Care Home: Avalon Park Nursing Home

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avalon Park Nursing Home Dove Street Oldham Lancashire OL4 5HB     The quality rating for this care home is:   three star excellent 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: Sylvia Brown     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Avalon Park Nursing Home Dove Street Oldham Lancashire OL4 5HB 01616335500 01616338483 avalonpark@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 60 Number of places (if applicable): Under 65 Over 65 0 60 0 dementia old age, not falling within any other category physical disability Additional conditions: 60 0 60 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 Physical Disability Code PD The maximum number of service users who can be accommodated is: 60 Date of last inspection Brief description of the care home Avalon Park is a care home providing 24 hour nursing care for 30 older people and specialist dementia care for a further 30 people. Avalon Park is owned and managed by Southern Cross Healthcare. It is managed on a day-to-day basis by a manager who is registered with us and is also a qualified nurse. The home is a purpose built, two-storey building and operates as two distinct units. Care Homes for Older People Page 4 of 28 Brief description of the care home Service users requiring general nursing care or personal care are accommodated on the ground floor. Service users requiring dementia care are accommodated on the first floor of the home. The first floor accommodation is secure with access controlled by a keypad system. There are two lounges and two dining rooms on each floor. All bedrooms are single rooms with en-suite facilities. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to the lounges and dining rooms. The home is located in the Salem district of Oldham, on a main bus route, within a residential area and close to local shops. Fees for accommodation and care at the home range from #360 to #727 per week. Additional charges are also made for hairdressing, chiropody, newspapers and personal toiletries. A service user guide and statement of purpose is kept in the reception area of the home, copies of which are given to service users and their families. Care Homes for Older People Page 5 of 28 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: three star excellent 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 inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed in January 2007. This was a key inspection which included a site visit to Avalon Park. The site visit was unannounced which means the registered manager and staff members were not told that we would be visiting. Throughout the inspection the registered manager made herself available and provided us with all the information we requested. As part of the inspection process we gathered information from a number of people which included talking with and seeking the views of service users. Service users is the Care Homes for Older People Page 6 of 28 preferred term to be used by the people living at Avalon Park and will be used throughout the report. We also sent out surveys to some service users and members of staff. This gave them the opportunity to make comments about the services provided at Avalon Park. Comments received are where appropriate, included within the report. We case tracked two service users, which means that we looked specifically at their care records and support packages and where possible met with them. This helped us get a better view about how people received a support service from the registered manager and the staff team at Avalon Park. In December 2008 the registered manager completed a self-assessment form that is called an Annual Quality Assessment Audit (AQAA). This told us what the registered manager had been doing since the last key inspection to meet and maintain the National Minimum Standards. It also told us what she felt the service was doing well, how it had improved within the past 12 months and her plans to develop the service in the next 12 months. We also gathered information through general contact with the registered manager through reporting procedures, these are called notifications. Since the last key in inspection which was completed in January 2007, we have conducted an Annual Service Review. This means we gathered information on the service and assessed if they were maintaining the rating we gave at the last key inspection. From the information we received we made the decision that the service was continuing to maintain a good standard and that we did not need to change our inspection plans. We have not received any issues of concern or complaints about the services provided at Avalon park. One allegation of abuse has been made which was investigated appropriately though the Local Authority safeguarding procedures. The fees range from threehundred and fifteen pounds to seven hundred and twentyfive pounds with additional cost for personal items such as newspapers, hairdressing, dry cleaning and private chiropody This report is a public document and can be made available upon request at the home. What the care home does well: The registered manager ensures that service users are treated with dignity and respect. We saw staff members supporting service users with patience and understanding, particularly those who have a dementia type illness and who at times became confused,have repetitive behaviour and require additional support. Service users informed us that they felt staff listened to them and were always available when required. They were given opportunites to make most choices and decisions for themselves and care records confirmed that they had been consulted about their individual needs and how they should be met. To make sure staff members had the information they needed when providing care support, the registered manager made sure good records were kept about service users particular needs and health care issues. We could tell from the records that service users received the support they needed to maintain as far as possible, good health. The records detailed when service users received visits from health care professionals,treatments and attended appointments. They confirmed within the surveys that they received the medical support they required and felt generally well cared for. When we looked at medication administration