Care Home: Aspen Court Nursing Home

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What the care home does well The service provides a well-managed care home for its residents, which is homely and welcoming. Residents and their supporters spoke very highly of the care that was provided, and of the efficiency and kind manner of the staff. We found that clinical assessments and corresponding care plans were well written, and the service demonstrated a good responses to other needs too, such as social recreation, stimulation and maintaining links with visitors and the wider community. What has improved since the last inspection? The service was assessed to be providing a good service at the last inspection. We have identified specific areas that exceeded the National Minimum Standard at this inspection, such as the management of complaints and how residents (and their supporters) feel that staff create an environment that promotes dignity and respect. Improvements have been achieved in the scope of staff training and available activities programme, as well as with the premises - particularly indoor and external areas for activities and relaxation. What the care home could do better: One requirement has been issued in this report, which is for the improvement of the medication practices on the nursing floor. Minor issues for development have been noted in this report, such as the need for staff to more closely audit care plans to ensure that information is consistently recorded in a `resident friendly` manner, taking into account that care plans will be read by some residents, and shared with relatives when applicable. We have also suggested ideas for the development of the garden and the menus. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aspen Court Nursing Home 17 Dod Street Poplar London E14 7EG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Greaves     Date: 3 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Aspen Court Nursing Home 17 Dod Street Poplar London E14 7EG 02075389789 02075150938 aspencourt@schealthcare.co.uk 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) : Southern Cross Healthcare Services Ltd care home 75 Number of places (if applicable): Under 65 Over 65 0 75 dementia old age, not falling within any other category Additional conditions: 75 0 The maximum number of service users who can be accommodated is: 75 The registered person may provide the following category of service only: Care home with nursing - Code N 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 Date of last inspection Brief description of the care home Aspen Court is registered with the Stratford East London Commission for Social Care Inspection Area Office as a care home for older people that also provide nursing. It is owned and managed by Southern Cross Healthcare that is one of the largest care providers in the UK. In its statement of purpose, the home underlines its commitment to individualised care and provision of an environment that service users regard as their home. The premises are purpose built and have their own parking facilities. All rooms (69 single and 3 double) have en-suite facilities and are fully furnished. Various communal areas are available, including a garden. The service provides Care Homes for Older People Page 4 of 26 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over three days. We gathered information by speaking to residents and their visitors (relatives and friends). Information was also sought through speaking to the registered manager and the staff team, in addition to looking at randomly selected care plans, staff files, health and safety documents, and other relevent documents (such as complaints, accidents and incidents, medication administration records, and policies and procedures). We toured the premises and checked the storage, administration and disposal of prescribed medications. 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: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 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 8 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective and existing residents (and their representatives) are assured that they will be provided with suitably presented information about the service, and that the needs of the residents are comprehensively assessed prior to admission. Evidence: We read the services Statement of Purpose and Service Users Guide, which were found to be appropriately written in a clear and straightforward style. Through speaking to residents and their visitors (family members), we noted that people were satisfied with the services approach to providing information about the care home prior to admission, including opportunities to visit before commencing a trial period. We looked at seven care plans during the course of this inspection, inclusive of the pre-admission assessments. It was noted that the care plans contained the assessments conducted by external health and social care professionals (such as the assessment co-ordinated by a community or hospital-based social worker) as well as Care Homes for Older People Page 9 of 26 Evidence: the assessments undertaken by senior staff at the care home. The Key National Minimum Standard 6 was not applicable for assessment, as the service does not offer intermediate care. Care Homes for Older People Page 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are assured that the service will provide a very good level of care to meet identified health and personal care needs, delivered in a manner that promotes an individuals entitlement to dignity and respect. Issues for the improvement of the management of medication have been identified. Evidence: We read seven care plans during this inspection; these care plans were selected from the two residential units and the nursing floor. It was noted that the care plans were well written with up-to-date and accurate clinical assessments (such as assessments for skin integrity to identify the risk of