Care Home: Aegel House

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What the care home does well The service provides good, nutritious and well balanced food. The service has a loyal and committed staff team who are caring and treat the residents with dignity and compassion. A resident told us "the staff are kind" and another said "I like living here". Recruitment is managed well. The communication between the manager, staff residents and relatives is good. The home has lovely grounds with a number of areas where the residents can enjoy sitting outside. The home is kept clean and offers a variety of communal areas. The service continues to offer formal supervision to all its staff. On the whole the administration and handling of medicines is managed well. What has improved since the last inspection? More members of staff have now gained a NVQ qualification. The service has had a permanent manager in post for more than two years. The service has not used agency staff for more than a year. What the care home could do better: People who are prescribed when required medicines that are given at the staff`s discretion need to have plans for this so that staff can monitor their continued use. The service needs to improve the provision of meaningful and stimulating activities for the residents to participate in. The care planning system needs to be improved so that the care required is more detailed. The service must ensure that it assesses all prospective residents prior to admission to the home. Ensure that staffing ratios are determined according to the residents needs. Ensure that the environment is free from hazards and that it is enhanced to provide a suitable, safe and comfortable home. Ensure apprpropriate accounting systems are in place for resident`s monies held by the home. Key inspection report Care homes for older people Name: Address: Aegel House Burgh Road Aylsham Norfolk NR11 6AS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Aegel House Burgh Road Aylsham Norfolk NR11 6AS 01263733171 01263731456 aegelhouse@norfolk.gov.uk www.norfolk.gov.uk Norfolk County CouncilCommunity Care care home 35 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 35 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Aegel House is a purpose built, two-storey residential Care Home managed by Norfolk County Council. The Home is situated on the outskirts of the market town of Aylsham and provides care for up to 35 older people. Originally built in 1962 the Home was extensively modernised during 1996/7 and now provides attractive accommodation in mainly single rooms. Aided bathing and toilet facilities are strategically positioned around the building and the Home is well equipped with hoists and handrails, etc. A shaft lift provides assisted passage to the first floor. There are a variety of communal areas dotted around the Home including a small library room. There is a large dining Care Homes for Older People Page 4 of 26 Over 65 35 0 Brief description of the care home room on the ground floor that leads to a small room used as a shop for the residents where they can make small purchases of toiletries and confectionary. The Home stands in its own extensive grounds, which include a large, secluded garden area to the rear of the premises. The patio area is furnished with very acceptable garden furniture that has been provided by the Friends of Aegel House, who are a very supportive group to the home. A day centre for older people is located within the Home and this is in active use on weekdays. The day centre, which can cater for up to twelve persons each day has its own exterior entrance, facilities and staffing compliment. This area of the building was not inspected, as it does not form part of the residential accommodation. The cost of a placement at Aegel House is £399.11 a week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection for this service has been carried out using information from previous inspections, information from some residents, people who work in the home and some visitors to the home. We also used information given to us by the service that was contained in their Annual Quality Assurance Assessment (AQAA). The main method of inspection used was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking the experience of people and speaking to them about the outcomes they experience as a result of the support provided. During our visit a tour of the premises was undertaken and residents records and staff files were looked at. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: People who are prescribed when required medicines that are given at the staffs discretion need to have plans for this so that staff can monitor their continued use. The service needs to improve the provision of meaningful and stimulating activities for the residents to participate in. The care planning system needs to be improved so that the care required is more detailed. The service must ensure that it assesses all prospective residents prior to admission to the home. Ensure that staffing ratios are determined according to the residents needs. Ensure that the environment is free from hazards and that it is enhanced to provide a suitable, safe and comfortable home. Ensure apprpropriate accounting systems are in place for residents monies held by the home. Care Homes for Older People Page 7 of 26 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 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 26 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 26 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. The admission process was not thorough enough for the residents who are admitted into the planning beds; however the process for the other residents is sufficient to ensure that people are only admitted if their needs can be met in