Care Home: Alex Wood House

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What the care home does well This home continues to do many things very well: staff training is good and ensures that residents receive their care from competent and qualified carers; activities continue to be regular and varied, offering residents real opportunity for stimulation and entertainment; staffing levels are good and ensure people`s needs are easily met and staff actively engage and consult residents in the service they receive. Residents we interviewed to spoke highly of the home. One told us: `staff make you feel one of a family, and if you have a problem you can talk to them Another stated: ``you can always rely on someone being there to help you`. One resident wrote on their survey in response to what the home did well: `keeps the place clean, good cooks, cheerful personnel- most satisfactory`. Relatives too thought the home was good, one commenting: `the staff are kind, courteous and patient, and my father seems content to be there`. The manager has is keen to improve her service and has been working hard in the last year to bring about positive changes. What has improved since the last inspection? The use of agency staff has reduced since we last inspected ensuring that residents receive their care from familiar who know them well. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.2 The temperature of the medication storage cupboard is monitored daily to ensure that medicines are stored safely and there are now medical administration records available in residents` rooms so that staff can sign easily to say that residents have received their creams etc. What the care home could do better: Staff at the home have been working very hard to improve residents` care plans with some success. However there is still room for improvement and further detail, especially around risk assessments is needed so there are clear and consistent guidelines for staff in how to keep residents safe and reduce any risk of harm. Medication practices need to be tighter and residents` medication records must accurately reflect what medication they have actually received, and what medication is actually held in stock. Finger food should be provided for those residents who have difficulty using cutlery so they can eat more easily. Staff must have a better understanding of the all the agencies involved in protecting vulnerable people and have good knowledge of where they can report incidents should the need arise to protect residents. The variable language skills of some staff is an issue that residents and relatives have told us about at this inspection and our last one, and more needs to be done to ensure these staff communicate clearly and effectively with residents. Key inspection report CARE HOMES FOR OLDER PEOPLE Alex Wood House 3a Fortescue Road Cambridge CB4 2JS Lead Inspector Janie Buchanan Key Unannounced Inspection 1st October 2009 07:10 DS0000015088.V377852.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alex Wood House Address 3a Fortescue Road Cambridge CB4 2JS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01223 578602 01223 578460 grace.willer@cambridgehs.org.uk Cambridge Housing Society Ltd Patricia Owen Care Home 31 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (31), Physical disability (31) of places Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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 Dementia - Code DE Physical disability - Code PD The maximum number of service users who can be accommodated is: 31 24th October 2008 2. Date of last inspection Brief Description of the Service: Alexwood House is owned and managed by Cambridge Housing Society, a charitable housing association. The home is situated to the north of Cambridge City and is about 2 miles from the city centre. There are shops, a post office and a library nearby at Arbury Court. Alexwood House was purpose built for older people in 1988 and offers mostly permanent care. There is also a busy day centre. It is a pleasant modern building, built around a central courtyard. All bedrooms have ensuite facilities. Charges vary between £375 and £625 per week depending on residents’ needs and funding arrangements. A copy of the most recent inspection report is available in the entranceway to the home. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. For this inspection we (The Care Quality Commission) looked at all the information that we have received. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a selfassessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. We also received 22 surveys from people living in the home, staff working there and from other people with an interest in the home. We spoke with 6 residents and 4 members of staff. We took lunch with residents so we could chat with them and also observe how staff supported and interacted with them. We looked at a range of policies and documents and undertook a brief tour of the home to check the environment and health and safety matters. What the service does well: This home continues to do many things very well: staff training is good and ensures that residents receive their care from competent and qualified carers; activities continue to be regular and varied, offering residents real opportunity for stimulation and entertainment; staffing levels are good and ensure people’s needs are easily met and staff actively engage and consult residents in the service they receive. Residents we interviewed to spoke highly of the home. One told us: ‘staff make you feel one of a family, and if you have a problem you can talk to them Another stated: ‘‘you can always rely on someone being there to help you’. One resident wrote on their survey in response to what the home did well: ‘keeps the place clean, good cooks, cheerful personnel- most satisfactory’. Relatives too thought the home was good, one commenting: ‘the staff are kind, courteous and patient, and my father seems content to be there’. The manager has is keen to improve her service and has been working hard in the last year to bring about positive changes. What has improved since the last inspection? The use of agency staff has reduced since we last inspected ensuring that residents receive their care from familiar who know them well. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.2 Page 6 The temperature of the medication storage cupboard is monitored daily to ensure that medicines are stored safely and there are now medical administration records available in residents’ rooms so that staff can sign easily to say that residents have received their creams etc. