Care Home: Brook Care Home

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What the care home does well The service offers a supportive and friendly home environment for service users taking account of a wide range of needs. All staff within the home work well as part of a team, and the management arrangements ensure that there is clear leadership and direction. Staff on duty were knowledgeable about service users care needs. Care plans are informative and help staff to understand the level of assistance service users want and need. Staff offer daily support to service users to regularly access community facilities and services. What has improved since the last inspection? A new mini bus had been purchased which is an eight seat vehicle and can be driven by several different members of staff. This has improved community access opportunities for service users. There was a new garden patio and new garden furniture. One of the first floor bathrooms was being refurbished. Staff had been given update training on adult protection, and a new staff call bell system had been installed. What the care home could do better: The middle bathroom on the first floor should be re-decorated and the marked floor covering repaired or renewed. The registered provider needs to ensure that records are kept in the home of their monthly visits to the home (regulation 26 visit reports). The manager needs to ensure that records are kept at the home to evidence that staff are given regular structured supervision and support. This can include 1 to 1 meetings and group meetings. The electrical installation in the home needs to be checked every five years by a person qualified to do this. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brook Care Home 17 Brook Close Rochford Essex SS4 1HN     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: Alan Thompson     Date: 0 4 0 6 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: Brook Care Home 17 Brook Close Rochford Essex SS4 1HN 01702549499 01702549499 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Vijay Luxmi Rattan care home 20 Number of places (if applicable): Under 65 Over 65 20 20 dementia mental disorder, excluding learning disability or dementia Additional conditions: 20 20 Personal care to be provided to no more than 20 service users with a mental disorder, excluding learning disability, over the age of 55 years. Personal care to be provided to no more than 20 service users with a mental disorder, excluding learning disability, over the age of 65 years. Personal care to be provided to no more than 20 service users with dementia over the age of 55 years. Personal care to be provided to no more than 20 service users with dementia over the age of 65 years. Total number of service users accommodated not to exceed 20. (Total number 20). Date of last inspection Brief description of the care home Brook Care Home is a detached property in a cul-de-sac on the outskirts of Rochford. The home accommodates up to 20 service users who are over the age of 55 years, with the majority of people in the home at this inspection over 65 years of age. Care Homes for Older People Page 4 of 27 Brief description of the care home Accommodation is provided on both floors in ten single and five shared rooms. All singles and two of the shared rooms have an en-suite wc. Communal space comprises a lounge, two conservatories and a dining room on the ground floor, with a small quiet sitting area on the first floor. The home has a passenger lift to provide easy access between floors. Bathing facilities available were three bathrooms and a shower room, all with wcs. Some of the bathrooms are equipped with fixed hoists. Outdoor space comprises a rear garden and a patio area, with car parking for visitors available at the front and side of the home. Local shops and public transport links are a short walk away. Since our last inspection an eight seat mini bus had been purchased to enable service users easy access to community facilities farther away, with staff support. Fees for the home range from £470 - £1180 weekly according to service users assessed needs. They do not include the purchase of newspapers, toiletries and hairdressing. Care Quality Commission (CQC) inspection reports can be obtained from the home, or via the CQC internet website, www.cqc.org.uk. 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 unannounced key inspection commenced on Friday 29th May 2009 with a second announced visit on Friday 12th June to complete the process. The manager was present on both days and assisted us in a professional and helpful manner. Our most recent inspection prior to this visit was on 18th June 2007. The content of this report reflects the inspectors findings on the days of the inspection along with information provided by the service and feedback by service users, staff and other parties. The manager completed and returned their Annual Quality Assurance Assessment (AQAA) to us in time for the inspection. This document gives homes the opportunity of Care Homes for Older People Page 6 of 27 recording what they do well, what they could do better, what has improved in the previous twelve months as well as their future plans for improving the service. Some of the information and detail provided within the AQAA has been included in this report. Discussions were entered into with the manager, service users, the deputy manager, visitors and staff on duty. CQC survey questionnaires were also provided to service users, staff and stakeholders, and over thirty completed surveys have been sent back to us. This is a very good response and reference to feedback from these has been made within this report. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. All matters relating to the outcome of the inspection were discussed with the manager of the home, with full opportunity for discussion given and/or clarification where necessary. 