developing a pressure sore). The care plans demonstrated that the the holistic (for example, personal care, health care and social care) needs of the residents were carefully identfied and appropriate interventions were recorded. We noted that some minor improvements could be sought and these were discussed with the registered manager (such as staff striving to consider the most sensitive wording to describe an individuals circumstances). It was also found that not all of the care plans contained a Life History of a satisfactory standard, Care Homes for Older People Page 11 of 26 Evidence: although this appeared to apply to residents that were unable to provide this information and did not have a relative/friend to do so on their behalf. We noted that the nursing staff provided good, clear explanations of clinical terms within the care plans that they wrote for people residing on the nursing unit. For example, a care plan for a resident with diabetes identified that this person was at risk from hypoglycaemia and hyperglycaemia; both terms were accompanied with straight-forward explanations of how a person would physically present with the symptoms of these conditions. Another care plan for a person with a formal medical diagnosis of hypertension contained an explanation that this meant high blood pressure. This level of detail made the care plans more accessible to residents, their supporters and care staff that were not trained nurses. We found that information within the care plans was consistent and up-to-date. For example, if a persons weight had changed this was recorded on their weight chart and staff had also made alterations if necessary to other clinical assessments that could be influenced by weight fluctuations. Discussions with the registered manager, residents and their visitors indicated that the service received good support from the General Practitioner service, and the care plans demonstated that people accessed other health care support such as podiatry and dentistry as required. Prior to the commencement of this inspection, we had been informed by the registered manager that she had detected a medication error during a routine audit; it had been noted that two residents had not received their medications in accordance to the prescribed regime. During this inspection we found a few issues of concern on the nursing unit, which were as follows: (1) a medication that should have been stored in a refrigerator was being kept in the medication trolley (2) alterations had been made to a pharmacy label by a staff nurse in accordance to the instructions of the General , Practitioner; however, the staff nurse had not signed the alteration to demonstrate professional accountabilty (3) a 2007 edition of the British National Formulary was being used although the service owned a more recent edition and (4) the recorded balances for two homely remedies medications were inconsistent with the number of tablets found. These findings were reported to the registered manager, who conducted a thorough investigation after this inspection and has reported that actions have been taken to remedy these issues. We received very favourable views from residents and their visitors regarding the manner that staff interacted with them; residents and visitors described the staff as being very caring and attentive and expressed their pleasure at having chosen Aspen Court. Through discussion with the registered manager and one of the staff nurses, we found that the service was using a recognised end of life care planning pathway and was accessing support from a local hospice. We looked at the documentation for a couple Care Homes for Older People Page 12 of 26 Evidence: of the residents that were being supported to plan their final care (with the involvement of their relatives and friends, where applicable), which was found to be thoroughly and sensitively presented. We spoke to the realtive of a resident who had passed away at the care home a few days before this inspection visit. The relative spoke very highly of the support and care that staff provided. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to engage in fulfilling activities and maintain their links with their families, friends and the local community. A varied, appetising and balanced food service was provided. Evidence: At the time of this inspection the care home did not employ a full-time activities organiser. We were informed that this position had been vacant for a couple of months; however, the regional manager stated that the service proposed to recruit for this position. We found that the nursing and care staff were active in their commitment to providing activities, which was evidenced through discussions with residents, their visitors and staff, in addition to other observations. The care home displayed a pictorial noticeboard in a communal corridor, which demonstrated the work undertaken by residents, staff and visitors in order to upgrade the garden area. We observed a gentle exercise session for residents and reviewed the documentation for previously held and forthcoming entertainments. We were informed that a visit from an organisation known as Music In Hospitals had been very successful and further contact was planned. The service offered a dedicated activities room and was in the process of creating a nostalgic-style pub. Residents were offered opportunities to visit Care Homes for Older People Page 14 of 26 Evidence: pantomimes and old-style music hall shows, and participate in activities that included darts, bingo, film sessions, pastry making , pampering sessions and discussion groups. We spoke to as many visitors as possible during the inspection. We received very positive feedback regarding how the service encouraged and supported residents to maintain their links with the local community. Visiting hours were flexible and visitors were able to take part in the daily life of the care home; for example, they were invited to functions and summer fetes, and