Inspection on 15/01/09 for Wellfield House

This inspection was carried out on 15th January 2009.

CSCI 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wellfield House 05/05/09

Wellfield House 25/03/09

Wellfield House 10/04/08

Wellfield House 14/11/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wellfield House Manor Road Catcott Bridgwater Somerset TA7 9HT     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: Jane Poole     Date: 1 9 0 1 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: Wellfield House Manor Road Catcott Bridgwater Somerset TA7 9HT 01278722405 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) : Farrington Care Homes Ltd care home 21 Number of places (if applicable): Under 65 Over 65 21 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Wellfield House is an attractive property located in the centre of Catcott village, approximately eight miles from Street and Bridgwater. The premises have been registered as a care home since 1989 and provide accommodation on two floors. There is parking for four to five cars at the front of the building. The home has a cottage annexe built in the grounds which houses a further three bedrooms. Wellfield House is registered with the Commission for Social Care Inspection to provide personal care for 21 people over 65 years of age. The home does not provide nursing care although district nurses visit the home regularly to provide treatment and advice. The home provides day care for a small group of people six days a week. Farrington Care Homes Limited purchased the home in 2005. The responsible individual is Mr Kiran Nathwani. There is currently no registered manager at the home. Care Homes for Older People Page 4 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 quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. This inspection was carried out over two days, one inspector was present on the first day and two inspectors on the second day. Care Homes for Older People Page 5 of 28 During the inspection we, The Commission, were able to speak with people living and working at the home, tour the building, view records and observe care practices. We were given unrestricted access to all areas of the home and all records requested were made available. Prior to the inspection the Commission received correspondence from visiting professionals and one healthcare professional was spoken with during the inspection. There is currently no registered manager at the home but there is a manager in post. An Annual Quality Assurance Assessment (AQAA) was completed by the manager in June 2008. This gave very basic information about the home and limited details of plans for the future. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report What the care home does well: What has improved since the last inspection? What they could do better: The home is not being effectively managed at the present time. There is no clear staffing structure in place and therefore no clear lines of accountability or responsibility. At the last inspection a requirement was made to ensure that all staff receive training appropriate to their roles. No formal staff training has taken place since the last inspection in April 2008. There has been a high staff turnover and new staff have not received adequate training or guidance to meet the needs of the people who live at the home. New staff begin work once an initial check against the Protection Of Vulnerable Adults (POVA first) has been received but before a full Criminal Records Bureau check has been returned. Recruitment records and duty rotas do not give details of how these people are being supervised to ensure that the risks of abuse are minimised. Although the home try to ensure that new or inexperienced staff work alongside more long standing staff, this has not always been possible and on occasions new staff have worked together without guidance or supervision from more experienced members of the team. Care Homes for Older People Page 7 of 28 At the last inspection it was recommended that staff be made aware of the local policies and procedures for recognising abuse and whistle blowing. This recommendation has not been acted upon. New staff were not aware of the whistle blowing policy and staff have not received guidance on the protection of vulnerable adults. There was evidence at this inspection that people living at the home were not always being treated with respect and this was discussed with the manager. The Commission is taking enforcement action - a Statutory Requirement notice is being issued, regarding breach of Regulation 18 (training.) 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to move into the home are able to visit to see if it is the right place for them. New staff do not always have the skills or experience to care for the people who live at the home. Intermediate care is not provided. Evidence: The home has a statement of purpose and service user guide but these are now out of date and do not clearly reflect the services and staffing at the home. Anyone wishing to move into Wellfield House is able to visit and spend time at the home. Two people who had recently moved to the home were spoken with on the first Care Homes for Older People Page 10 of 28 Evidence: day of the inspection. Both said that either they, or a family member, had visited the home before making a decision to move in. Copies of pre-admission assessments completed by professionals outside the home were seen in care plans. There has been a high turnover of staff in the home since the last inspection. New staff have not all received a full induction and some felt that they did not always have the skills or knowledge to care for people living at the home. 