Care Home: Belle Vue House

What the care home does well Bedrooms reflect individual preferences and the residents have been encouraged to bring personal effects into the home to furnish their rooms with. There are good arrangements in place to provide the residents with meaningful recreational and social activities. The home ensures that the healthcare needs of the residents are met. The staff are courteous and relate very well to the residents and their relatives. The relatives are encouraged to continue to be involved in the care of the residents. The kitchen is clean and well ordered, and the staff have good knowledge of the dietary needs of the residents. The residents and relatives made very positive comments about the home and the staff. Some of their comments include: "This is the best home in the area". "We are are well looked after here". "The staff always make you feel welcome and they keep you informed about what is happening to our relatives". "You will be hard pressed to find something bad about this place". "I couldn`t fault the girls who work here. They are like family to me". "The food here is excellent". "The staff are friendly and very professional. This is how it should be everywhere". "There is always plenty to do. We go for bus rides and visits to places". What has improved since the last inspection? Since the last inspection a number of improvements have been made to the care plans and new policies and procedures are being introduced. A training officer has been appointed by the company and she is responsible for inhouse training. What the care home could do better: The required monthly visits by the provider or their representative is not taking place. The only visit report that was available was for May 2009. The enviromental health officer`s report recommended that the damage to the kitchen floor should be repaired as this poses potential trip hazard to staff working in the kitchen. This is still outstanding and needs to be addressed. The grouting and seals round the main sink in the kitchen need to be repaired. The chairs in the lounges are suffering from wear and tear and most of these need to be replaced with new and appropriate ones. The medication system need to be audited more regularly so that any errors can be detected in time and corrective measures put in place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belle Vue House 1-3 Mowbray Close Hendon Sunderland SR2 8JB     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: Sam Doku     Date: 2 9 0 5 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: Belle Vue House 1-3 Mowbray Close Hendon Sunderland SR2 8JB 01915673681 01915657405 c.scott.hcg@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Devinder Mohan Malhotra care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 27 Dementia - Code DE, maximum number of places: 15 Date of last inspection Brief description of the care home Belle Vue House is located on a private mews close to Mowbray Park and comprises of 3 converted Victorian terraced houses. The original part of the building is three storeys high, with a two-storey extension having been added in recent years. It provides personal care for 27 older people, 15 of whom may have dementia. The home does not Care Homes for Older People Page 4 of 28 Over 65 0 27 15 0 Brief description of the care home provide nursing care. Many of the original features, including large fireplaces in the lounges and some bedrooms, have been retained, giving the building its character. On the ground floor there is a choice of lounges with a central dining room; a small number of bedrooms; a bathroom/WCs and kitchen/laundry facilities. Other bathrooms/WCs are located on the other floors. Access to other parts of the home is via a shaft lift, however this is not able to reach all parts of the home where mezzanine levels have been created when the buildings became adjoined. Although the main entrance is stepped, two ramped access points are available at opposite ends of the home and enable easy access for those people with physical disabilities. The home is located just off the main public transport routes and on the outskirts of Sunderland town centre. The scale of charges for the home is between 407.00 and 422.00 Pounds per week. 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: 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: The quality rating of this service is 2 Star. This means the people who use the service experience good quality outcomes.The inspection was unannounced and commenced on 27 May 2009 and completed completed on 29 May 2009. Before the visit the inspector looked at: Information we have received since the last inspection visit on 30 May 2008. How the home dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The providers view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQAA). During the visit the inspector did the following: Talked to the people who use the service, the manager and the care staff. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must Care Homes for Older People Page 6 of 28 be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The inspector told the manager what he found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The required monthly visits by the provider or their representative is not taking place. The only visit report that was available was for May 2009. The enviromental health officers report recommended that the damage to the kitchen floor should be repaired as this poses potential trip hazard to staff working in the Care Homes for Older People Page 8 of 28 kitchen. This is still outstanding and needs to be addressed. The grouting and seals round the main sink in the kitchen need to be repaired. The chairs in the lounges are suffering from wear and tear and most of these need to be replaced with new and appropriate ones. The medication system need to be audited more regularly so that any errors can be detected in time and corrective measures put in place. 