Care Home: Belvoir House Care Home

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What the care home does well Individual needs assessments were made before people were admitted to the Service so that their diverse needs were identified, planned for and individually met. People who use the Service had individual plans of care which demonstrated that their health and care needs were being met. They were being treated with respect. The Service provided a programme of activities and services that benefited people living here. Meals were varied and generally enjoyed by people. Good practices for handling complaints and abuse were being followed ensuring that people who live at the Service are fully protected. People were living in a clean, comfortable and homely environment. The Service had a good level of well trained and recruited staff to ensure that the people living here were safe and their needs were met. The Service`s management ensured that systems were in place that promote the interests of people living here. What has improved since the last inspection? Facilities had been put in place to further ensure that people`s right to privacy is upheld. An improved emergency call bell system had been installed. A new heating system had been provided and new carpets fitted. Some en-suite facilities had been provided. What the care home could do better: No requirements were made at this inspection. Some improvements to documentation, training, the environment and the quality assurance system are recommended. Key inspection report Care homes for older people Name: Address: Belvoir House Care Home Brownlow Street Grantham Lincs NG31 8BE     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: Anthony Barker     Date: 0 7 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 Older People Page 2 of 26 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 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 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 Older People Page 3 of 26 Information about the care home Name of care home: Address: Belvoir House Care Home Brownlow Street Grantham Lincs NG31 8BE 01476565454 01476565454 raj@jagroo.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barnby Gate Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Belvoir Care Home is registered to provide personal care to male and female service users who fall within the following categories: Old age not falling within any other category (OP) 24 Dementia over the age of 65 years (DE(E) 5 The maximum number of persons to be accommodated at Belvoir Care Home is 24. Date of last inspection Brief description of the care home Belvoir House is a detached, nineteenth-century, stone property, raised above pavement level, situated approximately 200 metres from the town centre of Grantham and a variety of shops and amenities. The Service is registered to provide personal care for twenty-four older people of both sexes. Accommodation is situated on two floors and is served by a lift. There are four double bedrooms and sixteen single - three of the latter have en suite facilities. There is one lounge/dining area and a separate smaller lounge. An enclosed patio and garden area is situated at the front of the property. A ramped Care Homes for Older People Page 4 of 26 Over 65 24 0 Brief description of the care home area gives direct access from the front door to the street. The Service has a very small car park to the rear. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The time spent on this inspection was 7.75 hours and was a key unannounced inspection. We spoke with several people living at the Service and to one in depth. We also spoke with one visiting relative and one visiting friend, with the Manager and with one care assistant. Records were inspected and there was a tour of the premises. Three people living at the Service were case tracked so as to determine the quality of service from their perspective. The Service provided us with a summary of completed satisfaction questionnaires from people living at the Service, and their relatives, from the Spring/Summer of 2009. This inspection focussed on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last key inspection on 19th April 2007. The Services pre-inspection, Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 26 (AQAA), self assessment form was reviewed prior to this inspection. A notice in the entrance hall indicated that a copy of the last inspection report is available in the office. The Manager informed us that the Services fees range from £360 to £446 per week. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual needs assessments were made before people were admitted to the Service so that their diverse needs were identified, planned for and individually met. Evidence: One of the people case tracked had been recently admitted and their file was examined. We noted that a Social Services Pre-Assessment Form had been completed for this person as well as the Services own pre-admission form. The latter had not been signed or dated but we saw that another pre-admission form had been signed and dated. The Service was not providing intermediate care. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the Service had individual plans of care which demonstrated that their health and care needs were being met. They were being treated with respect. Evidence: Three people living at the Service were case tracked so as to identify the standard of care provided from their own perspective and from individual records and discussions with them, the Manager and staff. The files of these people were examined and these included the persons photograph and care plans which were well worded and clearly set out how peoples individual needs should be met by staff. These documents were not, however, person centred in their wording and did not reflect or support the person centred way that staff were clearly working with residents. We discussed, with the Manager, future ways of addressing this matter. The care assistant we spoke with confirmed that residents, or their representatives, are involved in the care planning process including End of Life plans. Each file had Activities for Daily Living sections covering peoples social and emotional needs. We saw a well worded Equality and Diversity care plan on one file. Also, some files had Care Homes for Older People Page 11 of 26 Evidence: peoples social histories and some had Social and Recreational care plans - though there were none of these for the three people case tracked. Monthly reviews of care plans were taking place. The Services pre-inspection self assessment form told us that, Residents or families sign the Care Plan Agreement Form if they are happy with the care planning. We saw evidence of these forms at the inspection. Recorded risk assessments covered areas such as risks associated with falling, personal handling, nutrition and Tissue Viability and provided a means of measuring and minimising these risks. Reviews of these risk assessments were being made at appropriate intervals and were mostly being signed and dated. On one case tracked persons file we noted a signed authorisation form for the use of bed rails. We saw evidence of involvement with external health and social care professionals. Records of GP and district nurse visits were being recorded. A chiropodist visits every six weeks. The administration of prescribed medicines was being recorded accurately although only one staff members initials was being recorded against handwritten entries. Individuals photographs were beside medicine records. Medicine blister packs were being stored securely. We noted that controlled drugs were being safely stored and recorded in a Controlled Drugs Register. The administration of Co-codamol and Temazepam tablets were being recorded in books separate to the Medicine sheets. This is good practice regarding Co-codamol but we recommended to the Manager that Temazepam should be recorded in the Controlled Drugs Register. One person was prescribed Promazine prn - as and when required - and a care plan was in place for this. Medication requiring storage at a cool temperature was being stored in a dedicated refrigerator and its internal temperature was being recorded weekly. The Manager told us that weekly checks of medicines and medicine records are made and a full audit is undertaken every three months. The Manager and five senior staff administer medicines. Only three of these people have had refresher training in the safe use and recording of medicines within the past three years. We observed that people living at the Service were well dressed. All the people we spoke with told us that the laundry system was good and confirmed that people living here have need for privacy and dignity respected. One relative we spoke with said that, staff will come quickly when (the resident) wants to use the toilet. The care assistant we spoke with gave us examples of peoples privacy and dignity being respected. For example, she said she would, automatically shut the bathroom door, when assisting a person to have a bath and would ask the person, if they are comfortable with me being in the bathroom. The Manager explained that one person had, in the past, bathed themselves without staff help but was no longer able and safe to do this unaided. Residents are offered a cordless or a mobile telephone for their Care Homes for Older People Page 12 of 26 Evidence: personal use to ensure privacy. Also, staff are now able to make use of either of the two offices for their breaks so ensuring that residents are provided with a private and confidential space to meet with visitors if they so wish. These two improvements meet requirements made at the last inspection. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service provided a programme of activities and services that benefited people living here. Meals were varied and generally enjoyed by people. Evidence: The Service was providing a range of daily activities within the Service. The Manager told us that a care assistant is allocated each day of the week to initiate activities with residents. We examined the Activities Book in which was recorded activities such as dominoes, bingo, cards and nail care. One case tracked person we spoke with spoke of enjoying the dominoes and bingo as well as music and movement sessions and visiting singers. We were told that photographs of residents involved in recent activities over the Easter period were due to be displayed soon. We saw a poster on the residents notice board advertising a visiting singer on 16th April. Weekly visits to the Service are made by a hairdresser. We spoke with a friend who was visiting a resident and were told that staff do try to encourage the person to join in activities though, due to the persons high dependency, their motivation is low. The care assistant we spoke with said that, people do seem happy with activities here, though she felt shed like more time to involve people in activities. The Manager told us that occasional trips out, within the local community, are arranged - with individuals or in small groups. One visitor described how they take their relative into town occasionally Care Homes for Older People Page 14 of 26 Evidence: in their wheelchair. The relative we spoke with visits most days and confirmed they could stay as long as they wish. The residents friend we spoke with was also positive about the Services