Care Home: Anchor House

What the care home does well The service provides a good range of activities for people who use the service. People said they enjoyed the trips provided, as their relatives can go with them. One person said "I really enjoyed watching old musicals and joining in the art class". The staff works well with health care professionals and district nurses told us staff act swiftly to ensure early intervention when health issues arise. They said staff were very good at following instructions. People confirmed their health care needs were met, including visits from the optician, dentist and doctor. What has improved since the last inspection? Since the last inspection the home have made sufficient progress in a number of key areas. Medication procedures have improved, the records were an accurate reflection of the medication held at the home. They have refurbished areas of the home and purchased new furniture to improve the dining and lounge areas. Carpets have been replaced and a number of bedrooms have been redecorated. They have improved domestic arrangements so that there is now cover seven days a week. They have improved the recruitment and selection procedures to ensure the right staff are employed to keep people safe from harm. They have developed a training room so that staff can spend time accessing training resources. They have developed a training pack to ensure staff know what action they need to take to follow safeguarding procedures. The registered providers have improved their quality assurance audits and have made the reports available for inspection. They have sent quality assurance surveys to relatives and service users to gain their views on the service provided. However the outcome of the surveys were not available. What the care home could do better: Assessments should be undertaken by the manager for all admissions into he home. This will ensure the staff can meet the persons needs. The homes assessment and the placing authority assessment should interlink and form the basis for the care plan. Medication procedures have improved although the room used for storing the medication was above the temperature recommended for the storage of medicines. The manager was aware of the problem and was looking into resolving the issue. Some staff still require training to safely administer medication, although the manager could confirm dates when the training will take place. Mealtimes were well managed, staff were available to offer assistance where needed. The dining experience could be improved by ensuring the table is layed with side plates for bread and butter and serviettes and condiments should be available. The presentation of the meal could be better and the manager should continue to monitor the quality of food available. Some training still remains outstanding from the previous inspection, this must be completed within the timescales identified in this report. This will ensure that staff have the skills and competencies to meet the needs of people who use the service. Staffing levels need to be closely monitored to ensure there is sufficient staff to meet the needs of people who use the service. Key inspection report Care homes for older people Name: Address: Anchor House 11 Avenue Road Wheatley Doncaster DN2 4AH     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: Valerie Hoyle     Date: 0 6 1 1 2 0 0 9 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 25 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) 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 Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Anchor House 11 Avenue Road Wheatley Doncaster DN2 4AH 01302327004 01302327008 jas_toor@ntlworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Authentic Care Services Ltd Name of registered manager (if applicable) Mrs Karen Greaves Type of registration: Number of places registered: care home 23 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: 23 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 category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Anchor House is registered as a care Home for up to 23 persons who require residential care. All bedrooms are single occupancy and located at ground and first floor levels. A chair lift and stairs access the first floor. There is a lounge and dining room with communal areas on the ground floor. The registered provider is Authentic Care Services Ltd and the Home has a manager in place, although she is not the registered manager. Care Homes for Older People Page 4 of 25 Over 65 23 0 0 6 0 5 2 0 0 9 Brief description of the care home The Home is located in a residential area approximately one mile from Doncaster town centre. It is easy to access with a regular bus service. There is on street parking. There is a small garden to the front of the property and a larger garden to the rear. The registered person makes information about the service available to residents and their families via the homes Statement of Purpose and Service User Guide, which are presented in a Service Users handbook. The last inspection report dated 6th May 2009 is available at the home. Information gained during this inspection confirmed fees are 398 pounds and 72 pence per week, additional costs include hairdressing, private chiropody and newspapers. Care Homes for Older People Page 5 of 25 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 quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. This unannounced inspection took place over 6 hours starting at 09:00 finishing at 15:00; this included a partial inspection of the home. Six people who use the service and three staff were spoken to during this inspection; their views are included throughout the report. The manager Karen Greaves was available throughout the inspection and she assisted with the inspection process. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use the service are not being put at risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 25 Occupancy at the home follows current trends with 17 of the 23 beds occupied. Three care plans were looked at to assess how peoples care needs are met. Policies relating to medication, complaints, protection of vulnerable adults and handling of peoples monies were looked at. Five staff recruitment and training records were looked at to assess how people were protected. Procedures and risk assessments relating to health and safety were looked at and discussed with the manager. Six surveys were received from people who use the service. Three from health care professionals, and seven surveys were received from staff. The information has been collated and the results are included in this report. The Annual Quality Assurance Assessment (AQAA) was sent to the home for the manager to complete. This was received by us in a timely manner. An AQAA is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their services. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: Assessments should be undertaken by the manager for all admissions into he home. This will ensure the staff can meet the persons needs. The homes assessment and the placing authority assessment should interlink and form the basis for the care plan. Medication procedures have improved although the room used for storing the medication was above the temperature recommended for the storage of medicines. The manager was aware of the problem and was looking into resolving the issue. Some staff still require training to safely administer medication, although the manager could confirm dates when the training will take place. Mealtimes were well managed, staff were available to offer assistance where needed. The dining experience could be improved by ensuring the table is layed with side plates for bread and butter and serviettes and condiments should be available. The presentation of the meal could be better and the manager should continue to monitor the quality of food available. Some training still remains outstanding from the previous inspection, this must be completed within the timescales identified in this report. This will ensure that staff have Care Homes for Older People Page 8 of 25 the skills and competencies to meet the needs of people who use the service. Staffing levels need to be closely monitored to ensure there is sufficient staff to meet the needs of people who use the service. 