user guide should include information on the current level of fees for the service, this will ensure that people have the necessary information to assist with making a decision to move in or not. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative Records of the food and drink provided should be in sufficient detail to determine whether the diet is satisfactory for people. Staff should be instructed to ensure that a person is treated with respect and dignity at all times. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. Food and drinks should be readily available and provided to people when and where they require, this will ensure that people remain well nourished and well hydrated. The complaints procedure should be amended to include the correct details of the commission this will ensure that people are able to contact us should they wish to do so. Systems should be adopted to check the safety of the equipment in use at the home on a regular basis, this will ensure that people have a safe place in which to live and work. 2 7 3 8 4 5 10 12 6 14 7 16 8 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!