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 People using the service experience good quality outcomes in this area. The home’s admission procedures are good, ensuring that people move to a place where their needs will be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Residents who completed our survey told us they had received enough information to help them decide if the home was the right place for them. All residents are given a brochure and information pack which give good information about the home and what it offers. Residents are also issued with a ‘Licence to Occupy Residential Accommodation’ which clearly states the terms and conditions of their stay at the home. We viewed residents’ handbooks in some of the bedrooms. These gave residents information about local community services such as the library, churches and shop times; the aims and objectives of the home, and what the different staff uniforms mean. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 9 All prospective residents are carefully assessed by a manager and carer and then invited to spend time or have lunch at the home. A recent resident told us staff from the home visited her in hospital and she then came to visit with her family so she could assess its facilities. We viewed pre-admission assessments on all the files we checked. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 People using the service experience good quality outcomes in this area. Residents are treated respectfully by staff at the home and their health needs are monitored closely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We viewed the care plans for three residents. Residents’ needs in relation to, amongst other things, their dressing, eating, mobility, sleeping and communication were clearly documented. We sat with one of these residents to read through her care plan with her. She confirmed that information it contained was accurate, and reflected what staff did for her. Some information in the plans was good: in one instance giving detailed instruction of what staff must do if the resident became agitated, in another what they must do to support someone brush their teeth. However we viewed the risk assessment for a resident who was at high risk of walking out the home during the night. The information it contained did not provide enough detail for staff so they would know what to do in order to protect the resident Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 11 Residents who completed our survey told us that they received the care and support they needed and that the home made sure they received good medical attention. Residents are weighed regularly to monitor their health and their dependency profiles are done monthly to monitor any changes in their need. There is a monthly meeting with a district nursing sister where all residents and their health needs are discussed to ensure their well-being is maintained. One resident reported: ‘they are very attentive with my legs, and if they see a mark, they always make sure it doesn’t develop further’. We checked medication storage and a sample of residents’ medical administration records (MAR). We noted some shortfalls: • • • The amount of variable dose mediation given to residents had not always been recorded and therefore it was not possible to tell how much medication they had received The amount of paracetamol for one resident recorded in stock did not actually match the amount held in stock Temazepam for one resident had been signed by staff as having been given to the residents but was still contained in the blister pack We saw evidence throughout our visit that residents were treated in a dignified way. For example, during lunch one resident was unsettled and pacing around anxiously. A member of staff went up to her and asked her very quietly if she needed the toilet, thereby maintaining her privacy and dignity in a very communal place. Residents told us staff always supported them in a way that they liked. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. Residents are supported to live busy and active lives in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a busy and varied activities schedule, with at least two events happening each day including exercise classes, films, a reading group, arts and crafts, cooking and garden trips. These activities are well advertised around the home and we viewed copies of the schedule in residents’ bedrooms ensuring that they knew what was available and when. Every Friday there is the ‘Sunshine Group’, led by staff who have received additional training in providing activities specifically for people with dementia. On the day we visited there was an exercise class upstairs for residents and a quiz happening downstairs for those not wanting to exercise. One resident told us that he had greatly enjoyed a trip to Hunstanton where he walked on the beach and had fish and chips. Another told us that the exercise class was ‘a great laugh’. Residents’ spiritual needs are very well too. One resident told us she attends a Jehovah’s Witness meeting twice a week, staff take three residents every Sunday to the Good Shepherd church and a church service is held monthly at the home’s day centre to which residents can attend. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 13 We had lunch with the residents on the dementia care unit. Lunch consisted of fish, chips or mashed potato, and peas. There was also omelette or salad available as alternatives. Lunch was a relaxed and pleasant affair and residents did not wait too long once they sat down for their food. Staff made a real effort to offer them choice where they could. For example, one carer actually took the cartons of different juice to show each resident so they could easily point at which one they wanted: this is excellent practice. However, another carer tried to encourage one resident to use her fork when she clearly found this difficult and much preferred using her fingers. This resident should ideally be provided with finger foods to eat instead. Most residents we spoke to told us they enjoyed their meals and that the food was good, however one resident reported he sometimes waits a long time for his breakfast in the morning: he told us he gets up at about 7am and often doesn’t get his breakfast served until after 8am Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. Residents have good access to the home’s complaints procedure and their concerns are taken seriously by staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Cambridge Housing Society has its own, comprehensive, complaints policy that has been viewed on previous visits. Details of how to complain are also included in the home’s information pack and in the entrance to the home. There is also good information in the home’s foyer where residents sit about advocacy services, how to complain, elder abuse and the recent Mental Capacity Act, ensuring that this important information is easily available to residents and their visitors. Most residents who completed our survey told us they knew about the home’s complaints procedure. The home keeps a record of what it calls ‘informal’ complaints received (issues such as a badly smelling room, a water jug that was not changed, a dirty toilet). This was detailed and showed us clearly that staff take residents concerns seriously and resolve them quickly. There are also regular ‘complaints and compliments’ coffee mornings, where residents are actively encouraged to give feedback about the service. There has been one meeting held under adult protection procedures in the last year: the home responded appropriately and initiated changes in practice as a result. We talked to staff about their knowledge of how to safeguard older people. Their awareness of the different types of abuse an older person can Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 15 face was good and they were confident about reporting any incident they witnessed. However they were less clear about what other agencies they might report to, outside their own work place. