Inspection on 26/11/09 for Waterside Care Centre

This inspection was carried out on 26th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Waterside Care Centre 21/01/10

Waterside Care Centre 24/08/09

Waterside Care Centre 02/03/09

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Random inspection report Care homes for older people Name: Address: Waterside Care Centre Waterside Care Centre Leigh Sinton Malvern Worcestershire WR13 5EQ zero star poor service 02/03/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Seel Date: 2 6 1 1 2 0 0 9 Information about the care home Name of care home: Address: Waterside Care Centre Waterside Care Centre Leigh Sinton Malvern Worcestershire WR13 5EQ 01886833706 01886832882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Minster Care Management Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 46 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 46 The maximum number of service users to be accommodated is 46 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 46 Date of last inspection Brief description of the care home This is a purpose built two storey home situated in the village of Leigh Sinton, near Malvern. It provides nursing care on a permanent and respite basis for up to 46 older adults who have dementia and may also have some physical disabilities. All bedrooms Care Homes for Older People Page 2 of 18 0 2 0 3 2 0 0 9 Brief description of the care home are single occupancy and have ensuite facilities. There is a choice of well furnished seating areas. Bathing facilities are available on each floor offering a choice of a bath or shower. Aids and adaptations are available so that people requiring assistance can receive it safely. There is a passenger lift so that people can access all parts of the home and there is a secure garden to the rear of the premises that is accessible to people with limited mobility. At the front of the building is a car park providing off road parking for staff and visitors. The home has a no smoking policy. There is a bus route to Leigh Sinton and the home is within walking distance of the local shops. In the reception area there is a range of information for people living in the home and their visitors to access about the home . A copy of the inspection report should now be added to that information.The home has a range of fees and the manager should be contacted for up to date information about what these are. Care Homes for Older People Page 3 of 18 What we found: The reason for this inspection was to check the homes compliance with the requirements made under Regulations 12, 13(2), 15, 18, 26 and 37, of the Care Homes Regulations 2001 at the key inspection which took place over a three day period on the 10th September 2009, and the outcome is as follows: The visit to the home was undertaken over a period of one day when there were 28 people living there, two of these people were in hospital. The home did not know that we were visiting on that day. We looked at care files for three people living in the home, spoke with staff, relatives who were visiting the home, completed a partial tour of the building and observed staff performing their duties. We also reviewed the medication system, saw staffing rotas and staff training matrix and some other records about the running of the home. The acting manager and project manager were present at the home. Management and staff assisted us to complete our inspection and we were made to feel welcome. Choice of Home. We were told that there have been no new admissions into the home since we last inspected. Health and Personal Care We looked at the care files for three people who live at the home and it was positive to see that improvements had been made in relation to care plans. The care plans that we saw were now written in the first person as a reminder to staff that people and or their representatives should be encouraged to be part of the care planning process. The care plans provided staff with sufficient information about how they should assist people to meet their individual needs in a way that they prefer. We found specific instructions in one care plan for staff to follow and be mindful of when assisting the person with their personal care and recognising when a person is resistant to care. For example, Resistant to assistance, explain clearly all your planned actions and using short sentences. To do as much as I can myself to encourage independence. Space to calm down if I become aggressive or agitated whilst washing and dressing. Choice of clothing. One are that continues to need some improvement is to make sure all staff are recording in the separate records available when a person is assisted with their personal care tasks, such as, washing, bathing and or showering. We spoke with two members of staff about the importance of staff recording in this area and it was recognised that some staff are forgetting to record these tasks at times. From our observations no individuals looked unkempt and or unclean so we could not clearly state there are poor outcomes in this area for people. However, we shall continue to monitor staff recordings and observations of how people are supported and assisted with their personal care tasks as part of our regulatory activity, There were some good details recorded about how staff could assist people to maintain Care Homes for Older People Page 4 of 18 their independence. One care record referred to someone needing to wear comfortable shoes and environment to be clutter free. We observed this person wearing appropriate foot wear and enjoying their conversations with staff. Individual risk assessments had been written on the care records we sampled and these identified where people were at risk from falls, moving and handling guidance, nutrition, bowel and urinary incontinence. We shall be continuing to monitor peoples risk assessments and the review of care plans as part of our regulatory activity, but we consider that the requirements under Regulation 15 have been met. It was positive to see that in the care plans we sampled we found that staff are identifying individuals short term needs and risks to their health and wellbeing. In one care record we saw that the person had