offers of assistance from the relatives and friends of residents for social projects (such as the development of the garden and the pub room) were welcomed. Through speaking to the residents and their supporters, we found that the service supported people to make choices and to be as independent as they were able to be/or wished to be. For example, we checked a sample of the financial records and found that residents were choosing to spend their personal allowances on entertainments, clothes and confectionaries. The care home displayed information on a public noticeboard regarding local advocacy services and national organisations focused upon the welfare of older people. We joined the residents for lunch on two occasions on different units. It was noted that mealtimes were relaxing and well-organised, for example, the dining rooms had a peaceful view overlooking a canal, which some of the residents positively commented upon. We observed that staff were briefed about their specific duties prior to mealtimes by the person-in-charge of each unit, such as whether they would be assisting with the serving of food or would be providing direct support to an assigned resident. Some of the residents needed physical support and/or verbal prompting to meet their eating and drinking needs; this care was provided in an unobtrusive and dignified manner. We toured the main kitchen and spoke to the chef. It was noted that there was a plentiful supply of fresh fruits and vegetables (fresh fruit of an accesible nature for older people was available for residents to help themselves to in the dining rooms) as well as healthy items such as fruit juices, high-fibre cereals and yoghurts. We were informed by the chef that there were no residents that identified as being vegeterians or vegans at the time of this inspection, although eight people were being provided with a softened diet. We were satisfied that residents were supported to make choices, such as whether they wished to have a cooked breakfast and if they wanted an off the menu choice; this was confirmed through discussions with residents that were able to articulate these views. We have advised that the menu should more explicitly state what is available in order to avoid any misunderstanding for a new resident. For example, the lunchtime menu for one Friday stated that residents could have either fried fish or fish in a sauce; we have suggested that a clear alternative to fish should be stated on the menu. We have also advised that the menu should state that light snacks are served between meals, such as the tea, coffee and biscuits round at 11am. The chef demonstrated that home-made cakes and puddings were regularly provided, and sandwiches/toast were offered to residents that felt hungry at nightCare Homes for Older People Page 15 of 26 Evidence: time. Observations conducted in the residential units for people with dementia (talking to residents, reading care plans and participating at dining times) indicated that the dependency needs of the residents did not appear to presently necessitate the need for the service to develop a more in-depth night-time menu; however, the service should continue to review this on an individual basis, taking into account the eating patterns, health needs and weight status of each resident. 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. The service demonstrated thorough measures to listen to and protect residents. Evidence: We read the services complaints procedure, which was clearly written and based upon good practice. We noted that the registered manager conducted very thorough investigations of any complaints received, and found that residents and visitors were confident that any complaints would be promptly and fairly dealt with. We found that the registered manager implemented specific measures to address any shortfalls that a complaint identified. The service produced its own Adult Protection policy in addition to possessing a copy of the local Tower Hamlets guidance. We have observed that the registered manager has promptly notified the Commission of any Adult Protection issues, and has provided regular updates until issues have been resolved. It was noted that staff were provided with regular training regarding how to protect older people from abuse, such as direct training concerning Adult Protection and other relevant clinical training, such as how to prevent dehydration and malnutrition. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were provided with a comfortable, clean and well-maintained environment. Evidence: We toured the entire internal and external premises with the registered manager, in addition to viewing a substantial number of the bedrooms (in accordance to the agreement of the residents). We found the care home to be pleasantly decorated, with an inviting and homely ambience. There were pictures of old East London landmarks; the registered manager stated that some of the residents have recalled visiting the shops or amenities depicted in these photographs, which now no longer exist. We found that the service creatively used certain spaces, such as sitting areas in fyers for residents that might wish to sit quietly on their own or with a visitor. Discussions with the registered manager identified that the service had an on-going programme for the refubishment of the environment and the purchasing of new equipment, for example, at the time of this inspection new bedroom chairs had been ordered and the service proposed to install a lockable facility in each bedroom (for residents to lock up personal papers/treasured items, if they wish to). As previously stated in this report, the service provided an activity room, a garden and a pub-style room. Although the pub room was a work in progress at the time of this inspection, we found the activities room to be a suitably spacious and appropraitely equipped facility and the garden offered a combination of stimulating spaces and an area for quiet reflection. We noted