the home. Evidence: We looked at the records for three residents who had been admitted since our last visit to the home; one of these was a resident who had been admitted into a planning bed. The home has four of these beds which are used to accept people who are discharged from hospital and not yet able to move elsewhere. We noted that the home has limited information about these prospective residents and they are not assessed prior to admission to the home. The only information about the residents comes from the Social Workers and Care First and in some cases no discharge information is received from the hospital or what goals the residents wish to achieve. We were told by some staff members and the manager that one person arrived at the home in the evening before the Bank Holiday weekend and they had not been Care Homes for Older People Page 10 of 26 Evidence: informed of their pending arrival for that day. This person arrived in a taxi and unaccompanied with a bag of dirty washing and some medicines some of which did not belong to them. The carers told us that it is difficult to plan the care for these residents as they quite often have little information to go on. We noted that the other two residents had records for their admission process and their needs had been assessed by the manager before admission to the home. One resident and their relatives confirmed that they had visited the home to help them all decide if the home was right for them. The information gained about these two residents was then used to formulate a plan of care. Whilst we were visiting the home we noted the manager gave information to a relative for a prospective resident, this included a prospectus, a service users guide and information about fees. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The variable practice regarding the planning and delivery of care means that all residents cannot be sure that their health and personal care needs will be fully met. Evidence: We case tracked five residents records three of which were the newly admitted residents, one of which was the resident who had been admitted to the planning bed. These plans provided some information about the needs of the person and the goals they were working to wards; however there did seem some confusion about the plans as the staff who had completed them seemed to be unsure of what was an aspiration/goal and what was an objective or action. The directions in the care plans lacked detail and therefore did not ensure that all staff provided a consistent level of care. For example there were references about a resident needing encouragement to wash and dress rather than detailing how they wished to be supported. Another resident had a catheter in place, but did not have a care plan to describe care needed for this and also maintain infection control. We noted another resident had a sore sacrum, but no skin integrity assessment had been carried out; this resident also was Care Homes for Older People Page 12 of 26 Evidence: incontinent but details for care for this were missing and gave no indications for toileting. Another care plan lacked specific details for care of a diabetic and although this particular resident had had a skin integrity assessment it had not been updated since 2008. Daily notes were in place for each resident but lacked particular care that had been given to the residents on a daily basis and just mentioned that they had been washed and dressed; this lack of specific care notes means that there are no records to assist in evaluating care plans. We did note also that the care plans were reviewed on an ad hoc basis and only one care plan had been evaluated and there were no notes to signify if the plan had been effective in helping the person to achieve their objectives. This lack of regular and effective reviews could result in minor changes in care needs not being addressed. Despite the shortfalls in the care planning system the residents we spoke with said they received the care they needed. One resident commented that the staff treat me with respect and are kind and caring, they did go on to say that they did feel there were not always enough staff on duty to attend to their needs. One relative told us that the staff do their best, but not sufficient of them on duty and gave examples for this remark: they said that their relative often had to wait to use the commode, although the staff answered the bell fairly quickly they were always attending to someone else whose needs were just as important. They went on the tell us that quite often their relative was not able to get up in the morning until past eleven o clock. We noted that most of the residents in this home are very dependent and rely on the carers to give them the support they require to meet their needs. All the residents records we looked at had risk assessments in place for manual handling and guidelines for mobility however we noted that these assessments had not been evaluated so changes in the residents mobility needs had not been acknowledged. There was a lack of information in the care plans about the residents ability to make choices, but after discussion with residents and their relatives it was evident that people were supported to make choices and decisions in their daily lives. We carried out a spot audit of medicines, matching those that had been given with those that remained in stock, these tallied with the medicine record charts. Those residents who had been prescribed prn (as required medication) did not have care plans in place to justify continued use of these medicines. One resident had been prescribed an analgesic patch, this resident did not have a care plan for this activity to identify observations to be made of skin area around the site, no instructions for change of site and also no guidelines