a pressure ulcer. Staff should be commended for their work in drawing up this care plan as it provides staff with precise guidance in dressing the pressure ulcer. For example we saw, signs to observe for any infection, maintaining a nutritious diet and encouraging the person to change position in bed to alleviate their pressure area. It was also noted that a referral had been made to a Tissue Viability Nurse (TVN) suggesting a proactive approach to pressure ulcer treatment. We found that staff had fully complied with the instructions for treatment supplied by the TVN apart from one occasion when the dressing had not been changed for a period of eight days from the 17th November until the 25th November 2009. When it was changed it was noted, Area red swab taken and sent. We were told that it must have been changed but we could not find any recordings that would confirm this. Also there were some occasions when wound sizes had not been recorded, these shortfalls need addressing. Staff recordings will require monitoring to ensure that all are of an acceptable standard. We established with staff that we spoke to, which people who lived in the home had been identified as losing weight. It was positive that staff spoken with about this subject area were able to tell us the names of people who were experiencing weight loss. We looked at the daily recordings for these people and established that there is not a consistent in the methods used to adequately report what individuals have eaten and or drank during the day. For example, we saw documented for one person, 22.11.09 quarter of pudding and 100ml drink. 23.11.09 2 biscuits, 4 drinks but does not show volume. 24.11.09 1 breakfast, 3 drinks and 200ml. 3 biscuits. All main meal. Half of pudding. 25.11.09 All main meal. 6 drinks but does not show volume. 3 biscuits. This is one example but highlights others that we saw and reflects that staff are being inconsistent in their recording methods in relation to individuals food and fluid intake. We also spoke with some staff about appropriately recording meals and fluids. One member of staff said that they had not received any nutrition training but the acting manager showed us this staff members training certificate in this subject area. Therefore staff competencies must be monitored and reviewed accordingly so that dietary recordings for all people are completed using robust methods so that individuals health and wellbeing are not placed at risk. We found that one care plan that we looked at in relation to supporting a persons anxiety had been reviewed since we last inspected the home. It was positive to see that it now stated, Encourage and participate appropriately diversion activities with or without activity coordinator. Observe to establish if there are any triggers that activate anxiety. Staff using diversion activities with people who required support with their behaviour was not being put into practice when we last inspected the home. Therefore this shows that staff are being supported to move in the direction in identifying likely triggers to the type Care Homes for Older People Page 5 of 18 of behaviour individuals may potentially display and what staff should do to diffuse the situation. We spoke with some staff about the likes and dislikes of people who live in the home and how staff support individuals who have some behaviour difficulties. Staff showed they had some knowledge of what to do in practice but we also recognised that staff would value some further training in dementia to help them in their roles. We were told by the activity coordinator on the ground floor that she still has not received any training in dementia. However, the acting manager told us that she has put the activity coordinators on dementia training twice but they did not attend. The acting manager said that it is their intention that all staff have dementia training including the housekeepers. We did look at the training matrix which should have a clear date of when this was devised for monitoring and reviewing purposes so that staff training is planned effectively. Seven people have had dementia awareness training in 2008. We shall be continuing to monitor staff members knowledge and skills in relation to meeting and understanding individuals needs but we consider that the requirements under Regulation 12 have been met. Medications. The pharmacist inspector checked the management and control of medicines within the service. We looked at medicine storage, some care records and medicine administration records. We spoke to staff and the acting manager. Medicine procedures for the control and handling of medication were not immediately available. We were informed by a member of staff that the policy was kept in the downstairs office and not in either of the two medicine storage rooms. This means that staff did not have quick access to medicine procedures to ensure medication was handled safely. We saw that medicine was stored in two locked and dedicated medicine storage rooms, which included a sink and worktops. We saw one room upstairs and one room downstairs. All medication seen was secure and locked, which means that medicine is safe. The temperature of all medication storage was checked and recorded daily. We saw records for the temperatures for the two refrigerators and the two locked medicine storage rooms were within the recommended safe storage temperature ranges for medication. We saw that some medication was not stored correctly. For example, we saw in the upstairs medication trolley a prescribed ointment, which was to be used externally, was stored on the same shelf as medication to be taken by mouth and also next to an insulin vial. This means that there was an increased risk of contamination between medication for external use and medication to be taken by mouth. We found it difficult to easily locate peoples medication in the medicine trolleys. We found that medication provided by the pharmacy in individual named blister packs were easy to locate, however we found it more difficult to locate medication that was available in boxes or bottles. We found these on shelves in the door of both trolleys but it took some time to find a persons named medication. For example, we