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. Care plans have improved since the last inspection but would benefit from further development to ensure that they are fully reflective of current needs and give rationale for care practices. Some staff at the home have not received training or supervision to meet the health and medication needs of people living at the home. Evidence: Since the last inspection all care plans have been updated and they are now more comprehensive. 2 care plans were viewed in detail, both gave personal information about the person and their likes and dislikes. Both also contained social histories. One care plan gave instructions for staff to follow in the event of a specific difficulty but there was no rationale for the instruction. This was discussed with the manager. One care plan had a moving and handling assessment that had been completed over a year ago and there was evidence that it was no longer reflective of the persons needs. New staff working at the home have not received training in moving and handling and more Care Homes for Older People Page 12 of 28 Evidence: long term staff have not received this training since May 2007. Care staff spoken with said that they used the care plans to inform them. Nutritional assessments for individuals were not present in either care plan seen but records of regular weights were seen and these showed that people were maintaining stable weights. People have access to healthcare professionals according to their individual needs. One visiting healthcare professional was spoken with during the inspection. They felt that staff at the home sought advice and followed instructions when given. However other professionals have communicated with the Commission stating that they felt that staff lacked skills and competency when dealing with an emergency situation. There are no staff at the home who have received up to date training in first aid. Since the last inspection the home have changed their medication practices. They now use a Monitored Dosage System and have a lockable trolley for storage. Medication Administration Records (MARs) were viewed, these were generally well maintained although four hand written entries had not been double signed in line with good practice guidelines. Medication is signed for when it arrives at the home and when administered or refused. This gives a clear audit trail. Medication training was carried out by the last manager for more long standing staff in 2005. New staff have not received training in this area. On the second day the inspection some staff were asked to watch a DVD about the administration of medication, there is no system in place for checking the competency of staff in this area. Two staff said that they had been asked to administer medication with no training or supervision. The area manager highlighted the need for medication training in October last year but formal training has not been arranged for any staff. People spoken with felt that their privacy and dignity was respected. Throughout the inspection it was noted that people were able to spend time in the communal areas or in the privacy of their rooms. Staff were observed to interact with people in a kind manner although some concerns were raised with us which were passed onto the manager at the end of the inspection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are able to choose how they spend their time and visitors are always welcome. An activities programme has been put in place but this would benefit from being expanded to ensure that everyone is consulted about their interests. There is now a choice of food at each meal giving people more choice about the food they eat. Evidence: People living at the home said that they were able to choose when they got up, when they went to bed and how they spent their day. Two people said the good thing about the home was you can do what you like. There is no dedicated activities worker but since the last inspection an activities programme has been put in place which care staff facilitate. Records are maintained of the activities that people have enjoyed. On the day of the inspection the activity skittles took place in the main lounge which disturbed people sitting quietly or Care Homes for Older People Page 14 of 28 Evidence: watching TV. Two people said that they would like there to be more social activities but other people spoken with said that they were happy to occupy themselves. There is no evidence that people have been consulted on the activities programme in the home although social histories in care plans give some details about peoples hobbies and interests. Visitors are welcome at anytime and people are able to entertain them in communal areas or in the privacy of their rooms. Many people said that they continued to enjoy trips out with family and friends. People are able to have newspapers and magazines delivered and the mobile library visits the home every three weeks. One person said that a representative of the local church visits on a regular basis and others said that they had enjoyed some outside entertainment over the Christmas period. The main meal of the day is at mid-day and there is now always a choice of two meals. There is a lighter meal in the evening with a choice of hot or cold food. People living at the home said that they were asked each day what they wanted to eat. One person said that they could always ask for an alternative to the meals on the menu. Lunch was observed on the first day of the inspection, the meal was well presented and there was a relaxed sociable atmosphere in the dining room. Everyone asked was very complimentary about the food at the home. One person said the food is lovely another said food is wonderful. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have not received training or guidance on local policies and procedures for the protection of vulnerable people which could potentially place people at risk of abuse. Evidence: The complaints procedure is displayed in the main entrance. Since the last inspection the home has received one complaint that was effectively dealt with. The home are currently looking into another concern that has been raised with them and this was discussed during the inspection. At the last inspection a recommendation was made that all staff should receive training in abuse issues and be made familiar with the local policy on recognising and reporting abuse. Staff spoken with at this inspection had not received training in this area and new staff were not aware of the whistle blowing policy or the ability to take serious concerns outside the home. The whistle blowing policy is not easily accessible and it does not give clear information about the agencies that staff can contact if they wish to share concerns. This has been a recommendation at two previous inspections. The home does not act as a power of attorney or financial appointee for anyone living at the home, they do enable people to deposit small amounts of money for Care Homes for Older People Page 16 of 28 Evidence: safekeeping. Records of monies held are kept and assurances were given that people are able to access their personal money at all times. During the inspection it was observed that people had unrestricted access to communal areas and their personal rooms. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wellfield House provides a comfortable, homely environment for the people who live there. Evidence: Wellfield House is an older style property that has been extended over the years. The registered home consists of the main house which accommodates up to 18 people and a small cottage in the grounds which is able to accommodate a further 3 people. Communal areas consist of a large lounge/dining room and a small quiet lounge. All communal areas are on the ground floor and are accessible to people with all levels of mobility. Outside there is a pleasant garden with seating and a summer house. In the cottage there is a small lounge but this is mainly used for storage and is not an inviting space. People who live in the cottage are able to use the communal areas in the main house. Bedrooms are located on the ground and first floor with a stair lift giving access to the first floor. All rooms are for single occupancy and many have en suite facilities. A sample of bedrooms was seen, all were homely and had been personalised to reflect the tastes and needs of the individual. People spoken with were very happy with their private rooms and said that they were able to bring furniture and other possessions to Care Homes for Older People Page 18 of 28 Evidence: personalise their rooms. There is a small laundry which is appropriate to the needs of the home. On both days of the inspection all areas seen were clean and fresh. 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. Recruitment practices do not fully protect people from the risk of abuse. Staff do not receive adequate training to ensure that they have the skills to care for people living at the home. Evidence: The home employs 15 care staff, 6 (40 ) have a National Vocation Qualification (NVQ) in care at level 2 or above. 3 members of staff have begun NVQ training. A requirement was made at the last inspection for all staff to receive training appropriate to the work that they do. This requirement has not been met and since the last inspection there has been no training provided for existing staff. There is a brief induction programme for the home and then staff are expected to complete a more comprehensive programme which is line with the Skills for Care core standards. New staff spoken with said that more long standing staff were very helpful in assisting them to learn about routines in the home. Records of the homes brief induction were seen, in many cases all sections had not been completed meaning that new staff had not received the full induction for the home. Care Homes for Older People Page 20 of 28 Evidence: Since the last inspection there has been a high turnover of staff and the manager stated that they try to ensure that new staff work alongside more experienced staff. However the rotas seen showed that in some instances this has not been possible and inexperienced new staff have worked with other new staff. On the first day of the inspection two staff, who had both been at the home for less than two months, were working together in the evening. Neither had received training in the administration of medication. This situation was rectified before the inspector left the home, but staff spoken with stated that this had occured on more than one occassion. Three staff said that they had been expected to undertake tasks and responsibilities that they did not feel confident about. In one instance a new member of staff worked a night shift with an agency carer. Recruitment files were viewed. Staff begin work in the home once an initial Protection Of Vulnerable Adults check ( POVA first) has been received but before a full Crinimal Records Bureau (CRB) check has been returned. There is no indication in staff files or on the duty rota about how these staff will be supervised or by whom. Rotas seen showed that on one occassion two newly appointed carers worked together before either had a full CRB check in place and when only one written reference had been received for one of the carers. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being effectively managed. Staff have not received adequate training in health and safety to fully protect people living at the home. Evidence: There is currently no registered manager at the home. A new manager was appointed in May 2008 but has not yet applied to be registered with the Commission. The companys area manager visits the home on a regular basis but only two reports written under regulation 26 could be found at the home. The manager has limited experience of managing a care home and does not hold a qualification in care or management at NVQ level 4 or above. The manager stated that they do not receive formal supervision. No care staff have received formal recorded supervision since the last inspection. Care Homes for Older People Page 22 of 28 Evidence: Since the last inspection some systems to ensure records are organised and up to date have been put in place. There is no staffing structure in the home and therefore no clear lines of responsibility or accountability. There is currently no deputy manager and the home does not employ senior carers. Some carers at the home have considerable experience but have not been provided with training to ensure that their practices are kept up to date. The management do not act as a power of attorney or financial appointee for anyone living at the home. Small amounts of money are held for safekeeping and a sample of these were viewed, records kept correlated with monies held. All staff receive basic fire training when they begin work at the home and fire drills are carried out periodically, staff spoken with said that the instruction was basic and did not include fire safety and prevention. The fire alarms are tested weekly by the home and emergency lighting was last tested in November 08 by outside contractors. The fire risk assessment was last up dated in August 2007. There is evidence that lifting equipment in the home is being regularly serviced but staff have not received up to date training in moving and handling. Some staff received training in food hygiene in January last year but this was not certificated. New staff, including one cook, have not received basic food hygiene training. Quality assurance practices were not inspected on this occasion. No staff at the home hold an up to date first aid certificate. Care Homes for Older People Page 23 of 28 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 (1)c19 (1)bSch 2 You are required to provide 30/05/2008 formal and certificated training as necessary to all staff working at the home to enable them to fulfil their roles and to meet the needs of the people that use the service. Requirement made at previous inspection date for compliance 28/02/08 not met. 2 30 18 (1) a The registered person must forward to the Commission for Social Care Inspection details of all staff training undertaken and planned. The registered person must carry out a risk assessment in relation to their first aid needs and put appropriate measures in place. 16/05/2008 3 38 13 (4) 16/05/2008 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 1 4 (1)(2) 5 (1) (3) 30/03/2009 The responsible person must ensure that the statement of purpose and service user guide are up dated to reflect the current services and staffing arrangements at the home. To ensure that people moving into the home have adequate information about the home and staffing. 2 8 12 1 (a) The responsible person 27/02/2009 must ensure that staff working at the home have the skills and experience to meet peoples health care needs. To ensure that people receive appropriate care. 3 9 13 2 The responsible person must ensure that all staff who administer medication are competent in this area. 27/02/2009 Care Homes for Older People Page 25 of 28 To promote safe medication administration practices and protect people living at the home. 4 10 12 4 (a) The responsible person 26/01/2009 must ensure that people living at the home are treated with respect and dignity. To ensure that people are treated with respect by all staff. 5 18 13 (6 ) The registered person must ensure that all staff are familiar with local policies for recognising and reporting abuse. To ensure that people living at the home are adequately protected. 6 29 19 (1) The responsible person must ensure that no staff work unsupervised in the home until all checks, including Criminal Records Bureau checks and written references have been received. To minimise the risks of abuse to people who live at the home. 7 30 18 You are required to provide formal and certificated training as necessary to all staff working at the home. 23/03/2009 26/01/2009 20/02/2009 Care Homes for Older People Page 26 of 28 To enable them to fulfil their roles and to meet the needs of the people that use the service. 8 31 9 2 (b) [i] The responsible 23/03/2009 person must ensure that the manager has the qualifications, skills and experience to manage the care home. To ensure that the home is effectively managed. 9 38 12 12 (1) The responsible 23/02/2009 person must ensure that all staff receive up to date training in health and safety. To ensure that the home is conducted in a manner that promotes good health and safety practices. 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 7 The registered person should ensure that care plans are kept up to date and are fully reflective of individuals needs and wishes. The activities programme should be expanded to ensure that it caters for all tastes and interests. 50 of care staff should hold a National Vocational Qualification at level 2 or above. All staff should receive formal, recorded supervision. 2 3 4 12 28 36 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. 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