response to visitors. We read a comprehensive Visitors Policy that was displayed in the entrance hall. We also saw evidence in the Visitors Book to confirm that residents receive visits from relatives and friends on a frequent basis. The care assistant we spoke with told us that residents are helped to exercise choice over their lives. She gave examples on topics such as menus and clothing. We noted, on the residents notice board, details of Advocacy in Lincolnshire organisation and Care Aware Helpline. The Manager told us that no external advocates were currently used by residents. She also said that she and the Provider had attended an external training course on the Mental Capacity Act (MCA) and the staff group has received training, from the Provider, on the MCA and the associated Deprivation of Liberty Safeguards (DoLS). The Manager showed awareness of DoLS. We saw that food stocks were at a satisfactory level and the four-week rolling menus indicated that people are being provided with nutritious and varied meals. A choice of two main meals are available each day. A menu board was displayed in the hallway. The Manager said that residents are asked about their preferences mid-morning prior to lunchtime. Lunch-time tables, on the day of this inspection, were laid out with drinks and condiments, and the meal looked appetising. The people we spoke with were generally positive about the quality of catering. In the pre-inspection self assessment we were told that, Meals are well set up to reduce long intervals between meals. The Manager explained that supper snacks are now available to residents. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good practices for handling complaints and abuse were being followed ensuring that people who live at the Service are fully protected. Evidence: The Services written complaints procedure was examined and found to be appropriately worded. A copy of this was displayed in the entrance hall. The Service had no complaints record and so there was no way of assessing whether a satisfactory process would be followed when a complaint is received. The Manager said no formal complaints have been received and the Complaints & Suggestions book in the entrance hall was blank. The Services Service user satisfaction questionnaires summary sheet indicated that minor grumbles are listened to and dealt with appropriately. People we spoke with knew who to speak to if unhappy. The friend of one resident told us that, staff are approachable and cheerful. We examined the Services Safeguarding Adults and Whistle Blowing policies. The former was appropriately worded except that it did not clearly indicate that internal investigations should not be carried out before a safeguarding strategy meeting is called by Social Services. However, the Manager did show a clear awareness of who to contact, in the event of an allegation of abuse, and of when an investigation is undertaken. The Whistle Blowing policy was appropriately worded though it did not explicitly mention safeguarding adults. The Manager told us that all staff have received training in safeguarding adults from the Provider via a DVD and discussion. The care Care Homes for Older People Page 16 of 26 Evidence: assistant we spoke with showed understanding of how to safeguard vulnerable people and of whistle blowing. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were living in a clean, comfortable and homely environment. Evidence: All areas of the premises that were inspected on this occasion were found to be pleasant, clean and tidy with good standards of furnishing and decoration. Those bedrooms inspected were found to be attractively decorated and nicely personalised. Each person had a lockable facility in their bedroom and appropriate bedroom door locks were fitted. A new emergency call bell system had been installed following a requirement made at the last inspection. The Manager said that six or seven bedrooms were linked to this new system and fortnightly checks are made of call bells linked to the old system. There was a spacious garden/patio area with attractive garden furniture. There was rather a lot of moss on the tarmaced garden area which the Manager said would be cleaned off before residents use that area when the weather warms. We found the premises to be clean, though there was an unpleasant odour in one bedroom. The care assistant spoken with described good infection control practices. She told us she had undertaken Infection Control training as part of her induction training. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service had a good level of well trained and recruited staff to ensure that the people living here were safe and their needs were met. Evidence: Staffing rotas were briefly examined and these indicated that there were sufficient staffing levels at the Service. The Manager told us that no agency staff are used. Following a requirement made at the last inspection, staffing levels were reviewed, the Manager told us, to take into account the increased needs of people with dementia. She said that staffing levels were felt to be adequate. The care assistant spoken with confirmed that there were adequate numbers of staff on duty. People we spoke with also thought staffing levels were generally sufficient. We were pleased to note that there were two male staff employed at the Service; and at the time of this inspection there were seven male residents. The Manager told us that care plans record residents preferred gender of care staff. The Manager told us that eight of the twenty staff had achieved a National Vocational Qualification (NVQ) in Care at least to level 2. This does not meet our Minimum Standards, which expect that a staff