Care Home: Acorn Lodge

What the care home does well People who use this service made positive comments about the home in general. Comments included; `I like it, it`s nice`, `It`s not bad`, `It`s very easy here`. `It`s very nice, a good atmosphere`, `I enjoy it here` and `I never thought I would end up in a place like this but it is good`. Staff have developed good relationships with the people who use the service. We observed staff offering support and advice to individuals in a caring and friendly manner. People who use the service told us the staff were, `Very good`, `nice people` and that `they don`t mind what they do for you`. Everyone we spoke to enjoyed the food provided. People who use the service are listened to through regular meetings as well as through day to day contact with the manager. We saw that suggestions made by individuals at meetings had been implemented. The manager has developed good systems for regularly monitoring how the service is operating which makes sure that staff are working in line with the aims and objectives of the service. Staff have been provided good training opportunities which assists in making sure that people who use the service are supported by a well informed staff group. What has improved since the last inspection? Since the last inspection of the service staff have worked with the local Care Homes Support Group to improve the service they provide. The information sought before and at the time of admission to the service has been expanded which helps in giving staff a better understanding of the needs and strengths of individuals from day one of their stay. Staff have made real improvements in the care plans which assists in providing the right levels of care and support to individuals. More of the staff group have been involved in developing care plans which assists in making sure that important information on how to support people is shared. A number of bedrooms have been redecorated to a good standard which improves the environment for people who use the service. Staff have been provided with high levels of training over the last year which ensures they are provided with up to date information and assists in developing their individuals skills and knowledge. We observed meal times to be more relaxed and unhurried and people can now help themselves to drinks and condiments at the table which allows for more choice and independence. The manager has improved the monitoring of the service. What the care home could do better: To assist in ensuring the safety of people who use the service the organization must make sure that before anyone is employed they supply a full employment history with satisfactory explanations for any gaps in their employment. The organization must also confirm with the persons last employer the reason why they left. The improvements made in care planning should be continued particularly around how people would prefer their care to be provided. Staff should be encouraged to provide more detail in the daily record. A review of the activities and opportunities for occupation should be carried out to make sure that they meet the needs of the individuals using the service. Consideration should be given to improving the environment in the communal areas of the home to encourage communication and occupation. The improvements in the meals times should be continued with better access to the menu and choices available and further offering opportunities for people to help themselves at meal times. Consideration should also be given to offering opportunities for people to assist with the preparation of snacks and meals. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acorn Lodge 14 Abbotts Lane Kenley Surrey CR8 5JH     The quality rating for this care home is:   two star good 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: Elizabeth OReilly     Date: 2 9 0 4 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 29 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Acorn Lodge 14 Abbotts Lane Kenley Surrey CR8 5JH 02086600983 Telephone number: Fax number: Email address: Provider web address: acorn_lodge@hotmail.co.uk Name of registered provider(s): Type of registration: Number of places registered: Medicrest Ltd care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: A variation has been granted to allow one specified service user under the age of 65 to be admitted. As agreed on 12/05/2006, 2 service users with Dementia between the ages of 60 - 65 years old can be accommodated within the home. Date of last inspection Brief description of the care home Acorn Lodge is a situated in the rural area of Kenley. The only possible disadvantage of its pleasant location is that it is located some distance away from public transport. The main entrance to the home is by driving or walking up a steep lane from the nearest bus route and rail link. The Lodge adjoins a similar home (Acorn House), also managed by Medicrest Limited. The two homes share a large rear garden. The homes stated aims and Objectives are to `provide a home from home, friendly atmosphere where staff is approachable and an open relationship is encouraged Care Homes for Older People Page 4 of 29 Over 65 39 2 Brief description of the care home between residents, staff and relatives to ensure a happy home and ensure the well being of the residents. Fees for this service are from £400 to £420 per week. Care Homes for Older People Page 5 of 29 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out by two Regulation Inspectors on 29th April 2009. The inspectors had the opportunity to talk with fifteen people who use the service, four members of staff and the home manager. We looked at a sample of the records kept in the service. The manager provided to the Commission their own assessment of the service (AQAA) which provides information on how the service is operating and their plans for future improvements. We have used information from all of the above sources and our observations on the day of this visit to reach the judgments made in this report. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: To assist in ensuring the safety of people who use the service the organization must make sure that before anyone is employed they supply a full employment history with satisfactory explanations for any gaps in their employment. The organization must also confirm with the persons last employer the reason why they left. The improvements made in care planning should be continued particularly around how people would prefer their care to be provided. Staff should be encouraged to provide more detail in the daily record. A review of the activities and opportunities for occupation should be carried out to make sure that they meet the needs of the individuals using the service. Consideration should be given to improving the environment in the communal areas of Care Homes for Older People Page 7 of 29 the home to encourage communication and occupation. The improvements in the meals times should be continued with better access to the menu and choices available and further offering opportunities for people to help themselves at meal times. Consideration should also be given to offering opportunities for people to assist with the preparation of snacks and meals. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 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 29 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. Before anyone moves into the service an assessment of their individual needs is carried out. Admissions to the service only take place if the service is confident staff have the skills and knowledge to meet their needs. Evidence: People who use the service gave positive comments about the overall service. People told us, Its very nice here, There is a good atmosphere and Its very easy here. We looked at a sample of individual files. We found pre admission assessments had been carried out for each person. The service was provided with copies of the assessments carried out by the local authorities and staff from the service carried out their own assessments. Staff are using a pre admission audit form which has been improved to obtain more information on the social, emotional and cultural needs and strengths of the individual as well as their physical needs. Care Homes for Older People Page 10 of 29 Evidence: Pre admission assessments and audits are used to make sure that the needs of individuals can be met by the service and so that staff have information about each person before they move in. This information is used to set up an initial care plan. This service does not provide intermediate care. Care Homes for Older People Page 11 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An individual care plan is produced for each person who uses the service. Improvements have been made in the quality of the care plans in place. Further work could be done to expand the information available on how individuals would prefer their care and support to be provided. More detail in the daily recording would assist in developing individual care planning. The health needs of individuals are met and medication is well managed. Evidence: We looked at a sample of care plans held in the service. We found improvements had been made in the quality of the information which assists staff in meeting the needs of individuals. Care plans are written in plain language and are easy to understand. Individual care plans were seen to contain good information on some of the strengths as well as the the needs of people who use the service. This assists in promoting and maintaining independence. Good information was seen to be available for staff on how to support and reassure one person who suffers from frequent hallucinations. Staff have also included information on topics individuals might like to talk about which Care Homes for Older People Page 12 of 29 Evidence: helps in developing communication. Further work could be done to expand plans to include more information on how people would prefer their personal care to be provided. Care plans were seen to be reviewed on a regular basis. Staff keep a daily record for each individual. These records could be improved by including more details on the social and emotional support given with details of what type of support has worked or not for individuals. This information can then be shared and used to develop a more person centered care plan. Individual risk assessments were in place and reviewed on a regular basis. Staff were provided with a copy of the Occupational Therapist assessment for the use of a hoist for one person. This assists in ensuring that people who use the service are provided with the right equipment and support they need. The health care needs of people who use the service are met. Records show that staff make referrals to health care professionals when needed and individuals are offered regular check ups. We found medication to be well managed. Records were well maintained, up to date and accurate. Staff are provided with appropriate training for the management of medication. Staff informed us that individual reviews of medication are carried out regularly. Consideration should be given to providing a file for medication administration sheets which do not obscure the details of the medication being administered. We observed staff providing care and support in a considerate and discreet manner. Staff were found to have a clear understanding of the need to protect the privacy and dignity of the individuals they were supporting. Care Homes for Older People Page 13 of 29 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. People who use this service are provided with opportunities to take part in activities. Further work could be done to involve individuals in the day to day domestic life of the service and provide more items for people to occupy themselves with throughout the day. The service has space which could be used for activities and occupation. People who use the service enjoy the food provided. The improvements made in making meal times more interesting should be continued. Evidence: People who use the service gave us varying opinions on the activities available to them. Individuals said; there is quite a lot of social activities, we do go out a little bit and we sit around, its pleasant. However others said, theres not very much to do, sitting down, we do a lot of that, Id like to do a bit more, just sitting here nothing to do at the moment and we dont do much here. This is an area of the service which could be improved. Consideration should be given to further moving away from staff focusing on tasks to be completed during their shift to involving people who use the service in day to day domestic activities. The levels and type of organized activities on offer in the service should be reviewed. More detailed information on the social, cultural and emotional Care Homes for Older People Page 14 of 29 Evidence: needs of individuals could assist in providing a more varied activities based care. During the course of this inspection we observed that when staff were available in the lounge there were good levels of activity and interaction for people who use the service. However when there were low numbers of staff there was little activity and individuals tended to sleep, become withdrawn and disengage with each other. Lounge areas and corridors could be improved with the provision of items for people to occupy themselves with when they want to. This was discussed with the manager and further information has been provided by the inspectors following this visit. The inspectors identified space in the service which could be used as an activities area. This could allow for individuals to be involved in a variety of activities throughout the day. Consideration could be given to staff and people who use the service developing their own life story books. This could give people a better understanding of the life experiences of the people they work with. This was discussed with the manager at the time of inspection and she is