found that one person Care Homes for Older People Page 6 of 18 had two opened boxes of the same tablet and was located in two different doors of the trolley. We also found medication for the same person located on different shelves in the medicine trolley. This means that due to a lack of organisation within the medicine trolleys there was an increased risk of a medication error. We found a lack of stock control and rotation of medication. For example, we saw that there were four boxes of the same medication for an identified person stored in a cupboard. The medication was prescribed for Parkinsons Disease. We saw that one box was dated 9th September 2009, two boxes were dated 13th October 2009 and one box was dated 9th November 2009. We also found two open boxes of the medication in the medicine trolley dated 9th November 2009. Both of these boxes had been opened with tablets removed, however there was no date of opening recorded on one of the boxes. There was a lack of stock rotation and control of peoples medication. This means that it was not possible to accurately check the amount of medication that had been given to the person and there was an increased risk of a medication error. Controlled drug medication, which requires special storage, was stored according to legal requirements. We saw that the medication cabinet available for storing these medicines met the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973. We looked at the medication records and found that they were accurate. This means that there were safe arrangements in the home to meet legal requirements and ensure secure storage of peoples medication. Medication administration records (MAR) were not always documented with a signature for administration or an appropriate code documented with a reason why the medication was not given. For example, we looked at the MAR charts for an identified person and found gaps where there were no signatures for administration of one prescribed medicine for Parkinsons Disease. The medication was prescribed to be given six times a day. We saw that there was no record of the medication being given at 7.30pm on 16th, 20th and 24th November 2009. We checked the amount of tablets available in the home in order to determine whether medication had been given as prescribed. We found that the amount of tablets that had been removed from the container did not match with the record of receipt or the medication records for administration. We asked the unit manager what system was in place to ensure the person was given their medication six times a day. We were told that staff would hand over to the next person and they would know to give the medication. We asked what audits and checks were made to ensure that medication was given. We were told that there were no audits and we were not shown any audits. This means that due to poor records it was not clear if the person had been given their medicines as prescribed, which means that their Parkinsons Disease could become worse. Medication was not always given to the person as prescribed and records were not correct. For example, we looked at a blister pack, which was supplied by the pharmacy, for an identified person. The medication was prescribed for Parkinsons Disease and was to be given two tablets three times a day. We saw that two tablets were still in the container for Wednesday 18th November 2009.We looked at the MAR chart and saw that there was a signature for administration documented on the 18th November 2009. We showed this to the Unit Manager who was unable to explain why this had happened. We looked at the persons daily notes and found that the person had falls recorded and their mobility was very poor due to their Parkinsons Disease. It was therefore a concern that the person had not been given their prescribed medication for Parkinsons Disease but Care Homes for Older People Page 7 of 18 the records documented that it had been given. This means that the persons Parkinsons Disease was not treated according to a doctors instructions. Prescribed medication was not available to administer according to the directions of a doctor. For example, we saw a MAR chart for an identified person for a capsule to be given once a day to reduce acid in the stomach. We saw that the MAR chart had been documented with a code os from 10th November 2009 to 13th November 2009. A total of four days had been recorded as os. The code os was defined on the MAR chart as out of stock. We were informed by the unit manager that this can happen because it takes time to fax the order through to the surgery and then get the medication from the pharmacy. We were told that all trained staff should know how to order medication. We were shown some printed notes, which were not dated, that informed staff to order medication. We were told that nobody had informed a doctor that the person was without their prescribed medication. This means that due to the person not being given their medication they were at risk of increased acid in the stomach and therefore at risk of harm. Information relating to medication to be given when required was not always available. For example, we looked at two care plans for people who were prescribed medication used to treat anxiety and agitation when required. The tablet can cause drowsiness and sedation. The first care plan we looked at included a detailed and informative protocol which informed staff what calming measures should be used to help the person before administering a tablet. The tablet was prescribed as take one or two up to four times a day. The protocol also informed staff under what circumstances the tablet should be given. This means that there were clear written directions for nursing staff to follow. The second care plan we looked at did not include a protocol for the administration of the when required tablets. The tablet was prescribed as one to be taken when required up to twice a day. We looked at the MAR chart for the person and saw that the tablet was being given frequently and in particular during the morning. We also saw the person was not always given their other medicines because they were sleepy. We looked at the daily notes and saw that there was a pattern of the person sleeping in the morning. An entry dated 2nd November stated slept in this morning on waking lots of calling out and quite unsettled. 