as to how to encourage this person to accept the patch without continual refusal to use it. We checked the records for daily monitoring of the temperature of the medicines Care Homes for Older People Page 13 of 26 Evidence: fridge, these were in good order and evidenced them being carried out on a daily basis. Two residents are responsible for taking their own medication and we noted that correct procedures were in place for this activity along with appropriate risk assessments and continual review. Care Homes for Older People Page 14 of 26 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. More consideration needs to be given to ensure that residents are given the opportunity to participate in meaningful activities. Meals are managed well. Evidence: We spoke with residents about what they did in the home and if they were given th opportunity to go out. One resident told us that they had been out with their Key Worker; the other residents told us that there had been trips out but not recently. The manager informed us that the home had lost their Mini Bus driver but were hoping to find a replacement soon. The residents told us that there was not much to do in the home, however we did see some photographic evidence of some activities that had taken place. The manager also told us that mostly the residents refused to take part in activities and that there were opportunities to join in the activities provided by the day care centre. We noted that there were no records in the residents notes to confirm if they had taken part in any meaningful activities or had been offered them but refused; we also noted that the residents records did not contain any reference to what they liked doing. During our visit no one was being offered any form of entertainment or activity of any nature. Care Homes for Older People Page 15 of 26 Evidence: We had a discussion with the cook, she told us that the residents have a choice at all mealtimes, the sample of menus we looked at confirmed this. The menus were varied well balanced and nutritional. We noted that the main meal on the day of our visit was roast pork with all the trimmings, with alternatives for people who dislike pork. One resident told us that they did not eat pork and that they always have something else instead. One relative told us that quite often the staff forget that their relative has a special diet. The residents we spoke with told us that the food is good, one resident said food is always good and they acknowledged that they had choices. We observed lunch being served and residents were being asked what they would like; the lunch time was very relaxed the residents were talking to each other at their separate tables. Those residents who need assistance were being helped in an empathetic way and some were using special tools to aid them in eating. During our visit we noted visitors coming and going and were greeted by the staff in a friendly and welcoming manner. Care Homes for Older People Page 16 of 26 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 know how to raise concerns and felt that they would be listened to. Staff have been given the knowledge relating to safeguarding adults. Evidence: Discussion with the manager and checking records for complaints and concerns revealed that the home had received three complaints since the last Key Inspection. Records showed that the complaints had been dealt with well. We asked four residents and three relatives if they knew how to air their comcerns, they all agreed that they would go and speak to the manager; one resident told us that they had raised concerns with the management and felt that the manager listened to them. We looked at training records to see if all staff were up to date with issues relating to safeguading, some staff needed to be refreshed and we could see from records and what the manager told us that more training had been organised: this was also confirmed by those staff members we spoke with who were aware of issues relating to to abuse and protecting the residents. Care Homes for Older People Page 17 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of maintenance and re refurbishment means that the residents could be at risk from areas that are unsafe. The poor condition of the decor and fixtures means that the residents live in an inadequate environment. Evidence: We undertook a tour of the premises, we found the home to be clean and free from offensive odours; one resident told us the toilets are always spotless. The carpet in the main corridor leading to the dining room needs replacing, there is a wide expanse of bare concrete that is uneven and not flush with the rest of the flooring; it is hazardous and unsightly. We noted on our tour that the whole house is in need of refurbishment as there are many areas around the home that have paint peeling off the woodwork and walls and some rooms also have wallpaper peeling off the walls. We also noted that some rooms had a number of holes in the walls where once pictures have hung and the holes have not been filled and painted. Some curtains in a small sitting room were lacking some hooks. The area outside is very pleasant with a number of areas where the residents can sit, three residents told us that they do sit outside weather permitting. None of the rooms have en suite facilities which means that because of the nature of the residents mobility problems most of them use commodes in their rooms, this means that quite often unpleasant odours filter through to the rest of the home. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are not entirely met by the numbers of staff on duty at any given time. There is room for improvement in staffing levels which, should result in better outcomes for people using the service. Evidence: Comments made by some relatives, some members of staff and some residents suggested that people were not getting enough support they needed to meet their needs in a timely fashion. The residents and relatives we spoke with had high praise for the care staff saying that they are very kind, they do their best under difficult circumstances, they are always busy. The care staff said that they wished they had more time to spend with the residents. One relative told us that they had already complained twice to the service about the lack of staff and the inability of them to get residents up when they wished. The staff rosters showed that for the majority of shifts there were not adequate numbers of staff on duty to meet the assessed needs of a very dependent client group. The staff themselves felt that they were very busy and could not spend time with the residents and felt that the care was always rushed. The manager acknowledges that the many demands upon the staff affect the quality of care the staff can deliver including the maintenance of the individual care plans despite their Care Homes for Older People Page 19 of 26 Evidence: commitment and hard work. An induction programme is in place and we saw records for this, the induction included all mandatory subjects. We talked with four members of staff and asked them about the training that they had received, this included safe guarding, fire training, manual handling, food hygiene dementia care, pressure area care and this was confirmed by the training records we looked at. We did note however that there was a lack of training in relation to specific conditions that some residents had, such as care for those with strokes. Ninety seven percent of the staff have a NVQ qualification. The service shows compliance with the need for enhanced Criminal Records Bereau checks on all staff. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good management structure in place that will ensure that the service is being run in the best interests of the people who use the service however there are some systems that are not entirely effective to ensure that the home is always run in the best interests of the people living there. Evidence: Since the last Key Inspection the manager had registered with the Commission; she has the appropriate qualifications and experience to take on the role. The manager discussed with us some of the improvements in all areas of the service since she commenced her role but acknowledged that there were still improvements to be made in staffing levels and the environment. Staff whom we spoke with indicated that they met with senior staff for formal supervision and we saw records that confirmed this. These records showed that staff were supported to discuss their practice and identify any further training they may require. The staff told us that the manager was easy to approach, listened to them, and were all very sorry that she was leaving to take up another post. Care Homes for Older People Page 21 of 26 Evidence: People using the service have been given the opportunity to make their views known to the management; this was done by giving surveys to the residents, their relatives and staff. We saw the results of these surveys which were all very positive, some less positive comments were about the shortage of staff. All staff have received fire safety training and were frequently up dated as was confirmed when we looked at the records for this. We looked at health and safety related information, these showed that there were servicing arrangements for all equipment; these included the lift and the heating system, and hoists, fire safety records were in place. We carried out a spot audit of residents monies that is held by the home; we noted that one residents money was fifty pence short. This would have normally been picked up by the homes administrator who carried out weekly audits of the residents money, however the administrator had retired and a new one had not been employed at the time of our inspection. Care Homes for Older People Page 22 of 26 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 27 18(1)(a) Staffing ratios must be 31/12/2007 determined according to the assessed needs of residents and additional staff are on duty at peak times of activity during the day. This will ensure that the needs of the people living in the Home come first. Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 All prospective residents must be appropriately assessed before admission. This is to ensure that the service does not admit residents whose needs cannot be met or planned for. 07/05/2010 2 7 15 Care plans for residents must set out a full range of needs in all areas. This will ensure that people using the service will be confident that all their health care needs will be met by staff using a consitent approach to care 07/05/2010 3 19 23 All parts of the home must be kept reasonably decorated and well maintained. 08/06/2010 Care Homes for Older People Page 24 of 26 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 This will ensure that people who use the service live in an acceptable and safe environment. 4 27 18 There must be sufficient staff on duty at all times to meet the needs of the people using the service. This will ensure that the residents health, safety and welfare are promoted 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 12/05/2010 1 2 3 9 12 30 Consideration must be given to formulating care plans for people who are prescribed trans dermal patches. Consideration must be given to increase meaningful activities for the residents. Consideration should be given to the provision of more training in relation to specific conditions of the residents. Care Homes for Older People Page 25 of 26 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). 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