aware of the care that may need to be taken with this type of work. People who use this service have access to Aromatherapy and Reflexology every two weeks. The service books regular entertainers to visit. The manager informed us that recent entertainment had involved people who use the service making their own music. This had proved very successful with individuals who are not usually engaged enjoying the experience. Staff informed us that visitors are welcome at any time. The manager assists in keeping in touch with relatives through a regular newsletter which is sent out. People who use the service told us they can see their visitors in the lounge or in their own rooms. People who use the service told us; the food here is very nice, the food is quite good, and I am fussy, the food is good, we have a cooked lunch with roast at weekends, the cook is very good and the food is nice. No one we spoke to made negative comments about the quality of the food provided. The meal time we saw was an unhurried and relaxed occasion. Staff assisted individuals when needed in a discreet manner. Improvements have been made since the last inspection with drinks and condiments on the tables for people to help themselves. We saw one member of staff wearing a blue plastic apron and two staff wearing latex gloves during the meal time. These practices should be reviewed. Care Homes for Older People Page 15 of 29 Evidence: Only one person we spoke to before the meal knew what was for lunch. The menu was written on a white board but is not easily accessed. Consideration should be given to producing a photographic menu for offering choices and information which is more easily accessible. We noted that meals were served to people who use the service already fully plated. Consideration should be given to providing some items in serving dishes to allow for more choice at the table and to encourage more interaction at meal times. Consideration could also be given to involving people who use the service in the preparation of meals particularly tea parties, buffets and or barbecues. We saw that the menu was discussed at residents meetings and action is taken to include suggestions in the menu. The manager informed us that bacon roly poly had been added to the menu as a result of these meetings and egg and bacon was going to be provided at breakfast on certain days following requests. Care Homes for Older People Page 16 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service expressed confidence in the staff to listen to them should they have any complaint. The service has a complaints procedure in place and this is supplied to families on a regular basis. Staff have received appropriate training to ensure the safety and protection of people who use the service. Evidence: People who use the service told us they go and see the principle, tell my family or get the staff to sort it out if they had a complaint. No one we spoke to during the course of this inspection felt they had any complaint about the service. Since the last key inspection safeguarding issues have been investigated by the local authority. The manager and staff have worked with the local authority Care Home Support Team to improve the service. The manager has sent the abuse policies to the Safeguarding Officer at the local authority for comment to make sure that these dovetail with the local authority procedures. All staff have been provided with training on safeguarding people. Staff we spoke to had a good understanding of their role and responsibilities in recognizing and reporting any suspicions or allegations of abuse. A copy of the complaints procedure is provided to each person when they move into Care Homes for Older People Page 17 of 29 Evidence: the service. The manager informed us that a copy of the procedure is sent out to each next of kin every six months to ensure they know who to contact and what will happen if they have any concerns. The service keeps a record of all complaints along with information on actions taken and outcomes. Care Homes for Older People Page 18 of 29 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. People who use this service are provided with a comfortable environment. The management monitor the condition of the building and environment on a regular basis. Improvements could be made in the layout and availability of communal rooms. Communal areas could be improved with the introduction of more things for people to interact with. Evidence: The manager and home owner have developed a rolling programme for the redecoration of the service. Since the last inspection a number of bedrooms have been up dated to a good standard. People who use the service have been encouraged to individualize their own bedrooms with the addition of personal items such as photographs and ornaments. A new call bell system has also be installed since the last inspection. People who use the service have access to a large lounge area, dining room and garden which can be accessed from the first floor of the building. The lounge is comfortably furnished but could be improved and made more homely with softer lighting, occasional tables, sofas and less wing backed chairs could allow people to interact with each other and staff more easily. The introduction of more items for people to pick up, look at and interact with could make the lounge area more interesting. As noted previously in this report another communal area could be created Care Homes for Older People Page 19 of 29 Evidence: in the service which could be used as an activity space, quiet lounge and or sensory area. The garden area was not in use when we visited and did not appear to be well used with the garden chairs stacked up. Consideration should be given to providing opportunities for people who use the service to be involved in the development of the garden. The provision of raised beds could be useful in encouraging individuals to get involved with this. All areas of the service we saw were clean and fresh. People who use the service told us that they keep things very clean here. Care Homes for Older People Page 20 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty at any one time to meet the present needs of people using this service. Staff are provided with very good opportunities for training. Further improvements need to be made to the staff recruitment process to assist in safeguarding people who use the service. Evidence: People who use the service made positive comments about the staff group. People told us; the girls are very nice they help you, I get on alright with the staff here, the staff are very good, very bossy, but good and they are pretty good here. We found sufficient staff on duty to meet the needs of the present group of people living at the service. Staff told us they felt well supported in their work and that they worked well as a team. Individual staff told us they had taken part in several training sessions since the last inspection which had helped them in their work. Records showed significant training