Care Home: Belmont Grange Residential Home

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What the care home does well Belmont Grange provides people with a clean and homely environment. Individuals are encouraged to personalise their rooms are are able to bring in their own items of furniture. Care and support is well planned and provided by a staff group that understand the needs of frail elderly and confused people. Individuals who live at the home said ``staff are all really lovely, they can`t do enough for you. They are very busy, but always kind and caring. I have no problem with the staff, they are all great.`` Two health care professionals returned surveys and one commented ``All the patients/clients are well cared for, all the care staff are friendly and helpful. The district nurse team all have a good working relationship with all members of the staff, achieving good patient care.`` Six surveys were returned from people who live at Belmont Grange and in answer to the question what does the home do well comments included ``Keep a peaceful place. Staff are friendly and helpful and appear to me to keep the home running efficiently whether or not management are present. Care side girls and staff are very caring.` We also spoke with two visiting relatives who commended the staff are level of care provided. One family said ` We have nothing but praise for the level of care and kindness shown by staff to our relative. They have kept us very well informed and we have felt confident that our relative is being well looked after.` The home endeavors to provide a stimulating environment and activities that suit peoples needs and wishes. They try hard to ensure that people are given opportunities to go out on trips, and also have regular paid entertainers. The management of the home is open and inclusive and they actively seek ways of ensuring that people who live in the home and their families and carers have opportunities to have their say about how the home is run. What has improved since the last inspection? Plans of care are now well organised and give staff clear information about what individuals assessed needs are and how these needs should be met. PRN (as needed) medications are clearly recorded in the personal plan of care with details of if and when PRN medications should be considered. What the care home could do better: The home needs to continue with the work to make plans more person centered and include details of individuals preferred routines and social and diverse needs. Staff need to ensure that they are proactive in assisting people to use the complaints process. The home needs to ensure that it listens to people in respect of their meal choices, they need to ensure that a good choice and balanced diet is offered including fresh vegetables that people have said they have asked for. Currently only frozen vegetables are being used. The registered provider needs to ensure that all parts of the home are safe and well maintained, this includes following up on the structural survey in respect of the chimney stack and also ensuring the Parker bath is installed safely. Staffing levels need to be kept under review to ensure that the ongoing needs of people can be met in a timely fashion. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belmont Grange Residential Home Belmont Grange Belmont Road Ilfracombe Devon EX34 8DR     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: Joanne Walsh     Date: 1 1 0 8 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 27 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 27 Information about the care home Name of care home: Address: Belmont Grange Residential Home Belmont Grange Belmont Road Ilfracombe Devon EX34 8DR 01271863816 Telephone number: Fax number: Email address: Provider web address: kerry.dempsey@btconnect.com Name of registered provider(s): Type of registration: Number of places registered: Belmont Care (Devon) Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 25. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (Code MD) Dementia (Code DE) Old age, not falling within any other category (Code OP) Date of last inspection 25 25 0 Over 65 0 0 25 Care Homes for Older People Page 4 of 27 Brief description of the care home Belmont Grange is a residential home registered to provide care to 22 service users. The home is also registered for older people with a mental health need and/or dementia type illness. The categories of registration are for people over 65 years of age with or without dementia or mental disorder excluding learning disability or old age not falling within any other category. The home is situated on the outskirts of Ilfracombe town centre making this readily accessible but via a steep hill. There are two spacious lounges and a separate dining room. Service users can choose to have their meals in the dining area, in the lounges or in their own rooms. Pleasant sitting areas have been provided in communal parts of the home. The home is on two floors linked by a lift. The range of fees can be obtained directly from the home. The fees do not include toiletries, hairdressing or chiropody. The inspection report is available in the entrance hall of the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in August and lasted approximately 6.5 hours. During this time we spoke to 5 people about their experiences of living at Belmont Grange. We also spoke to three care staff, the assistant manager, the manager and the cook. We looked at some of the key documents including plans of care, pre admission assessment information, staff recruitment and training files, records relating to medication and individuals monies. This helps us to understand how well the home is run and managed. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. Care Homes for Older People Page 6 of 27 During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 6 people living at the home, and from 4 staff. We also received 2 surveys from social and health care professionals. Their comments and views have been included in this report and helped us to make a judgment about the service provided. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to continue with the work to make plans more person centered and include details of individuals preferred routines and social and diverse needs. Staff need to ensure that they are proactive in assisting people to use the complaints process. The home needs to ensure that it listens to people in respect of their meal choices, they need to ensure that a good choice and balanced diet is offered including fresh Care Homes for Older People Page 8 of 27 vegetables that people have said they have asked for. Currently only frozen vegetables are being used. The registered provider needs to ensure that all parts of the home are safe and well maintained, this includes following up on the structural survey in respect of the chimney stack and also ensuring the Parker bath is installed safely. Staffing levels need to be kept under review to ensure that the ongoing needs of people can be met in a timely fashion. 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 27 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 27 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. Individuals needs are assessed prior to them being offered a place at Belmont grange. Evidence: We looked at the pre admission assessment information for the two newest people to the home and spoke with them and their carers. We saw that the home had obtained a copy of the care management assessment and care plan. This is the information gathered by the funding authority and gives details of assessed needs. We also saw that the home had completed their own pre admission assessment prior to people moving in. One person was able to confirm that they were visited by the home and asked about want care and support they needed. Staff spoken to during the inspection showed a good understanding of individuals needs, and when asked they said that they are usually given pre admission information about new people. Care Homes for Older People Page 11 of 27 Evidence: One persons details gave very detailed assessment information about the individuals physical needs as specialist equipment needed to be in place before they could move in. The assistant manager said that where possible they encourage the person to come and visits for several times and to view other homes so that they can make an informed choice. Care Homes for Older People Page 12 of 27 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. Individuals personal and health care needs are well met. Evidence: During this inspection we case tracked three people, including looking at their plans of care, records relating to their medication and where possible talking to them and the staff about how well their needs are being met. We looked at people with complex physical needs, including someone who needed specialist hoisting equipment. We also looked at a person who was very frail and in poor health and at a more physically able person who had some moderate dementia. We saw that plans of care were well organised and contained good basic information about what had been identified as individuals personal and health care needs and how needs should be met by staff. We saw that assessment tools were used such as the Waterloo score to assess risk of pressure areas. We saw risk assessments in place for falls, use of bed rails and moving and handling. There is a separate section for recording of any health care professional input and these records showed that individuals had access and were referred to health care professional appropriately. Care Homes for Older People Page 13 of 27 Evidence: The home have also started work on ensuring plans of care are more person centered with a section called about me. This has information about the persons childhood, family, working life, things that are important to them, significant life events and family and friends. They are also looking at how they can ensure that individuals personal and preferred routines are included in their plans. This will help to ensure that care is delivered consistently and in a person centered way. People we spoke to including those we case tracked spoke positively about how well they are cared for at the home. Comments included staff are all really lovely, they cant do enough for you. They are very busy, but always kind and caring. I have no problem with the staff, they are all great. Two health care professionals returned surveys and one commented All the patients/clients are well cared for, all the care staff are friendly and helpful. The district nurse team all have a good working relationship with all members of the staff, achieving good patient care. Six surveys were returned from people who live at Belmont Grange and in answer to the question what does the home do well comments included Keep a peaceful place. Staff are friendly and helpful and appear to me to keep the home running efficiently whether or not management are present. Care side girls and staff are very caring. We also spoke with two visiting relatives who commended the staff are level of care provided. One family said We have nothing but praise for the level of care and kindness shown by staff to our relative. They have kept us very well informed and we have felt confident that our relative is being well looked after. Staff who we spoke to and those who returned surveys said that they believed they provided a high level of good quality care to people. Some staff said that they were very busy throughout the day and would like more opportunity to spend quality time with individuals. One carer said that they have to be very task focused, and often this lead to having to rush personal care. This was supported by one person who lives at the home. They told us staff are all lovely, but having a bath or shower can be a bit of a rush, I would like more time to relax. We observed staff being busy during the morning time getting people up and ready, it appeared a little more relaxed during the afternoon shift with