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 9 of 25 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 10 of 25 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. Assessments are not always undertaken by staff at the home, which means they may not be able to demonstrate their ability to meet the needs of people who use the service. Evidence: The home has an assessment document that covers all aspects of personal care. A number of care plans were looked at, although they did not have a completed assessment. The manager said the assessment was not always completed as they used the assessment completed by the social worker. The process was discussed with the manager, to ensure she had a full understanding of the importance to undertake a comprehensive assessment prior to admission to the home. Five surveys were returned from people who use the service. Three people said they received enough information about the service which helped them to decide if the home was right for them. Care Homes for Older People Page 11 of 25 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. The health and personal care that people receive is based on their individual needs. The medication procedures have improved to ensure people receive their medication safely. Evidence: A number of care plans were looked at. They included sufficient information to enable staff to deliver peoples care. Risk assessments and daily records provided information to staff to enable people remain independence while remaining safe. There was evidence that the care plans were reviewed and family were kept informed about any changes to the persons care. The manager has updated the medication policy and has placed a summary in the front of the medication administration record folder. An audit of the records and observation of the medication being administered to people confirmed the procedures were followed. The room where medication was stored was quite warm, which may not be suitable for the storage of some medicines. This was discussed with the senior responsible for medication. Staff responsible for the administration of medication was Care Homes for Older People Page 12 of 25 Evidence: due to have some refresher training on the 9th an 17th November which was identified in the last inspection of the service. Staff were observed interacting with people throughout the day, they spoke in an appropriate manner and were seen offering choice with regard to refreshments and meals. Some people stayed in bed until late into the morning and the staff said they were provided with choice of times to get up and go to bed. People were addresses using their first name which was agreed with the individual. Staff were observed knocking on peoples bedroom door before entering and people confirmed staff respected their privacy and dignity. Three of the five surveys returned to us said the usually receive the care and support they need. Three said staff were always available while the remaining two said sometimes they had to wait for the care they needed. Peoples healthcare needs were met and there was evidence to confirm regular visits from healthcare professionals. The staff had regular contact with the district nursing services and they offer advice and support. Three surveys were returned from healthcare professionals and they said staff are friendly, professional and caring. If staff need advice and information they always contact us and they always follow instructions given to them. Surveys returned from people who use the service said they always received the medical care they need and most said staff listened and acted on what they said. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to socialise with family and friends and mealtimes were unhurried with staff being available to offer support. Evidence: The home has an activity coordinator who plans and facilitates social events for people who use the service. She keeps weekly records of the activities and completes social care plans for each individual. The home was decorated with Halloween bunting, and people had been involved in making pumpkin posters. People said they had enjoyed a fireworks party the previous night and had enjoyed a trip to the wetherby whaler earlier in the week. Three surveys received from people who use the service said they liked the activities provided, while two said they only sometimes liked the activities. One person with a particular interest in art was able to show a number of pictures that they had completed. Relative and visitors are able to visit the home at any reasonable time, and surveys returned confirmed visitors were made welcome. People said they liked to entertain their relatives in their own room, while others were happy to spend time in the lounge with their relatives. People said they were able to bring in personal possessions when they moved into the home and a tour of the home confirmed people had brought in Care Homes for Older People Page 14 of 25 Evidence: small items of furnitures and pictures and ornaments to help them feel at home. Mealtimes were relaxed and people were given a choice of scampi, fish fingers or fish in breadcrumbs served with chips and peas. Staff were available to offer appropriate support to people. The presentation of the meal could be better as there was no serviettes and the vinegar was shared between a number of tables. The food did not look very appetising, although there were no complaints from people who use the service. People were offered bread and butter with their meal, although there was no side plate to place the bread on. The kitchen is in the basement of the home and food is delivered to the dining area via a dumb waiter. Three surveys returned told us that they always liked the meals provided while two said they usually enjoyed the meals. The kitchen is currently being refurbished, it was quite untidy with some of the workmens equipment under the worksurfaces. The hand wash sink had been removed and was also under the work surface. The cook said refurbishment was taking place in the afternoon which means afternoon tea is prepared in the staff kitchen. The storage of food was looked at and there were sufficient supplies of food, which was raised as a concern at the last inspection. Care Homes for Older People Page 15 of 25 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 are able to express their concerns, and have access to a effective complaints procedure, and they are protected from abuse. Evidence: The manager has updated the complaints procedure and they have also introduced a comments and suggestions folder so that people can raise any issues before they become formal complaints. The AQAA told us that they have not received any complaints, and surveys told us that they know who to speak to informally if they have a problem and they know how to make a complaint. Surveys returned from staff told us they are confident in the action they would take if someone had concerns about the care provided at the home. The home operates to the South Yorkshire Safeguarding Adults