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 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 8 of 27 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. People considering moving into the home can be confident that the admission processes ensures that the home can meet their needs. Evidence: The manager said that two staff will visit prospective new service users to undertake an assessment of their needs. This will usually be the manager and deputy manager but may sometimes include a senior carer. Evidence of this process was seen in two files for people admitted since the last inspection. Assessment headings looked at included background information, personal care, communication, behaviours, medication, moving and handling, memory, intellectual ability, social contacts, relationships, domestic skills, mobility, sleep, elimination, sight, medical, eating and drinking needs and considerations. Files seen also had a thoroughly compiled initial risk assessment and contained the information Care Homes for Older People Page 11 of 27 Evidence: needed for staff to provide the right initial support when the service user first moves in. Copies of assessments carried out by the placing authority were also seen. The manager confirmed that trial visits are available for prospective new service users and discussions with relatives and service users confirmed this. One said we could look at the home before deciding if it was what we wanted. 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. The information in care plans ensures that peoples needs could be met in a way they would wish. Evidence: Three care plans were inspected. Included was background information, personal details, and next of kin contacts. Assessments of identified needs were recorded with instructions of the care required to meet these needs. Areas of assessment were based on those identified upon admission and added to afterwards. Care plans seen included risk assessments on mobility, moving and handling, falls, health, mental capacity, medication, finance, behaviours, fire and smoking. Risks assessments showed the perceived hazard with a risk reduction plan and the actions needed by staff to reduce risk. There were records of reviews and of daily staff observations. The manager had compiled the format for staff to use to record daily issues and the areas of information covered on this were detailed. Records of service users weight had also been kept Care Homes for Older People Page 13 of 27 Evidence: along with records of GPs visits and treatment and on any other medical consultations. Service users night time needs were included in care plans. Care plans are reviewed regularly with key workers involved in ensuring that daily notes record any changing needs. Care plans seen had been signed as agreed by the service user and appropriate relative, and the manager. The manager said that Brook Care Home gets good support from District Nursing services on pressure care assessment and with the supply of appropriate treatment. Continence issues are supported by the community continence team with staff in the home ensuring regular communication and updates on changing service users continence needs. Hearing needs are provided for by GP referral to a local hospital. Dental services are available to service users by visiting a community based dentist or by seeing a dentist who comes into the home. One GP practice serves the home and service users usually visit the GP at the surgery. Podiatry services are used when needed and an optician visits to provide treatments and services to service users. Records of visits with written outcome notes were seen. The homes medication policies and procedures were seen and included detailed instructions and guidance on ordering, receipt, storage, administration, self medicating and returns of unused stocks. This included guidance on homely remedies and a risk assessment format for service users who ask to look after their own medication. Training had been provided to staff on medication practice, certificates to evidence this were seen. Only the manager, deputy manager or senior carers deal with medication and practice assessments are carried out by the manager to ensure staff remain competent for this role. Medication administration records were inspected no shortfalls were noted. Discussions with individual service users and comments made in surveys returned confirmed that they thought they were well cared for and were treated with respect by staff. Staff on duty were seen to be attentive and helpful in their dealings with service users. Comments made to us included excellent care here in all respects, I feel the home suits my needs very well, nice staff (here), the staff are truly friendly and helpful, excellent for individual care, very considerate, treat people as individuals, they care for their residents in very thorough and dignified manner. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Brook Care Home can expect to have a lifestyle that matches their expectations through opportunities for activity, and enjoyable food. Evidence: Service users meetings had been held but not on a regular basis. Minutes of issues discussed had included activities and staffing. The manager said that service users views and opinions were listened to every day with activities and routines based, where possible, on peoples wishes. Service users spoken with agreed that they spoke daily with staff about their preferences and likes and dislikes and they thought that the manager listened to their views. The homes staffing rota has designated activities hours two afternoons a week but staff offer activities each day. The deputy manager had received training on providing activities to people who have dementia and cascades this knowledge to staff. There was no structured programme of planned