group with at least 50 qualified staff is maintained. The Manager said that three staff without this qualification were now taking the course. Care Homes for Older People Page 19 of 26 Evidence: The file of the most recently appointed member of staff was examined. There was a recruitment check list on the front of the file, which is good practice. All matters relating to her recruitment were satisfactory, except that there was no photograph to provide proof of identity. The Manager indicated that good practice is followed by telling us that no person starts employment until a full disclosure is received from the Criminal Records Bureau (CRB). The Services staff training record indicated that all staff had completed mandatory training courses, within the previous three years, and had had fire training within the past 12 months. The Manager said that all training is undertaken in-house by the Provider, via a DVD, and that he is qualified to provide training in Moving & Handling. She also told us that all but two new staff have had training on the topic of dementia. The Manager confirmed that new staff follow induction training to the required Common Induction Standards and we saw evidence of this. The care assistant spoken with confirmed she had attended a good range of training courses over the past 12 months. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Services management ensured that systems were in place that promote the interests of people living here. Evidence: The Manager told us that she is a registered nurse but she has not completed a management qualification at NVQ level 4, as we expect. She has worked in the social care sector since 1985 and has been manager here since 2008. We observed the Manager having a very positive approach with residents and clearly providing a good role model for staff. A range of quality assurance measures were in place, including annual satisfaction questionnaires for residents and relatives. We examined the summary of these completed questionnaires from the Spring and Summer of 2009. They were generally very positive. The friend of one resident we spoke with confirmed receipt of quality questionnaires from the Service. The Manager spoke of plans to send questionnaires to external professionals and we discussed with her the benefits of gaining staff views Care Homes for Older People Page 21 of 26 Evidence: too. We examined the Services brief Business Plan Summary, 2005-2011, and brief Maintenance Plan 2008-2010. There was no Annual Development Plan. In the preinspection self assessment we were told that the Service has received, An excellent rating from the County Council, as part of the Councils Quality Assessment Framework. Residents Meetings were being held every three months approximately and we examined a copy of the minutes from the last meeting in February 2010. Record sheets of personal monies belonging to two of the people living at the Service were examined. These were found to be satisfactory. We confirmed the accuracy of one residents sheet by cross referenced entries against actual money held. Money was being stored securely. The kitchen was clean and good food hygiene practices were noted. The Environmental Health Officer last visited in November 2009 and gave the Service a 5* rating with no recommendations. The Fire Officer visited the Service on the day of this inspection. Environmental Risk Assessments were in place. Cleaning materials were being securely stored and Product Information Sheets were kept in the office, though this was some distance from one of the cupboards. We checked one bedroom hot water tap and noted that its thermostatic valve was operating properly to prevent scalding. Information provided in the pre-inspection self assessment, and later by the Provider, indicated that equipment was being checked and maintained appropriately. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 7 7 9 All peoples files should include a care plan to reflect their social, emotional and recreational needs. Care plan documents would be improved by following a person centred approach, as discussed. Two staff members initials should be recorded against hand written entries, on medicine records, to provide a stronger audit trail. All staff who administer medicines should be provided with refresher training in the safe use and recording of medicines, at least every three years. A complaints record should be drawn up, as discussed with the Manager. The Services Safeguarding Adults policy should clearly indicate that internal investigations should not be carried out before a safeguarding strategy meeting is called by Social Services. Moss should be cleaned off the tarmaced garden area to prevent residents slipping. 4 9 5 6 16 18 7 19 Care Homes for Older People Page 24 of 26 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 8 9 10 11 12 13 14 15 19 26 28 29 31 33 33 38 Weekly checks should be made, and recorded, of call bells linked to the old emergency call bell system. Further attempts should be made to remove the unpleasant odour in one bedroom. At least 50 of care staff should have obtained a qualification in Care at NVQ level 2. A recent photograph should be on file as proof of a job applicants identity. The Manager should complete a management qualification at NVQ level 4. Quality assurance questionnaires should be sent to staff and to external professionals. An Annual Development Plan should be devised, with target dates, as discussed with the Manager. Copies of cleaning materials Product Information Sheets should be kept in each cupboard. Care Homes for Older People Page 25 of 26 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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