2mg diazepam administered as prescribed. We were concerned that medication was being given to sedate the person with no agreed protocol available. We spoke to the acting manager who informed us that they had asked for a doctor to review the person and their medication. This was not documented in the persons care plan. This means that due to a lack of protocols with regard to when required medication people were at increased risk of harm. When we arrived for the inspection we saw that staff were receiving training from a pharmacist on the safe handling of medicines. This means that medication was being given to people by nursing staff that were kept up to date with good practice in medicine management. Requirement 13(2) made at the last inspection has not been met and therefore this service has now been referred to the Regional Enforcement Team to consider what further action may be undertaken. Environment At the key inspection on the 10th September 2009 we found that two free standing fans Care Homes for Older People Page 8 of 18 were situated, one on each floor of the home, in the corridor area which were potentially hazardous to individuals who wandered around the home unsupervised. We found that these fans were not in operation on this random inspection and the acting manager confirmed that they were no longer in use at the home. We consider Regulation 13 has been met in relation to the hazards of free standing fans in relation to protecting peoples safety within the home. Staffing During our visit we spent some time sitting in the lounge/dining area on the ground floor and sitting by the lounge and dining areas on the first floor. We observed staff practices and found there was more engagement in terms of staff conversing with people who live in the home. There was a less chaotic and rushed atmosphere and we did not see individuals left unsupervised which ensures the safety of the people living in the home. We observed staff taking people from the lounge, to the toilet and then to the dining table whilst conversing with people. This meant that people were being told what was happening and where they were going. We also saw staff telling people what is on offer for lunch and lunchtime was at 12:50 am. All of the staff spoken to were able to tell us about individual people and knew what their needs, likes and dislikes were. As stated previously in this report staff must now remember to complete all of their recordings to mirror the assistance and support they provide to people who live in the home. These recordings are important to assist with the monitoring and reviewing of individuals needs ensuring that any difficulties are picked up in a timely manner and any external professional guidance is sought. We were told that staff levels have improved since we last inspected the home and all shifts are covered appropriately. On occasions there is sickness but we were told that if this happens shifts are covered so that there is always six care assistants on duty together with two nursing staff on the early shifts. We were advised by the acting manager that bank and agency staff together with staff from the providers other homes when the necessity arises. We shall be continuing to monitor staffing levels at the home as part of our regulatory activity, but we consider that the requirements under Regulation 18 have been met. Staff training is now being proactively booked so that any identified areas of gaps where staff require training are being sought. We saw on the notice board that POVA training was booked for the 17th November 2009 and challenging behaviour was booked for the 2nd December 2009. It also stated, staff must make every effort to attend. Staff have appropriately received food hygiene training and manual handling training was noted on the notice board and training matrix. This practice should make certain that staff have received the appropriate training to ensure that they have the knowledge and skills to meet the individual and collective needs of people living at the home. We shall be continuing to monitor staff training in relation to food hygiene and manual handling as part of our regulatory activity, but we consider that the requirements under Regulation 13 in relation to training have been met. Management and Administration. Care Homes for Older People Page 9 of 18 From our findings we note that action has been taken in some areas since our last key inspection and this has been briefly highlighted in this random report. We were shown records that reflected that the project manager has been completing Regulation 26 visits since we last inspected the home. This contains more detail than some of the previous reports that we have seen about the quality of service being provided. We are now receiving notifications (Regulation 37) about any incidents that may affect the wellbeing of people who live in the home. We were told by staff who we spoke with that there have been no incidents where individuals have left the home unescorted since we last inspected the home. The acting manager also told us that they are educating staff in relation to completing Regulation 37 notifications and this work is ongoing. We shall be continuing to monitor these reports as part of our regulatory activity, but we consider that the requirements under Regulation 26 and 37 have been met. What the care home does well: What they could do better: When a person is admitted into hospital a reassessment must be done by the manager and or staff who have the designated responsibility to do this. This will make certain that the home is able to meet the individuals needs if and when they are discharged from hospital. Care Homes for Older People Page 10 of 18 When staff are assisting people with their personal care tasks they must remember to record these so that we can be confident that people are receiving the support and assistance required to maintain their personal hygiene needs in the way they prefer. It is important that when a person is identified as losing weight and or nutritionally compromised due to a medical/health needs then staff