activities as activities are decided on each day with service users involvement. Records had been kept of the activities offered and included indoor games, cards, puzzles, trips out in the bus, bingo, colouring, shows, walks, sing a longs and painting. Some people commented in surveys returned Care Homes for Older People Page 15 of 27 Evidence: to us that in would be good if there were more outings out of the home. The manager said that now the home had a mini bus that could be driven by several staff more outings would take place. A recent example quoted was a trip to a restaurant in Pitsea. Outings recorded before this had been to a butterfly farm, Colchester Zoo and Hyde Hall. The manager also said that local clergy visit monthly to hold a service in the home and a service user regularly attends a local church. Hairdressing is available in the home or some people go to a salon outside. Service users spoken with said they took part in activities and that they were usually enjoyable, although some spoken with were not interested in taking part much. When asked, service users told the inspector that their family and friends could visit at anytime and that staff always made them welcome. Comments in surveys and from relatives spoken with confirmed that they visit regularly and at any time. Inspection of private rooms evidenced that service users had been permitted to bring their own personal items with them on admission. Information for service users and their relatives on how to access independent advocacy support was included in the service users guide. This had been used by some for advice relating to individual service users. Nutrition records and menus were looked at, these evidence choice and variety. The cook confirmed that the main daily meal is lunch with two main choices but with further options provided if service users did not like the menued meal. Teas are usually a hot dish or sandwiches. The manager said that cooked breakfasts are available however this is dependent on dietary health considerations for individuals. Food stocks were good and service users spoken with at the inspection were satisfied with the food. Actual comments made included, the food is good and I get enough to eat, the food is great, the food is first class, the food here is quite good really, the meals are highly enjoyable with a section of meals. Records are kept of peoples food and fluid intake so that any changes in eating habits can be looked into without delay. Care Homes for Older People Page 16 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. Practices in the home safeguard service users and ensure that concerns are listened to and addressed. Evidence: The complaints procedure was seen and contained guidance on how to make a complaint and who to complain to. Also included were timescales for responses from staff and a standard template for staff to record any complaints and concerns. Information in the AQAA states that no complaints had been received in the twelve months leading up to this inspection and so there were no records of complaints for us to look at. However the manager confirmed that if any are received records would be kept on how they are dealt with and of the outcomes. Service users spoken with said they knew who to speak to if they had any concerns, and they seemed confident that any concerns would be looked into properly. Comments from relatives also indicated that they were confident that complaints or concerns would be dealt with appropriately. The homes policy on adult protection was inspected. There was written guidance for staff on recognising and reporting abuse, and action to be taken by staff if abuse is suspected, this included a policy on whistleblowing. There was also written guidance and a policy statement for staff on assessing mental capacity to ensure peoples rights Care Homes for Older People Page 17 of 27 Evidence: were respected. Staff spoken with displayed awareness of this subject and procedure and had received training on adult protection procedures, certificates were seen to evidence this. The homes induction training covered adult protection and safeguarding 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable, clean and homely environment. Evidence: Brook Care Home provides a comfortable and mostly well maintained environment. The site visit included a tour of the premises when it was noted that the home was mostly clean and tidy, and there was no evidence of any unpleasant odours. The bedrooms, lounges and dining room were acceptably decorated, but one of the first floor bathrooms had marked floor covering and paintwork that should receive attention. Bathrooms had aids and adaptations to meet the needs of the people using the service, and there were sufficient toilets sited close to communal rooms. The manager said that all bathrooms had wcs and as already mentioned in this report many bedrooms have a private ensuite wc. Bedrooms seen were acceptably decorated, clean, comfortable and made homely with peoples personal possessions. During discussion with service users all who expressed a view confirmed that their rooms were comfortable and kept clean. There is one lounge with an adjoining conservatory which is designated for use by service users who smoke. In additional to these communal rooms there is a dining Care Homes for Older People Page 19 of 27 Evidence: room and a second conservatory on the ground floor, and a small seating area on the first floor. The garden was well maintained and had a new patio with new seating. The laundry was on the ground floor. The equipment in place was suitable for the size of the home and there was sufficient space for staff to work in. 