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,29 People using the service experience good quality outcomes in this area. Residents live in a comfortable and well maintained environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is purpose built for older people and has a variety of aids to assist residents such as hoists, bath chairs and grab rails. All bedrooms meet minimum size requirements and furnishings and fittings are of good quality. We toured the home and found it to be safe and hygienic. One relative told us: ‘The care home is kept clean and heating is always adequate’ .However one resident’s bedroom we entered smelled a little unpleasant. The courtyard area of the home had been update since we last inspected and was a particularly pleasant place for residents with garden seating, raised beds Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 17 and colourful planting for them to enjoy. Residents went to the garden centre to choose bulbs for this garden. The home is undergoing some refurbishment currently to create extra bedrooms, a conservatory and better communal areas for residents to use. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. Residents receive their care from well trained staff who are easily available to them when they need. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We received many positive comments about the staff both from residents and relatives. One resident stated: I think they provide an efficient and friendly care service’. However one relative told us: ‘recently a lot of new staff have been employed and although they appear to be good at their job, the language problem is difficult for my mother to understand. Communication is vitally important’. Staffing levels are good with a manager, an assistant manager and 6 carers on throughout the day to meet the needs of 31 residents. They are supported by 2-3 general assistants. Staff told us that the use of staff from outside agencies had reduced considerably since we last visited and residents told us they didn’t wait long for help, one commented: ‘there are always minders around’. Training for staff continues to be good and is clearly appreciated by them. One general assistant told us she had achieved NVQ level 2 in both food processing and cooking, and cleaning and support services and commented: ‘I’ve done Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 19 more learning here than I ever did at school’. Another told us: ‘There is a lot of staff training to keep us up to date’. Most care staff have completed an NVQ level 2 in care and three senior staff have completed level 4 of this award. Training files we viewed showed us that all staff had undertaken relevant training to their role and to help them understand the needs of people they support. We were not able to check staff personnel files during our visit as they are held centrally by Cambridge Housing Society; however one recent staff member told us she received an application for to fill in, that she was interviewed by two people for the job and that she did not start working until her CRB check had been completed. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,344,36,38 People using the service experience good quality outcomes in this area. Residents live in a well run home where their views are valued. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is experienced in caring for older people and was an assistant manager at the home for three years previously. She holds an NVQ level 4 in Health and Social care and the Registered Manager’s Award, giving her the skills and knowledge to manage a residential home. The manager completed our AQAA (annual quality assessment). This was detailed and gave us excellent information about the home. It showed us that she was very aware of what the home did well and what they needed to improve on. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 21 There are regular staff meetings where information about the home is shared and where staff can raise any issues and concerns they have. Staff we spoke to told us they received regular supervision and files we checked also confirmed this. Those we talked to told us they enjoyed their work and felt supported. There are regular meetings with residents which they clearly found useful. One told us ‘I went to a meeting last week, they keep us up to date with all the alterations and banging going on’. We viewed minutes from these meetings where issues such as the building work, management arrangements, activities and food were actively discussed with residents. The home holds cash for some residents and we checked a sample of cash sheets which showed us that written records of all transactions undertaken on behalf of residents were kept as were receipts kept to ensure their money was properly accounted for. We viewed a number of records in relation to health and safety (including water temperatures, call bell servicing, portable appliance testing, hoist and lift servicing) which showed us that the home regularly maintains and checks its equipment and appliances. We viewed a recent environmental services report which stated the home’s kitchen had ‘excellent standards at time of inspection’ Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 3 x 3 x 3 Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(b) Requirement Risk assessments for residents must be much more detailed to ensure staff have the information they need to keep residents safe. Residents’ medication records must accurately reflect what medication they have actually received, and what medication is actually held in stock. Staff must be aware of outside agencies involved in protecting vulnerable adults so they know who to contact should they need arise. Timescale for action 01/12/09 2 OP9 13(2) 01/12/09 3. OP18 13(6) 01/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations Staff should have adequate language skills so that they can understand residents and be understood by them. DS0000015088.V377852.R01.S.doc Version 5.3 Page 24 Alex Wood House 2 OP15 Finger food should be provided for residents who have difficulty using cutlery. Alex Wood House DS0000015088.V377852.R01.S.doc Version 5.3 Page 25 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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