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 7535. Care Homes for Older People Page 9 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 10 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. The home provides good information for prospective residents. Furthermore, there are good assessments processes in place for identifying peoples needs before admission is arranged. This ensures that prospective residents have all the necessary information available to them to help make informed decisions about the home. Evidence: The manager and staff described the homes admission procedure to the inspector. The policy includes giving prospective residents the opportunity to visit the home to see for themselves the facilities that are available to help care for them. Two visiting relatives confirmed that they had the opportunity to visit the home on behalf of their parents before they decided on accepting Belle Vue as their preferred home for the relatives. The manager stated that in the case of the residents on the dementia unit, it has not always been possible for people to visit the home and see the place for themselves Care Homes for Older People Page 11 of 28 Evidence: before admission is arranged. She explained that in such cases, relatives or friends would visit on the prospective residents behalf. Four residents files were inspected and the files contained the pre-admission assessments that have been carried out by the manager or a senior staff member. There were also assessments from the care manager. The assessments are very detailed and they form the basis for developing the care plans for the individuals. The company has contracts with the residents which provide details of the conditions of residence and the responsibilities of the provider. These have been signed by the residents or their representatives. The files for two privately funded residents were examined and these contained contracts which have been appropriately signed and dated. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents receive care that meets their personal and healthcare needs. However, in order to maintain the welfare of residents, there need to be regular audit of the medication system in order to detect any errors so that they can be promptly put right. The residents are treated with dignity and their right to privacy is upheld. Evidence: The care plans set out the health and social care needs of the residents. All the four care plans that were examined contained very good information about residents needs and generally provided detailed information to staff on how those needs are to be addressed. Risk assessments have been carried to make sure that staff support residents appropriately. For example, there were risk assessments for supporting people to mobilise properly,nutritional risk assessments and environmental risk assessments. The residents and relatives who were spoken with confirmed that they have access to Care Homes for Older People Page 13 of 28 Evidence: healthcare facilities, including GP support and other healthcare professionals, such as psychiatrist, district nurses, optician, chiropodist, dentist, speech and language therapist and dietitian. The daily records provided detailed record of the healthcare support that residents receive from other healthcare professionals. The home has detailed policies on the storage and administration of medicines. These are followed by the staff who have overall responsibility for the administration of medicines in the home. A random check of the medicines administration system was undertaken by the inspector. There was one discrepancy in the recording system, and also an error in the total number of tablets for one residents. The senior carer was not sure how this occurred and indicated that she would ensure that there is regular audit of the medication system. At the time of the inspection the staff were noted to relate very well with the residents and there was obvious respect between staff and the residents. The residents confirmed that the staff treat them with respect and dignity. The staff were friendly and professionals in the way they interacted with the residents. Two visiting relatives also said that the staff are very professional in the way they carry out their duties and they are always made to feel welcome. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides meaningful and fulfilling activities which enhance the wellbeing of the residents. The residents are provided with good variety of wholesome and nutritious meals, which promotes their health and wellbeing. Evidence: The notice board in the reception area provides information about the social and recreational activities that have been arranged for the residents. This include church service, art and craft, visiting semi-professional entertainer, fitness exercises, outings to Mowbray Park, Seaham and Penshaw monument tea room. There are some residents who go out and are supported to maintain their outside interests. The home has their own mini bus and this allows the staff to arrange unplanned trips when the opportunity arises. The residents are supported to enable them to make choices and make independent decisions about their care and the way they wish to be looked after. One residents said that he is able to do the things he likes to do with the support of the staff. Staff also describe how they