procedures and the AQAA told us that there have been no referrals since the last inspection. They have developed there own internal training to ensure staff are alert to the signs of abuse. The training also ensures staff are aware of the procedures they need to follow if they suspect an incident of abuse has taken place. Care Homes for Older People Page 16 of 25 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. The home provides a clean and safe environment for people who use the service. Evidence: The home has undertaken a considerable amount of refurbishment since the last inspection of the service. They have replaced dining and lounge chairs and replaced several carpets. Redecoration of a number of bedrooms has improved the environment for individuals, although some rooms still need to be refurbished. A partial inspection of the service found the home to be clean and tidy, although one room needs the wallpaper boarder fixing as it was peeling off. A new toilet had been fitted on the first floor although the room still needed decorating, and the downstairs bathroom was cluttered with hairdressing equipment. The chair weighing scales were in need of some attention as the paint on the seat was peeling off. They home now employs domestic cover over the seven day period and surveys received from health professional confirmed the home was always clean and tidy. Care Homes for Older People Page 17 of 25 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. There is a stable staff group who have access to training which enables them to meet the needs of people who use the service. Recruitment procedures are followed to ensure the right staff ware employed to keep people safe from harm. Evidence: There is a stable staff group with a number of staff that have worked at the home for a considerable length of time. They have improved the way staff are recruited to work at the home and all staff files that were looked at had the required employment checks. Surveys returned to us from staff confirmed that they were employed fairly and that they were asked to provide the required information to ensure they can work with vulnerable adults. They have improved staffing levels to ensure the home has domestic cover seven days a week. Staffing levels were appropriate to the number of people currently living at the home. The levels should be monitored to ensure peoples needs can be met in the afternoon and evening when there is only two staff on duty. Since the last inspection they have created a training room where staff can undertake NVQ assessments, and training material is available for them to develop their skills and competencies. They have a comprehensive induction programme, although it had not been fully tested as most staff have been employed for a number of years. The Care Homes for Older People Page 18 of 25 Evidence: manager has developed a training plan which identifies gaps in staffs training and it confirmed that some of the essential training which was required at the previous inspection has not been undertaken. Health and safety training and food hygiene training remain outstanding although dates had been arranged for January and March 2010. Training to ensure staff have an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards should be arranged as soon as practicable. Surveys returned from staff told us that they receive training that is relevant to their role and helps them to understand the needs of people who use the service. They said they feel supported by the manager and some said they are encouraged to share information about the service. The home continues to meet the required levels of NVQ qualified staff and the registered providers continues to provide a commitment to staff, to undertake the qualification. Care Homes for Older People Page 19 of 25 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. The management of the home promotes openness and respect and they have effective quality assurance systems which helps people to give their views on the service. The lack of health and safety and food hygiene training means people may be at risk from harm. Evidence: The manager was employed in 2006 and has submitted her application for registration with the Care Quality Commission. She had completed the Registered Managers Award and NVQ Level 4 in management. She works mostly off rota, although she occasionally covers for carers where needed. She has responsibility for the day to day management of the home and she is in regular contact with the registered provider. People who use the service were able to manage their own finances, although some prefer the manager to assist with dealing with their personal monies. Records were looked at and they were an accurate reflection of the accounts held on behalf of people. Care Homes for Older People Page 20 of 25 Evidence: The manager undertakes quality assurance audits to ensure people can express their views on the quality of the service. The manager confirmed recent surveys from relatives, health professionals, and people who use the service gave positive comments about the service. However, an action plan had not been developed. The registered provider undertakes Regulation 26 visits and a number of reports were looked at. They described good outcomes for people who use the service. Maintenance and service records were looked at and were up to date and appropriate to the service provided. Fire safety procedures were in place and service records were looked at and were up to date, ensuring people who use the service were safe and protected. The rating in this outcome group reflects the lack of response to the previous inspection report requirements. Essential health and safety and food hygiene training has not been completed, which poses significant risk to people who use the service. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 Staff must receive refresher training to ensure they have the required skills and competencies. To ensure they can meet the needs of people who use the service. 03/08/2009 Care Homes for Older People Page 22 of 25 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 30 18 Staff must receive training to ensure they have the required skills and competencies To ensure they can meet the needs of people who use the service 11/01/2010 2 38 18 Staff must receive refresher training in health and safety and food hygiene. To ensure they have the required skills and competencies to help keep people safe from harm. 11/01/2010 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 3 Assessments should be undertaken on all prospective people prior to admission into the home. This will ensure they are able to meet the needs of people who use the service. Care Homes for Older People Page 23 of 25 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 2 9 The medication store should be not exceed the manufactures recommended temperature of 25 degree. This will ensure the medicines are not affected and stored safely. The manager should ensure while the kitchen is being refurbished the food preparation area meets environmental health standards. The manager should monitor the food served to ensure it is good quality and well presented, which includes the use of side plates, condiments and serviettes. The home should continue to with their refurbishment programme, to improve the environment for people who live at the home. The manager should continue to monitor staffing levels in the afternoon and evening to ensure they are sufficient to meet the needs of people who use the service. 3 15 4 15 5 19 6 27 Care Homes for Older People Page 24 of 25 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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