Care Home: Beckdale House

What the care home does well People using this service are treated as individuals by meeting their support needs in a person-centred way. The service responds to their support needs by providing the right amount of support to achieve their personal goals and aspirations safely. This is done through a robust system of assessment, review and monitoring, that responds well to personal changing needs. People are treated with respect and dignity and are supported to make choices and decisions that are important to them. Skilled and committed staff provide safe care and support to enable people to lead active and healthy lives with full participation in their local community. Staff communicate well with people living in the home and have developed good relationships with those they support and their representatives. Management provide good support to staff through ongoing training and development. This has enabled the staff team to develop the skills, knowledge and experience to continually meet the changing needs of the people they support. One of the people accommodated told us that he likes living in the home and gets on well with staff. Another person wrote in a comments book that she feels safe and that this was very important to her. What has improved since the last inspection? This was the home`s first key inspection. What the care home could do better: We made four good practice recommendations during our visit. Written information about the services provided by Beckdale House was given to people making enquiries about the home. We recommended that this be reviewed and updated as some of the information in the copy we were given was incomplete. This will ensure that people have full and accurate information on which to base their decisions on whether the home would be the right place for them to live. People admitted to the home had assessments of their nutritional needs. However, nutritional risk assessments should be introduced for people who may be at risk of weight loss or poor nutritional intake. This is to ensure that the health and welfare of people living in the home is maintained. The recruitment process was effective in obtaining the required pre-employment checks in order to safeguard the interests of the people accommodated. However, records should be held to explain any gaps in employment. By making this improvement the home will maintain full and accurate information about the background and integrity of the staff appointed. Certain aspects of the support staff are expected to provide relate to important tasks such as helping people to take their medication correctly. Staff had received training in this area, although there was no written evidence that they had been assessed as competent in dealing with this in a safe manner. Key inspection report Care homes for adults (18-65 years) Name: Address: Beckdale House 3 Beaufort Road Sale Cheshire M33 3WR     The quality rating for this care home is:   two star good 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: Val Bell     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Beckdale House 3 Beaufort Road Sale Cheshire M33 3WR Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kathryn Anne Allan Type of registration: Number of places registered: care home 10 Care Network Solutions Limited Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To people of the following gender: Either. Whose primary care needs on admission to the home are within the following category: Learning disability - Code LD. The maximum number of people who can be accomodated is: 10. Date of last inspection Brief description of the care home Beckdale House was registered in October 2009 to provide care and accommodation to ten adults with learning disabilities. The home is a large detached house in keeping with properties in the same locality, between the village of Sale Moor and Sale town centre. 10 single bedrooms, located over four floors, provide private en-suite toilet and shower facilities. Separate kitchen and lounge facilities on each floor enable people to learn and maintain independence skills. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 10 Brief description of the care home The home is conveniently situated near to local public transport facilities and motorway networks into Manchester and the North West. The weekly fees for this service are £1494.91. Further information can be obtained by contacting the manager at the home. Care Homes for Adults (18-65 years) Page 5 of 30 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which included a visit to the home. The visit was unannounced, which means the manager was not told beforehand that we were coming to inspect. This was the homes first inspection since registering with the Care Quality Commission. During the visit we spent time with people living in the home and had conversations with the manager, deputy and a support worker. The manager had completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment of how well the home is performing in meeting the National Minimum Standards. There were eight people living in the home when we visited. In January 2010 we sent staff and service user surveys to the home, although none of these had been returned Care Homes for Adults (18-65 years) Page 6 of 30 by the time of our visit. The manager explained that there were only two people using the service at that time. We also examined care plans and other documents during our visit and assessed the quality of the environment provided for people using this service. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: We made four good practice recommendations during our visit. Written information about the services provided by Beckdale House was given to people making enquiries about the home. We recommended that this be reviewed and updated as some of the information in the copy we were given was incomplete. This will ensure that people have full and accurate information on which to base their decisions on whether the home would be the right place for them to live. People admitted to the home had assessments of their nutritional needs. However, nutritional risk assessments should be introduced for people who may be at risk of weight loss or poor nutritional intake. This is to ensure that the health and welfare of people living in the home is maintained. The recruitment process was effective in obtaining the required pre-employment checks in order to safeguard the interests of the people accommodated. However, records should be held to explain any gaps in employment. By making this improvement the home will maintain full and accurate information about the background and integrity of the staff appointed. Certain aspects of the support staff are expected to provide relate to important tasks such as helping people to take their medication correctly. Staff had received training in this area, although there was no written evidence that they had been assessed as Care Homes for Adults (18-65 years) Page 8 of 30 competent in dealing with this in a safe manner. 