support and encourage residents to maintain their preferred Care Homes for Older People Page 15 of 28 Evidence: lifestyle. One relative was pleased that the staff allow her to continue to be involved in her mothers care. She regularly takes her mother out to the nearby shops and for walks. Another relative also commented on the flexibility at the home which enables her to continue to be involved in her mothers care. Residents and relatives commented positively on the food provided in the home. Examination of past menus show that the home provides a choice of menus for the residents. Those residents with special dietary needs are catered for. Practices observed at breakfast time show that the home promotes the dietary needs of the residents. Breakfast was served in a relaxed and calm manner. All residents were provided with what they like for breakfast and there was a wide selection on the menu for people to choose from, including, sandwiches, cereals, boiled eggs, fried eggs, fresh orange, pineapple and cranberry juices. All the residents individual and personal preferences were catered for. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure that is accessible to residents and relatives, thus promoting the residents right to express their views about the service. Staff are aware of safeguarding adults procedures and have received suitable training which safeguards the welfare of the residents. Furthermore, there is a good accounting procedure in place to protect the residents monies and protect them from any financial abuse. Evidence: The home has a complaints procedure and a copy of this is posted in the reception area for residents and visitors to see. A summary of the procedure is the service user guide. Details in the complaint book show that the home takes complaints seriously. The book contains details of two complaints that have been received since that last inspection visit. A number of residents and relatives were spoken with about the homes complaints procedure. Residents said they are aware of the procedure and feel confident about raising any concerns with the manager, if they were unhappy about anything. Staff have had training in safeguarding adults, and the training record shows that a large number of the staff have received this training. Staff who were spoken with were familiar with the homes policy on safeguarding vulnerable people. Care Homes for Older People Page 17 of 28 Evidence: There was one recorded incident in which the Police had to be contacted when a resident refused to go into hospital. The manager acknowledged that the matter was handled wrongly and since then, suitable safeguards have been put in place to ensure that the proper procedures are followed whenever such a situation arises again. All staff have had CRB checks done on them and the recruitment process is followed by the manager to make sure that the residents are protected from unsuitable carers. The home has good system in place for holding the residents monies on their behalf. The system is robust and secure. A random check was carried out on three residents finances and no discrepancies were found. All transactions made on behalf of the residents have been accounted for and receipts have been kept as proof of purchase or transactions. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building has limitations as a home for accommodating people with mobility problems and with dementia. This compromises the otherwise good care that is provided in the home. Evidence: The home is clean and generally maintained to good standard. The bedrooms that were visited were clean and personalised, reflecting individual tastes and preferences. Residents have been encouraged to furnish their rooms with personal items, making it homely and comfortable for them. All radiators have protective coverings and window have restrictors on to ensure that they can only open so far to ensure safety of the residents. The corridors are narrow and do not allow people with walking aids to move around freely. The building is not ideally suited for caring for people with mobility problems and also for people who suffer from dementia. The first floor of the building which accommodates people with dementia has very narrow corridors and a number of connecting doors. There is the added problem of the confusion door handles which effectively stop residents from getting out of their immediate environment if they wish to do so. Urgent action must be taken to replace these locks or door handles with more appropriate ones. Care Homes for Older People Page 19 of 28 Evidence: The lounges are appropriately furnished and decorated for the residents to use. However, the chairs in the lounges are mostly plastic covered chairs and worn and needing to be replaced. The manager stated that there are plans for refurbishment of the building and replacement of all the chairs with new and comfortable ones. There are detailed written policies covering all aspects of the running of the home. These include policies on infection control policies. Staff have had training in infection control and records show that the home has adhered to infection control procedures. There are anti-bacterial hand washing dispensers in bathrooms and toilets. The kitchen was clean and appropriately maintained. However, there is a damage to the flooring which the Environmental Health officers report recommended that it should be repaired. This is still outstanding. The grouting and seal round the main sink in the kitchen need attention as these are beginning to show serious defects. Care Homes for Older People Page 20 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. The staffing numbers