practices must be improved in the area of recording each persons nutritional intake in a precise and adequate manner. This will make certain that individuals are not left at risk from their health and or wellbeing deteriorating due to inappropriate monitoring and reviewing tools. Staff must be trained in meeting individuals nutritional needs and staff practices must be monitored and reviewed to show any deficits in staff competencies in this area where further knowledge may be required. This will ensure that individuals are receiving the care and support they need in relation to meeting their nutritional needs so therefore remaining healthy and well. Staff recordings must reflect what is happening in practice specifically in the area of staff practices when attending to individuals pressure areas. This will demonstrate that people are receiving the care that is required to meet their health needs and act as a monitoring/reviewing tool to promote individuals healiing processes. Staff competencies in the area of administering medication must be assessed, monitored and reviewed on a regular basis by the manager or the person who is designated to be responsible for this. This will make certain that people are protected by robust medication processes. There must be regular auditing of medications by the manager or the person who is designated to be responsible for this. This practice will highlight any medication discrepancies, errors and or oversights to make sure that people are protected from harm. All staff must have received dementia training and for staff competencies in this subject matter to be regularly assessed to ensure that people are in safe hands at all times. Please see the report of the key inspection of 10th Septmber 2009 for other information about areas where the home need to make improvements. 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 2. Care Homes for Older People Page 11 of 18 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required, as directed and self administered medications. This will make certain that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. 26/11/2009 2 9 13 The quantity of any balances 26/11/2009 carried over from the previous cycles must be recorded. This will enable audits to take place to demonstrate the medicines are administered as prescribed. 3 9 13 The medicine chart must 26/11/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the residents medicines and be signed directly after the transaction and accurately record what has occurred as Page 12 of 18 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action some gaps were found on the MARS. This is to ensure that the right medicine is administered to the right resident at the right time and at the right dose as prescribed and records reflect practice. 4 9 13 The receipt, administration 26/11/2009 and disposal of controlled drugs must be recorded in a controlled drugs register. This must be referred to before the preparation of the residents medicines and be signed directly after the transaction by two members of staff and accurately record what has occurred as some controlled drugs were unaccounted for. This will make sure that individuals are receiving their medications as prescribed by their clinicians to promote their health and wellbeing. 5 9 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice. This is to ensure that all Care Homes for Older People Page 13 of 18 26/11/2009 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action medicines are administered as prescribed and this can be demonstrated. 6 9 13 Staff who administer 26/11/2009 medication must be competent and their practice must ensure that residents receive their medication safely and correctly. This will make sure individuals receive their medications as prescribed by their clinicians. Care Homes for Older People Page 14 of 18 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, 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 12 When a person is discharged 27/11/2009 from hospital the manager of the home and or the deisgnated person must ensure that a reassessment of the persons identified needs are completed prior to them returning to the home. This will ensure that staff are confident in meeting peoples needs so that their health and safety is not placed at risk. This will ensure that staff are able to meet a persons health needs with confidence so that people are not at risk. 2 7 12 Staff must clearly record 27/11/2009 individuals nutritional intake on a daily basis by documenting portions of food with quantity eaten and volumes of fluids that have been drank. This is important for people who have been identified as losing weight and or nutritionally Page 15 of 18 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 compromised due to their health needs. This will make certain that individuals health and wellbeing are not placed at risk due to being nutritionally compromised. 3 7 12 Staff must be able to demonstrate they are monitoring and communicating health concerns such as individuals pressure areas by recording all relevant assessments changes in needs and decisions made. This will ensure that peoples heath concerns are managed in a timely way. 4 18 12 Staff must show that they 27/11/2009 have received training in nutrition and can indicate their knowledge around nutrition both in practice and when asked to reflect staff competency in this subject matter. This will make certain all individuals can be confident that staff skills and knowledge in nutrition is promoting their health and wellbeing. 5 18 12 Staff who work with people 27/11/2009 with specialist needs such as dementia must have the appropriate training and be able to demonstrate their Page 16 of 18 27/11/2009 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 competence both in practice and through discussions. This will ensure that people receive specialist care that is based on current good practice and reflect relevant specialist and clinical guidance. 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 17 of 18 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 18 of 18 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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