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. People are cared for by a properly recruited and trained staff team. Evidence: The homes staffing rota was inspected and showed daytime staffing levels as four carers on morning shifts with three on afternoons. The managers hours are supernumery on some shifts but are part of the core care team on others. There is no administrative support for the manager. Night staffing is two waking carers. In addition to the care staff there is one full time cook, one weekend cook, one part time domestic, one full time handyperson and a part time activities person. Two staff recruitment files were inspected. Evidence was seen to confirm that staff are properly recruited with application forms completed, interviews held, written references obtained, written terms and conditions issued, and criminal records checks undertaken. Copies of proof of ID, photographs and job descriptions were also on files. Staff are encouraged to undertake NVQ training and information in the AQAA states that ten out of sixteen permanent staff have achieved their NVQ 2 awards. This exceeds the 50 recommended number with this award. Staff records seen showed that new staff undergo initial first day induction and then Care Homes for Older People Page 21 of 27 Evidence: move onto induction training based on the Skills for Care common induction standards for social care staff. Staff said that they received induction training, they also said that the manager is supportive and will respond quickly to any queries or concerns they may have regarding service users well being. All staff have individual training records and there is a training matrix which identifies training undertaken for the whole team, as well as when updates are due. Training records seen and discussion with staff confirmed that staff had been provided training for their roles, which had included dementia awareness, safeguarding adult protection, medication, first aid, health and safety, fire awareness, manual handling, food hygiene, activities for people who have dementia, dealing with aggression, the mental capacity act, diet and nutrition, risk assessment, palliative care, infection control and NVQ. 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. People live in a well run home that is managed in their best interests. Evidence: The manager of Brook Care Home had been in post for three years, and said that overall she has fourteen years experienced of working in the social care sector. The manager has the Registered Managers Award with an NVQ level 4 in Care, and is an NVQ Assessor. The quality assurance (QA) process used at Brook Care involves an annual audit of the service by the manager. A copy of this assessment was seen. This exercise includes gathering the views of service users and looks at care practice, equipment, personnel, health and safety, daily life and social activities, service user rights, accommodation, complaints and the statement of purpose and service users guide. The audit showed the findings and resulting actions taken to try to meet peoples expectations. Care Homes for Older People Page 23 of 27 Evidence: The manager confirmed that personal allowance monies are held for safe keeping for all service users. Records had been kept of the balances held and of receipts for expenditure. A random sample of these were checked and found to satisfactory. There was a written policy covering 1 to 1 support for staff, this included the areas to be considered in good supervision and how staff could be supported by management. Supervision records were looked at but did not fully evidence that staff were provided regular opportunities for 1 to 1 supervision. This was discussed with the manager on our first visit who responded positively to our request, and by the time of our second visit the manager had begun keeping better evidence of the support provided to staff. Staff were asked if they felt properly supported by the manager and all who responded agreed that they were. Random samples of records required to be kept were inspected. These included, assessments, care plans, staff rotas, staff recruitment, visitors book, fire drills, nutrition, medication, background info and next of kin details and fire procedures. All of these seen were satisfactory, however we also asked to see evidence of the registered providers monthly visits to the home (regulation 26 reports). There were none available since November 2007. The manager did say that the provider visited the home regularly however we need to see evidence of monthly reports from these visits. Discussions with staff, management and inspection of records confirmed that training is provided to staff in moving and handling, fire safety, food hygiene, first aid and infection control. Certificates and service records were seen to confirm that the homes hoists, fire equipment and alarms, passenger lifts, gas boilers and portable electrical appliances had all been tested/serviced. Hot water temperature is regulated and manual checks are also carried out regularly, these were seen. We also saw premises and fire risk assessments in place to try to minimise risks in these areas. The five yearly check of the homes electrical installation was overdue. This needs to be actioned by the provider. 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 1 37 26 Evidence must be available for inspection to confirm that the registered provider regularly visits the home, and reports on their findings. To show that the manager and staff are supported. 30/11/2009 2 38 13 The electrical installation supply in the home needs retesting. To show that checks are made to this equipment every five years. 31/07/2009 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 19 The first floor middle bathroom would look cleaner and better maintained for service users to use if painting and repairs were made to the jaded and marked paintwork, ceiling and flooring seen at the inspection. 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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