staff having time to sit and chat to people for short periods of time. Care Homes for Older People Page 14 of 27 Evidence: The medication storage and records were checked during this inspection. Records appear well maintained, although staff are reminded that where changes are made and alterations in records are handwritten in, these should be double signed to help prevent errors occurring. We were told that only staff who have had medication training take on this task and that their competencies are checked on a regular basis via supervision. We had previously recommended that an PRN (as needed) medications, should be clearly detailed in plans of care as to if and when PRN should be considered. The home have ensured that this is now in place. This helps to provide consistent care Care Homes for Older People Page 15 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals social needs appear well met, but improvements are needed to ensure people get a wholesome and varied diet. Evidence: The home employs and activities coordinator who works several days per week and plans and initiates group and individual activities for people. One person we spoke to said that they were really impressed with the fact the the activity person had got them some coloring materials that were not childish, but suited their tastes. They made the point that she had listened then spent the time looking for resources that suited the individual. Another person told us that they had been out for more trips. We had a lovely trip to the Valley of the Rocks, and a loverly picnic, we really appreciated that for a change. During the afternoon the home had a paid entertainer who sang and played a keyboard. There were 6-8 people enjoying this activity and two people who were sleepy and disengaged during the morning became very animated singing along to old songs. The entertainer said that he visits the home about every 4-6 weeks and that people appeared to enjoy the old songs and music from their era. Care Homes for Older People Page 16 of 27 Evidence: One relative that we spoke with said that although they did not live local, they were kept very well informed of ow their relative was and that they could visit the home at ant time and were always made welcome by staff and offered refreshments. The main criticism came when asking people about the meals. Comments included utter rubbish, I eat out if I can. I have been a chef and what they serve here is disgusting. We get no real choice, it is always mash and always frozen vegetables, which are terrible. The food is okay. Six surveys were returned from people who live at the home. In answer to the question what could the home do better comments included I would like hot meals to arrive hotter, with more fresh green vegetable. More fresh veg instead of frozen carrots, more pasta dishes or sweet and sour chicken etc. A more varied menu, with fresh veg. We asked the cook why only frozen vegetables were used and was told that they had been informed by the registered provider that this is what they must use. They had also been told not purchase named brands of food stuffs. This included the coffee, which tasted so bad that staff brought in their own. One staff member made a coffee for the inspector from their own supply. A person living at the home started to drink this and said thats much better, but could I have some sugar in this please. Some staff did express concern about that use of poor quality food and beverages and said that they had prided themselves on provided little extras for people that made it more homely, but that with cut backs this appeared to be going out of the window. The registered manager, who was present for the feedback said that whilst some budgetary constraints had been implemented that this may have been taken too far and that she would look at what drinks and other food items could be improved. She said that the frozen vegetables was due in part to the fact that the catering staff did not want care staff to use the kitchen. The home does need to consider the wishes and concerns of the people who live at the home. They are clearly saying they want more variety and more fresh vegetables. The home also needs to look at how drinks and snacks can be offered to people and their visitors if care staff have no access to the kitchen and catering staff are not on duty or busy cooking. Care Homes for Older People Page 17 of 27 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. Individuals views are not always listened to and staff need to be more proactive in helping people to use the complaints process. Evidence: The home have a stated complaint procedure and use this well for major concerns, detailing what actions have been taken and how matters have been resolved, but appear not to use this for more minor concerns such as those expressed by people about the food and particularly the use of frozen vegetables. Staff say that people have been complaining about this issue for some time. People we spoke to said that they had told staff about their complaints about the food, but this has not been formalised using the complaints process. Staff spoken to said that they had had training in the protection of vulnerable people and they were aware of what to do if they suspected abuse. Recruitment practices further protect people by ensuring people are only employed once they have been checked to be suitable to work with vulnerable people. Care Homes for Older People Page 18 of 27 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. Belmont Grange provides a warm and homely environment, but some improvements are needed to ensure it is well maintained and safe. Evidence: The home is kept clean and free from offensive odours. Communal areas are homely and efforts have been made to make small sitting area around the home so that people have a variety of space to enjoy. Areas of improvement have included fitting a new gate with a coded lock to the downstairs basement which should only be accessible to staff. The new gate improves safety of the people