records we identified that service users received their medication as prescribed and as required and that the registered manager had good management systems in place to manage medication records and stocks safely. The registered manager successfully managed to maintain the large building in a homely manner and made sure it is adapted to meet the varying needs of service users. Communal and private areas looked at were inviting, clean and pleasant places to sit and offered service users comfort and security. Fixtures and fittings were of a good standard and all parts were clean and free from odours. Service users informed us that they felt the home was always kept fresh and clean with one service user saying we are all happy here. When we looked at staff files we could tell that staff members were appropriately recruited , well trained and supported. When we spoke with them they were knowledgeable about service users health and personal requirements and we observed that service users had formed positive relationships with them and appeared relaxed in their company. There has been a low turnover of staff within the last twelve months which is positive for service users and means they are more likely to receive care from people they know and feel safe with. Staff told us that they received information as they needed. One member of staff stated that they were always kept informed of any changes to the needs of service users and that information on new service users is always given to them. This means staff members know what is expected of them and have all the information they need to carry out support tasks the service user needs or requires. Robust complaints and adult safeguarding procedures are in place at the home and when asked service users told us they had someone to talk to if they had concerns. One service user told us they would go to the office another stated they would tell Vivian (the registered manager) if they were not happy about something. Care Homes for Older People Page 8 of 28 The registered manager ensures she meets with service users regularly and gives them the opportunity of talking with her as a group and as individuals. Because of this they are able to tell her what they think and have confidence that she will take seriously any comments and suggestions they make. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 9 of 28 7535. Care Homes for Older People Page 10 of 28 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 11 of 28 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. Systems are in place which ensures that prospective service users receive information about the service, are able to meet the registered manager and visit the home before making any decisions about moving in. This ensures that service users are able to make informed choices and that the manager is confident that with the staff team they can meet their needs. Evidence: From looking at service users records, from consulting with them and from what the registered manager told us within the AQAA, we know the registered manager ensures that all prospective service users receive information about the home and services on offer before they make any decisions about moving in. Records identified that prospective service users are visited by the registered manager in their own home or placement which makes sure they have the opportunity to discuss any matters of concern they may have and find out more about the home. At the same time the Care Homes for Older People Page 12 of 28 Evidence: meeting helps the registered manager to gain more information about the service users needs and individual requirements. Prospective service users are invited to visit the home and test drive the service which means they can spend time at the home, view rooms, have a meal and join in the day to day activities before they make any decisions about moving in. Care Homes for Older People Page 13 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are consulted about their needs, preferences for care and as far as possible supported to maintain good health. This means they have individualised care plans and support packages to meet their needs and requirements. Evidence: All the service users records we looked at were mainted in good detail, including service users who were recently admitted and or who were on short stay visits. We could tell that they had been consulted about their needs and their personal preferences for care and support recognised and recorded. The health care needs were assessed and were kept under review which means changes in their health care needs were quickly recognised and met. Service users surveys confirmed that they felt their health care needs were being supported well. Care records identified that service users received visits from medical professionals, attended health care appointments and had routine check up and Care Homes for Older People Page 14 of 28 Evidence: treatments such as optical, dental, hearing and chiropody. Service users weights were recorded and where required specialist advice sought where weight loss was causing concern. This means that service users were supported as far as possible to main good health. We think the registered manager could develop service users care plans to include oral hygiene support more specifically. This would ensure that staff know what individual service users require, what service users could do for themselves or the level of support to be provided. Such information can prompt staff members to support service users to maintain some self care skills which would otherwise be lost. Risk assessments and management programmes were in place, because of this service users were supported to maintain their independence and were able to make some choices for themselves whilst as far as possible being kept safe. All the service users we case tracked received support from staff members to take their medication, when we looked at records we found them well maintained. The registered manager had systems in place for the monitoring of staff members practice and made sure that records were routinely checked for errors. Medication audits were completed as were spot checks on medication management systems. We observed medication being administered in a discreet and dignified manner with staff members demonstrating patience and understanding when providing service users with their medication, particularly to those who have mental health frailty due to dementia related illness. One service user stated everyone gets excellent care. Throughout the inspection we saw that service users were supported well, when we spoke with staff members they had good insight into the individual needs of service users and their support requirements even though some service users were new to the home. Furthermore we saw one new service user experiencing difficulties in joining in with others, a member of staff was observed sitting with the service user and talking with them, making them a drink and generally being kind and sensitive in trying to support the service user to relax and be at ease with others. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user is treated with dignity and respect, they were supported to live as far as possible as they desired. They were consulted about their opinions, had choice of meals and were able to join in activities as they desired. This means service users were able to retain their individuality, make positive relationships with each other and staff members. Evidence: Throughout the inspection it was evident that the service users observed were contented in their surroundings and felt relaxed in the company of each other and staff members. We observed the activities coordinator talking and chatting with service users as she provided some with manicures. Service users told us they enjoyed this activity and liked to talk to the co-ordinator and others whilst having this done. We also noted that the daily newspapers were being read with service users and conversations were being made about the days news and world events. Each service user has a social profile within the file which contained their personal Care Homes for Older People Page 16 of 28 Evidence: history , previous hobbies and interests and current activities they like. The homes activities programme was varied. We were told by the registered manager that service users have been consulted about what activities take place which we confirmed when we looked at service users meeting notes. We also saw photographs of events and activities that had taken place within the previous six months. The photographs were used with some service users to promote and stimulate conversation. The visitors record was kept up to date and identified that service users received visitors when they wished and had opportunity for visiting friends and family outside of the home. During the inspection site visit we were able to join service users at midday for a meal. The homes menu offers service users ample choice of hot and cold food at each mealtime including breakfast. The meals served were hot, tasty and enjoyed by service users. In addition to a main meal, service users receive a variety of hot and cold drinks and snacks throughout the day. Some service users have difficulty with eating or retaining a healthy weight. Where this is recognised nutritional assessments were completed and professional support services had been sought and provided. We saw a number of service users receiving soft or liquidised diets. These were prepared and presented correctly with each food item separately softened and displayed nicely when served. This means service users were able to taste each food item and take enjoyment from what they were eating. Throughout the inspection all service users observed wore clean, well pressed and well maintained clothes. Some ladies wore jewellery and some gents work suits, hats and ties. This confirmed to us that service users were supported to maintain their individuality, were treated with dignity and respect and were able to retain their own dress styles. Care Homes for Older People Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are made aware of safeguarding and complaints procedures and consulted about any concerns they may have. This means they know if they raise any concerns or complaints they will be taken seriously and be protected. Evidence: Southern Cross has its own written adult protection procedures which staff members are trained in and service users told about. In addition to those procedures the registered manager told us that she is aware of and operates Local Authority safeguarding procedures if a suspicion or allegation of abuse is made . This means that independent and relevant professionals are notified and take action to ensure investigations are independently investigated and that appropriate action is taken to ensure the service user(s) are kept safe. There has been one allegation of abuse raised within the previous 12 months which was appropriately referred to and investigated by the Local Authority. Four returned service user surveys identified that each service user had someone to talk to and whom they trusted if they had any concerns or felt unsafe. Two stated that they felt able to talk with the registered manager or staff members about their concerns. At the time of admission information provided to service users include information Care Homes for Older People Page 18 of 28 Evidence: about the homes complaints procedure. Information is displayed within the home about how to make complaints and inform the registered manager about any dissatisfaction about the services provided. The registered manager holds service user meetings which gives service users the opportunity as a group to talk about any concerns they have. We looked at regulation 26 visits, which are conducted by an operations manager each month. Those visits are recorded and we could see they took time to talk alone with service users and staff members to seek their views on the service. Three complaints have been registered at the home, all of which were taken seriously and were recorded. Records detailed the nature of the complaint, the action taken to investigate and the outcome. Confidential comment cards are also made available within the home which enables service users, staff members and visitors to make comments on the service anonymously if they prefer. Care Homes for Older People Page 19 of 28 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. Avalon Park offers service users a welcoming, homely and pleasant environment. This means that service users were able to live and relax in an environment they liked and which was suitable to meet their needs. Evidence: When we visited the home we were able to look around the