are satisfactory and promote the safety and welfare of the residents. The home adheres to good recruitment practices, which safeguards the welfare of the residents from unsuitable carers. Evidence: The past rotas showed that there is always sufficient staff on duty to meet the needs of the residents. The staffing rota for this week showed the following details: Between 8 am and 5pm there are 5 care staff plus manager and ancillary staff. Between 2 pm and 5 pm 4 carers plus manager and then 5 pm till 8 pm 5 care staff including a senior carer. At night there are 2 carers but 3 till 9 pm. Staff were spoken to about the staffing levels in the home. They all said that the staffing levels are always adequate. However staff expressed concern about the the night shift and feel that the extra staff on night duty would be most helpful, even if that extra person were to be a sleep-in person who can be called upon at times of greater needs or in an emergency situation. The manager confirmed that the staff have received training in moving and handling, first aid, protection of vulnerable adults, fire safety, food hygiene and health and safety training. Staff records show the training that they have received. Care Homes for Older People Page 21 of 28 Evidence: Four staff files were examined to check on the recruitment process by the manager. The files show that the home has been following good recruitment procedures. All the files contain completed job applications, copy of job description, appropriate references, evidence of CRB checks and record of induction and training. Information in the AQAA shows that fifteen care staff have NVQ Level II or above. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a qualified and experienced person who generally, runs the home for the benefit of the residents. The safety and welfare of residents is protected by the regular servicing of equipment and safety arrangements that are in place. Evidence: The registered manager has a long experience of managing a residential care home. Staff, residents and relatives commented that the manager is very approachable and always available to talk to. Staff also said that she is supportive of them and also of the residents. The home has suitable system in place for staff to receive one to one supervision but this is not happening and some staff have not received their supervision in several months. The manager acknowledged her failings in this respect and indicated that she is now in a position to provide supervision to the staff more regularly. Care Homes for Older People Page 23 of 28 Evidence: The companys policies and procedures are currently being replaced with new and updated ones. In the mean time, the current policies are being used effectively by the manager and her senior team. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). There is evidence that staff adhere to the policies as set by the company. Staff have received training in fire safety, COSHH, first aid, food hygiene and infection control. The recently appointed training officer by the company has enabled staff training to provided more readily. Servicing and maintenance records show that all portable appliances have been tested. A record is maintained of regular water temperature in bedrooms, toilets and bathrooms. Regular servicing of fire equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. The homes fire risk assessment is up to date. Records examined indicate that fire precautions relating to weekly fire alarm testing and record of inspection takes place. There are records in the home indicating fire drills and fire instructions with staff. The manager confirmed that all staff have received up to date fire safety training, and the local fire safety officer for the local Fire and Rescue service confirmed that he is satisfied with the arrangements for fire safety and staff training in the home. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 31 26 The provider must make suitable arrangements to ensure that the Regulation 26 visits are conducted regularly. This protects the interest of the residents. 30/06/2008 Care Homes for Older People Page 25 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 1 19 16 The damage to the flooring 28/08/2009 in the kitchen must be repaired as there is potential risk to the staff who work in the kitchen The EHO recommended that the damaged floor is repaired and to date this remains outstanding. 2 19 13 The grouting and seals 28/08/2009 around the main sink area in the kitchen must be repaired as these are beginning to show serious defects. The grouting and the seals round the main sink area are potential risks to food safety and hygiene. 3 20 23 The use of confusion lock 31/08/2009 on the interconnecting doors on the EMI must be replaced with a more appropriate and suitable locks. The current confusion Care Homes for Older People Page 26 of 28 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 locks cannot be operated by residents and thus restricting and compromising their freedom to move freely. 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 9 The manager should ensure that there is a robust medication audit system in place to ensure that any errors are detected in time and remedied. Where a resident refuses treatment by refusing to go into hospital, the home should ensure that the proper procedures are followed to make sure that the residents rights are upheld at all times. The manager should ensure that all care staff receive regular one to one supervision in line with the national minimum standard. 2 17 3 36 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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