living at the home. They home have also purchased a new overhead hoist to assist one person who was finding the usual hoist equipment painful and uncomfortable. We were told that new fencing outside had also improved the safety of people. Unfortunately the funding the home had applied for to improve the garden areas did not get granted and their regular gardener had recently passed away, so the agrden work has come to a standstill, although there are areas people can sit in and enjoy. The general decor of the home still needs updating and the registered provider is slowly working to improve the fabric of the home, although priority has had to be given to structural works such as the roof. There is still some uncertainly about whether the roof stack is safe. A report from June by an independent consultant agency being used to complete regular monthly unannounced visits to the home Care Homes for Older People Page 19 of 27 Evidence: states that the home need to record the outcome of structural engineers report on chimney stack and floor This report also recommends that the home check the safe installation of the Parker bath in accordance with the manufacturers instructions. There is no evidence to show that either of these safety matters have been followed up, and they should be to ensure that the environment is well maintained and safe. Staff say they having training in infection control and that there are gloves and aprons available at all times. The laundry room appears well organised and this is currently done by the housekeeper, but some staff said that this duty will soon be part of the care staff role and that they are concerned they may not have the time to do this effectively. Care Homes for Older People Page 20 of 27 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 staff team are well trained and supported to provide quality care and support, although staffing levels should be kept under review. Evidence: The staffing levels appear sufficient for the current number and needs of the people that live at the home. There are usually 4 care staff on mornings, 3 during the afternoons/evening and 2 waking night staff. In addition there is a manager, cook and housekeeper, although we understand this is under review. Staff spoken to and those who returned surveys say they enjoy working at Belmont Grange, that they have good opportunities for training and that they work well as a team. Most staff have worked at the home for a number of years, and have good knowledge and experience of the needs of frail elderly and confused people. A stable staff team helps to provide consistent care and quality outcomes for the people who live at the home, and this was commented on by one family member whose relative lives at the home. Staff recruitment files were checked for the two newest members of staff and this showed that robust procedures are in place. People are only employed once they have been checked as suitable to work with vulnerable people. Care Homes for Older People Page 21 of 27 Evidence: Some staff said they would like more time to ensure each persons care and support needs are fully met, that they are not rushed. The morning do appear to be quite hectic for staff, making sure people are assisted to get up. Staffing levels need to be kept under review. Care Homes for Older People Page 22 of 27 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 well managed and run in the best interests of the people who live there. Evidence: The registered manager is qualified and experienced to run the home. She has completed training in understanding the needs of the people who live at the home as well as the relevant management training. Staff and individuals who live at the home say that the manager has an open and inclusive approach and that both can talk to her about any concerns they have. She is currently on maternity leave but did make herself available for the latter part of the inspection. The home try to involve family and friends of people who live at the home as much as possible, both in formally reviewing the quality of care and support via surveys, but also less formally, with regular chats with visiting family and friends of people who live at the home. The home only handles small amounts of cash for individuals for ensuring that they Care Homes for Older People Page 23 of 27 Evidence: can purchase items and pay for things such as hairdressing. They have a good audit trail of receipts and access to the cash is limited to the manager or assistant manager. The AQAA provided us with information about how well the home ensures health and safety is protected via regular servicing of equipment and maintenance of electrical and heating systems. Staff told us that they have updated training in all aspects of health and safety, and the home now needs to ensure that induction training for new staff follows national guidance as specified by The Skills for Care Council. Care Homes for Older People Page 24 of 27 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 25 of 27 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 2 3 9 15 15 Any alterations to medication records should be double signed to help prevent errors occurring. The home needs to provide a varied and wholesome diet including fresh vegetables as people have requested The home should be able to make drinks and snacks available at all times for people who live at the home and their visitors. Staff need to be more proactive in supporting people to use the complaints process, to ensure that the registered provider is listening to their views. The registered provider needs to ensure that the roof stack has been looked at and any work to ensure it is safe carried out. The Parker bath should be installed according to the manufacturers instructions to ensure the safety of people using it and staff. 4 16 5 19 6 19 Care Homes for Older People Page 26 of 27 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). 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. 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