building, particularly the EMI unit where we spent the majority of time. All parts of the home we looked at were clean and without odours. Communal areas were bright and cheery and professional advice was sought about the decoration of rooms used by service users with mental health and dementia related illness. Each lounge contained new large screen televisions, DVD players and CD facilities which meant service users have a choice of what they watch or listen to. Dining areas were pleasantly decorated and nice places to sit at meal times. Tables were laid appropriately and time and consideration had been given to making the rooms homely and inviting. Service users private rooms were individually decorated and furnished. Routine Care Homes for Older People Page 20 of 28 Evidence: redecoration programmes ensure that standards are maintained and we were told by the registered manager that when a room becomes vacant they are redecorated in readiness for a new admission. Upgrading continues in the bathrooms and toilet areas however some still need attention. The manager was informed that waste bins should have lids to prevent the spread of infection, in addition notices directing staff in various aspects of practice were displayed in areas used by service users which reduced the effects of the homely environment. We have recommended that such notices are removed where possible. Care Homes for Older People Page 21 of 28 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. Service users are supported by staff members who are recruited, trained and supervised correctly. This means they can have confidence that their needs will be understood and met appropriately. Evidence: After inspecting two staff files we found that all the correct documentation was in place. Prospective staff members had completed a detailed application form which included details about their education, past work experience and skills to apply for the position of employment on offer. The registered manager had followed robust recruitment procedures and ensured that references and other statutory checks had been received prior to the staff members being appointed. Letters of appointment were in place as was induction procedures, probationary periods, supervisions and training. The AQAA confirmed that within the last 12 months there had been a low turn over of staff which means staff members have been able to develop in teams and form good working relationships, all of which supports service users to have a consistent support service. Care Homes for Older People Page 22 of 28 Evidence: New members of staff are provided with mentors who have achieved a good standard of care practice and who have the skills to share their experience and working knowledge about how to provide as good cared service. The registered manager stated this supports new staff members to feel care for and valued by the employer. When we spoke with staff they told us they were able to talk with the registered manager about any concerns they have and that they felt supported by her. We looked at a number of staff meeting records and could see that staff are kept up to date with changes and kept informed of any developments within the home. The AQAA identified that there is a total of fifty -seven care staff working at the home, of which thirty- three have completed the induction training prgrammes which meets the standards set by Skills for Care. There are thirty-seven care staff and nine registered nurses employed at the home. Ten care staff members were identified as achieving National Training Qualification (NVQ) at level 2 or above. Staff files contained training and development plans and appraisals. Due to the majority of staff members being from minority ethnic groups, the registered manager has systems in place to support them with their understanding of the English language both written and spoken where required. Care Homes for Older People Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Avalon Park is a well run home which is managed for the benefit of service users. This means they are well cared for and supported with their health and safety needs prioritised Evidence: Avalon Park is managed by a registered manager who has been at the home for nine years and who has thirty-five years experience in delivering care support. She has the appropriate qualifications and is registered with us as a fit person to run and manage a care home. The registered manager continues with her training and has within the last twelve months received updated training on various management courses, safeguarding and has commenced Investors in People . The registered manager is supervised and monitored by the operations manager who has responsibility to make sure the home maintains and meets the National Minimum Standards. Care Homes for Older People Page 24 of 28 Evidence: Where the manager maintains small balances of money on behalf of service users, records were kept which were audited by others to make sure accounts and receipts were accounted for correctly. Service users are consulted with and have opportunity to meet together and talk with the registered manager. Service users also have the opportunity to comment on services offered to them by use of comment cards which are displayed within the home. The orgaisation completes annual quality assurance procedures from which a public report is produced and can be requested at the home. We have not been provided with a copy of the last completed quality assurance outcome as required and have made a recommendation for this to be done. Health and safety records were well maintained and we could see from the records kept that action is taken to ensure as far as possible the health and safety of service users and staff. Care Homes for Older People Page 25 of 28 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 26 of 28 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 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 8 Service users care plans should include oral health care needs and the individualised support service users require to maintain self caring skills. A copy of the last completed annual quality assurance report should be supplied to us. This should be provided each time such procedures are completed and outcomes known. 2 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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