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 Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Detailed assessments make sure peoples needs and personal aspirations are written down and responded to appropriately. Evidence: We examined the written information given to people enquiring about this service. The document entitled Statement of Purpose, aims and objectives was dated 2009. It contained useful information on the homes philosophy of care and the services provided. Some information in the document was incomplete. This included the managers qualifications and previous experience and the Commissions contact details. A more detailed description of the procedure for expressing concerns and complaints should be included in this document. This will ensure that the relatives of people using the service know what to do if they need to express concerns or complaints. We recommend that the document be reviewed and updated to ensure that people are provided with this information. We looked at the care records belonging to two people to see how their needs had been assessed before they moved into the home. Written information had been Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: provided by each persons care manager. In-house assessments of need had been completed from information shared during conversations with the person using the service and their representative during pre-admission visits to the home. Individuals had signed their needs assessments, providing evidence that they had agreed with the information recorded. This was a robust system of assessment that ensured people moving into the home would receive support to meet their needs in accordance with their personal preferences. The home had a comments book for people to write down their views of the service being provided. One person had commented that she was happy living in the home. She said she felt safe and that this was very important to her. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 using this service are supported to maximise their independence by taking responsible risks and making important decisions about their chosen lifestyles. Evidence: We looked at care plans belonging to two people using the service. These had been written in a person-centred way, which means that people using the service were central to the service being provided. Individuals choices and preferences had been written down and it was evident that they received support to make informed decisions about their chosen lifestyles. Care plans had been drawn up in consultation with each person and they detailed the personal, healthcare and social support that was being provided. Restrictions on choice and freedom of movement had been carefully risk assessed and the outcome had been discussed and agreed with the individual concerned. People received support appropriate to their needs assessments in relation to Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: managing personal finances. Each person had their own bank account and secure facilities in their rooms for the safekeeping of money and/or valuables. A system was also in place to keep personal money safe in the homes office. Appropriate accounting procedures were in place for this and people using this service had access to their money at all times. A good system of risk assessment was in place. This had generally been kept under regular review to ensure that people living in the home continued to develop the skills needed to live their chosen lifestyles. We had recently been notified by the home of incidents of unexplained absences relating to people using the service. Timely and appropriate action had been taken according to the services procedures. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 take part in activities that suit their lifestyles, maintain their interests and develop their confidence and self-determination. Evidence: Care plans provided good evidence that people were being supported to develop their independence by engaging in their chosen daily activities. People had access to the full range of community facilities, such as education, occupation and social and leisure activities. At the time of our visit one person had gone away on an activity weekend and we observed people being supported to access community facilities according to choice. One person told us that he was going to meet his girlfriend and would later have tea at his mothers house. Routines in the home were flexible in relation to the activities of daily living. People were expected to take responsibility for housekeeping duties with staff providing Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: support according to each persons assessed needs. Staff were observed to respect peoples right to privacy and dignity, for example by only entering a persons bedroom with their permission. Each person had been issued with a key to their bedroom. We observed good interactions between people using the service and the staff that supported them. One person wrote in the comments book that she was happy living in the home and that she felt safe. She said this was very important to her. Each person decided their own menus and staff provided support for food shopping and cooking meals according to each persons assessed needs. Care plans contained nutritional assessments and records of the food eaten by each person. One of these records told us that the person did not like to eat breakfast. We were concerned to find that this person had also regularly refused meals at lunchtime and in the evening. These records had not been consistently kept up to date and the persons nutritional assessment had not been reviewed since February 2010. Weight records for February, March and April showed a marked variance in weight and suggested that the person may be losing weight. The manager told us that staff had been reminded that the scales should always be placed on a firm and level service to get an accurate reading. We recommend that the home implements guidelines on nutrition support in care homes produced by the National Institute for Health and Clinical Excellence (NICE). This will ensure that each person admitted to the home has a plan of care and support for their nutritional needs and that prompt action is taken when poor dietary intake and weight loss are identified. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 principles of respect, privacy and dignity are put into practice so people living in the home can be confident they will be well cared for. Evidence: Two care plans that we examined provided evidence that people were receiving personal and healthcare support according to their stated preferences. People using the service were observed to express their individuality and personalities by the way they dressed and the manner in which they organised their personal living space. Care records also provided evidence of good support with healthcare needs. Prompt referrals had been made to healthcare professionals and follow up action had been taken in line with guidance given by healthcare professionals. It was particularly pleasing to find that staff had been provided with training in understanding specific mental health conditions relating to the diagnoses of the people receiving support. One of the support workers told us that this learning had developed her understanding of the persons behaviour and the strategies used for supporting the person. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: We examined the system in place for administering medication to people living in the home. Assessments had been undertaken to determine if individuals could safely administer their own medication. Where assessments showed that people needed support to take their medication, this had been provided in a safe manner. Medication received into the home had been checked for errors and unused medication had been regularly returned to the pharmacy. Medication records appeared to be accurate and up to date and secure storage had been provided. However, we were concerned that the medication was being stored in a locked cupboard in a persons room as this could be seen as an invasion of that persons privacy. The manager told us that alternative storage arrangements had been agreed. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. There are good procedures so people who live in the home are able to express their concerns and be listened to, their rights are protected and they are safeguarded from abuse. Evidence: The home had a suitable policy and procedures in place for managing concerns and complaints. This included timescales for investigating and responding to complaints. A recent complaint from an external source had been managed well. The procedure included letters to acknowledge receipt of a complaint and to inform people of the progress and outcome of the investigation. One of the people accommodated told us that if he had concerns he spoke to staff who always, Sorted it out. He said he trusted and liked staff and had good relationships with them. The home had a copy of Traffords safeguarding policy and procedures and this was held in the office and accessible to staff. A support worker told us about the safeguarding training she had and we saw a copy of the certificate in her personnel file. The support worker confidently spoke about what action she would take if there was a suspicion or allegation that a person was at risk of abuse. She understood the process and the managers responsibility to report the allegation to the local authority safeguarding team and to give the Commission formal notification. Two referrals had recently been made under the local authority safeguarding adults Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: procedures. Care Homes for Adults (18-65 years) Page 20 of 30 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Beckdale House provides a safe and homely environment that is well maintained and decorated and furnished to a high standard. Evidence: We were shown around the home by the manager. We found the environment to be clean, safe, hygienic and well maintained. Facilities provided for people living in Beckdale House are designed to meet their needs in terms of developing independence with their activities of daily living. Two people gave us permission to look in their bedrooms. People had chosen their decor and colour schemes and had personalised their private space to reflect their interests and personalities. Bedrooms were single with en suite toilets and showers provided. The provision of kitchen and laundry facilities to separate floors empowered people in developing their independent living skills. Procedures were in place for the control of infection and staff had received training in this area. People had access to a private garden area at the rear of the house, where they were able to socialise and entertain relatives and friends. Plans were in place to encourage Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: peoples participation in developing the garden area by cultivating a vegetable patch and container growing. Care Homes for Adults (18-65 years) Page 22 of 30 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Good systems for recruitment and training ensure that people are cared for and supported safely. Evidence: Emphasis had been placed on ensuring that staff employed to work in the home had relevant training opportunities for developing the skills and knowledge needed to support the people accommodated. This included access to National Vocational Qualification (NVQ) programmes in care. Following their appointment each member of staff had undertaken a relevant induction programme that included mandatory training in health and safety. Ongoing training and development had been provided to equip staff with the specific skills for meeting the assessed needs of the people they were supporting. Evidence of this training had been recorded in each staff members personnel file. We saw evidence that staff had received training in the safe administration of medication. We asked a member of staff if they had been assessed as competent in this area following their training. Although the member of staff and manager confirmed that competency assessments had taken place, there was no written evidence of this. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: We looked at the personnel file belonging to a support worker who was on duty at the time of our visit. We found evidence of a robust system of recruitment, which made sure that relevant checks had been obtained before they were confirmed in post. Checking the background and integrity of staff in this way provides safeguards to the welfare of people using this service. However, we noted that the job application form for this person included a 12-month gap in employment. The manager told us that this would have been explored with the candidate at interview, although a written record had not been kept of the outcome of the discussion. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Beckdale House is managed well and the high level of consultation with people means that their views contribute to the development of the service. Evidence: The manager of Beckdale House has relevant experience, training and qualifications for the efficient running of this service. In discussion with one of the people accommodated and members of staff we were told that the manager is approachable and responsive when support is needed. The home was being managed in an open and transparent manner and communication between management, support workers and the people accommodated was good. The home has a robust system of quality assurance that requires the manager to prepare a monthly report to senior management on the conduct of the home. In this way the quality of the service being provided was consistently monitored to ensure positive outcomes for people receiving the service. The people accommodated had a range of opportunities to express their views on the quality of the service, both formally and informally. The results of satisfaction surveys had been collated and Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: these were used to inform the future development of the service. We examined a sample of health and safety records and found these to be accurate and up to date. Care Homes for Adults (18-65 years) Page 26 of 30 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 Adults (18-65 years) Page 27 of 30 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 1 Written information given to people enquiring about this service should be reviewed and updated to include all information required by regulations. This will ensure that people have sufficient information to enable them to make informed decisions about whether the home is the right place for them to live. 2 17 Peoples nutritional needs should be assessed and regularly reviewed to identify and manage risk factors associated with weight loss, obesity and eating and drinking disorders. This will ensure that people experience healthy outcomes from balanced nutritional intake. 3 34 During the recruitment process, gaps in employment should be explored with the job candidate and the outcome recorded. To ensure that decisions taken to employ staff are based on relevant information and are made in the best interests of the people using the service. 4 35 Evidence should be available to confirm that staff have the Page 28 of 30 Care Homes for Adults (18-65 years) 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 confidence and competencies required to undertake tasks that relate to the health, safety and welfare of people using the service. Care Homes for Adults (18-65 years) Page 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!