Care Homes for Older People Page 18 of 26 Evidence: that there were delightful ornaments and windchimes; however, we have suggested that the service should consult the residents about whether they would like a broader scope of statues or other items in the quiet area. It was observed that the communal bathrooms in the units for people with dementia had pictorial signs to indicate the purpose of the room; however, individual bedrooms did not have pictures or other material (such as memory boxes attached to the bedroom door) to assist a person with dementia to easily find their own room. This was discussed with the registered manager, who stated that none of the residents needed this level of support. We observed this during the course of the inspection and found the services assessment to be correct. The registered manager stated that signage aids would be provided in the event of being required by any residents. The bedrooms that we visited were nicely decorated and had been personalised by the residents and their visitors. All of the bedrooms provided an en-suite toilet and the communal bathrooms were equipped with bathing and showering facilities to meet the varied mobility and dependency needs of the residents. The premises were very clean and free from offensive odours. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service demonstrated that staff are safely recruited and well trained for their roles. Evidence: The staffing levels and skills mix was considered to be satisfactory. Via discussion with the registered manager, we were informed that the service provider was looking at the staffing structure of Aspen Court with regard to the creation of a deputy manager post; we were of the opinion that this was a positive proposal for the ongoing development and stability of the service, taking into account the substantial size of the care home. We found that the care home offered a very comprehensive programme of training for staff, which included a broad range of relevant topics to neet the holistic needs of older people that require residential and nursing care. The training programme included mandatory training (such as moving and handling, food hygiene, Adult Protection and fire safety) as well as additional training focused upon the needs of the residents, including pressure area care, accidents and incidents reporting, care planning and how to meet nutritional needs. The registered manager stated that the service was planning a diabetic care training session. We noted that over 50 of the care staff had attained a National Vocational Qualification in Care at Level 2, as required by the National Minimum Standards for Care Homes for Older People. Additionally, over 50 of staff had successfully Care Homes for Older People Page 20 of 26 Evidence: completed a dementia training course. This training course, known as Yesterday, Today and Tommorow, was delivered by the registered manager who is an approved trainer and was conducted in eight sessions over the course of six to eight weeks. We looked at a random sample of the staff files in order to check the quality of the recruitment; no issues of concern were identified. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents (and their representatives) benefiitted from receiving a service that is wellmanaged, responsive to their views and safely delivered. Evidence: The registered manager is a qualified nurse, with qualifications in general nursing and mental health nursing. She has attained an appropriate management qualification and has additional qualifications for staff training. This report has identified one specfic area that requires continuous and rigorous monitoring, which is the management of medication. However, the management of all other aspects of the service was of a high standard. We read the monthly-unannounced reports by the area manager, which were of a good quality; we have suggested that the template could benefit from being extended so that there was more space to record information such as the views of the residents and their visitors. We were fortunate to meet a significant number of relatives during this inspection, Care Homes for Older People Page 22 of 26 Evidence: who were keen to discuss their view of the service. Residents and relatives described Aspen Court as being an excellent place to live, particularly because the registered manager and staff listened to their opinions about current standards and suggestions for continuous development. We checked the financial records for four randomly selected residents. We found that the systems were clear and regularly audited. Receipts were produced for any expenditures and there were no concerns regarding how residents spent their money; for example, there was no evidence to suggest that people were being asked to purchase items that the care home should be providing as part of its basic service. We checked the following health and safety records and practices, which were found to be satisfactory: first aid box, Landlords Gas Safety certificate, portable electrical appliances testing, water temperatures for hot and cold water, fire training for staff, fire risk assessment, weekly checking and periodic maintenance of fire equipment, and regular checks upon wheelchairs, window resrictors and call bell systems. We observed that one resident chose to keep air freshner in their bedroom; although this was deemed to be a safe practice for the individual, we have advised that this item should be kept in a safe place within the bedroom so that it was not accessible to other residents with confusion. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 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 9 13 The registered person must ensure the safe management of prescribed medications. So that residents are receiving their medications in a safely managed way, to prevent dosage errors. 28/02/2009 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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