had taken place over the last twelve months. Training covered included; abuse, medication, moving and handling, health and safety, dementia care, first aid, infection control, diabetes, food hygiene, continence, pressure area care, sensory deprivation, malnutrition and fire. The manager confirmed that all staff had taken part in safeguarding training. The manager also informed us that a talk on Alzheimers Care Homes for Older People Page 21 of 29 Evidence: Disease had been provided for the families of people using the service. We looked at a sample of staff files. In the majority of files evidence of the appropriate pre employment checks were in place. In one file only one reference was available. In a number of instances the owners had not sought references directly from previous employers but had relied upon references headed as to whom it may concern. In order to ensure that these references are genuine and to meet with current requirements checks must be made with a persons last employer to confirm why the person left this employment if they were working with vulnerable adults or children. The organization needs to be seeking their own references for each member of staff before they commence work in the service. A full employment history must be sought from each person with an explanation for any gaps in their employment to assist in safeguarding people who use the service. Consideration should be given to increasing the domestic atmosphere in the service by staff not wearing uniforms. Care Homes for Older People Page 22 of 29 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. People who use this service live in a home which is well run. The views of individuals who use the service are sought and acted upon. Staff make regular checks on the building and equipment to assist in ensuring the health and safety of all who live in or visit the service. Evidence: The manager has the appropriate knowledge and experience to manage a service of this type. Staff informed us that they feel well supported by the manager, that the manager was fully involved in the service and that she was approachable. The manager informed us that she was working to wards further training in dementia care. This will assist with the continued development of the service. The manager has worked with the local authority Care Home Support Team to improve the service. Further quality monitoring has been introduced which is carried out in detail each month. This assists in ensuring that the service is meeting desired aims and objectives and helps in highlighting any shortfalls. Resident and relatives meetings are held on a Care Homes for Older People Page 23 of 29 Evidence: regular basis and we saw that suggestions and requests made by people who use the service are listened to and implemented where possible. A newsletter is produced every two months which assists in keeping families informed of activities and aids communication in the service. At the time of this inspection no money was being held for individuals who use the service. Staff informed us that they receive regular one to one supervision from the manager. This assists in ensuring that individual staff are working in line with the stated aims and objectives of the service and provides opportunities for staff to discuss any difficulties they may be having. In order to ensure that care planning remains up to date, accurate and comprehensive consideration could be given to discussing individual care plans within supervision. We looked at a sample of the records kept to protect the health and safety of people using the service, staff and visitors. These records were found to be well maintained, up to date and accurate. The manager has recently carried out fire drills for night staff and following this will be doing these more frequently. Care Homes for Older People Page 24 of 29 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 29 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 29 19 A full employment history 01/09/2009 with satisfactory explanations for any gaps in employment must be sought from staff before they commence work in the service. To assist in safeguarding people who use the service. 2 29 19 The organization must seek references directly from referees. Confirmation of why staff left their previous employment if they were working with vulnerable adults or children must be sought and recorded before they start work in the service. To assist in safeguarding people who use the service. 01/09/2009 Care Homes for Older People Page 26 of 29 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 Staff should be encouraged to provide more details in daily recording which can be used to develop and improve the care planning process. The improvements made in care planning should be continued to expand and include more information on how individuals would prefer their care and support to be provided. A new file should be provided for medication administration record sheets which does not obscure information on the medication prescribed. Consideration should be given to staff and people who use the service developing, where appropriate, life story books or files which could assist in a better understanding of the life experiences of individuals. Consideration should be given to providing more materials and objects for people to occupy themselves with throughout the service. A review of the type, frequency and way in which structured activities are offered should be carried out to ensure that these meet the needs and wishes of people who use the service. Consideration should be given to providing more opportunities for people to be involved in the day to day domestic activities in the service. Consideration should be given to providing people who use the service with opportunities to assist in the preparation of meals. A review of the way in which people who use the service are offered choices at meal times should be carried out. Consideration should be given to using photographic menus and offering more choice at the table. Consideration should be given to providing people who use the service with more opportunities to serve themselves with staff support at meal times. Consideration should be given to updating the second communal area and making this available to people who use the service. Consideration should be given to providing more opportunities for people who use the service to become involved in developing and maintaining the garden area. Page 27 of 29 2 7 3 9 4 12 5 12 6 12 7 15 8 15 9 15 10 20 11 20 Care Homes for Older People 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 12 20 Consideration should be given to providing more domestic style lighting, furniture, sofas and occasional tables in lounge areas to provide a more homely environment and provide more opportunities for interaction. Consideration should be given to discussing individual care plans as part of the supervision process. 13 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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!