Care Home: Carlton Nursing Home

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What the care home does well The home has good recruitment procedures and all the required checks are done before new staff start work. This helps to make sure people are protected. People living in the home told us they enjoy the food and are always offered a choice of meals. People told us staff treat them well and visitors said they are satisfied with the care provided to their relatives. What has improved since the last inspection? There were two requirements following the last inspection. One has been dealt with and the other has been carried forward as a recommendation. The acting manager has been in post since December 2009. She told us she has improved the way people`s nutritional needs are identified and met, this includes providing a new weighing scales to make it easier to monitor people`s weight. What the care home could do better: More needs to be done to make sure that everyone living in the home is given the right support to make the most of their abilities, follow their personal interests and take part social activities that are appropriate to their individual circumstances. The home must make sure that there are enough staff on duty at all time to meet people`s needs. Staff must be given relevant training to make sure they have the knowledge and skills they need to understand and meet people`s needs. More needs to be done to give people opportunities to share their views of the service and contribute their ideas and suggestions for improvements. This will help to make sure the home is run in the best interests of people using the service. The manager should apply for registration so that people can be confident that the home is run by a suitably skilled and experienced person. Key inspection report Care homes for older people Name: Address: Carlton Nursing Home Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ     The quality rating for this care home is:   one star adequate 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: Mary Bentley     Date: 0 3 0 6 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 25 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 25 Information about the care home Name of care home: Address: Carlton Nursing Home Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ 01132509633 01132509633 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Helen Lamb,Mr John Lamb Name of registered manager (if applicable) Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is:29 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia Code DE, Mental Disorder, excluding learning disability or dementia - Code MD. Date of last inspection Brief description of the care home The Carlton Nursing Home is a converted Victorian building situated in a residential area on the borders of Leeds and Bradford. Personal care with nursing is provided for older people with dementia or mental disorder. Both men and women are catered for in this 29 bedded home which can provide single bedrooms as well as shared Care Homes for Older People Page 4 of 25 Over 65 0 0 29 29 Brief description of the care home accommodation. The home is set in large grounds, which are not accessible to service users without close supervision. The area is purely residential and as such there are no convenient local shops or other amenities. The home is not accessible by public transport. In June 2010 the weekly fees ranged from GBP 350.00 to GBP 750.00. Fees do not include personal newspapers and magazines, hair dressing, private chiropody and some outings. Further written information about the services and facilities at the home can be found in the statement of purpose and service user guide that are available at the home. Care Homes for Older People Page 5 of 25 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: one star adequate 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 last inspection of this service was carried out on 29 May 2009. We looked at the information we have received or asked for since the last key inspection. This included Information we have about how the home has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that have been made to the service in the last 12 months. Care Homes for Older People Page 6 of 25 Relevant information from other organisations. What other people have told us about the service. On this occasion we did not ask the home to complete an annual quality assurance assessment (AQAA) and we did not send surveys to people using the service. An unannounced site visit carried out by one inspector. We spent approximately 7 hours in the home. During that time we spoke to people living in the home, visitors, staff and management. We looked at various records including care records, observed staff as they carried out their duties and looked around some parts of the home. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations but only when it is considered that people using services are not being put at significant risk of harm. In future, if requirements are repeated it is likely enforcement action will be taken. Care Homes for Older People Page 7 of 25 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 25 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 25 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. Peoples needs are usually assessed before they move in and whenever possible the person or their representatives is involved in the assessment process. This helps to make sure that the home will be able to meet peoples needs. Evidence: The acting manager told us peoples needs are always assessed before they move. In one persons care records we could not find any evidence of a pre-admission assessment. The person was admitted before the current acting manager took up her post. She told us she believed the previous manager had carried out a pre-admission assessment but could not find a record of it. The home has only had one admission since the new manager took up post in December 2009. The person had been coming to the home for respite care before moving in permanently therefore staff were aware of their needs. Care Homes for Older People Page 10 of 25 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. For the most part peoples personal and health care needs are met. However, because of the staffing difficulties the home has been having and insufficient training there is a risk that peoples needs could be overlooked. Evidence: During the visit we looked at two peoples care plans. There is a lot of information in some of the care records and this can make it difficult to get an overall picture of peoples needs. This was discussed. Peoples needs are assessed and the information from the assessment is used to draw up the care plans. The care plans were up to date and reviewed every month. The care plans provide staff with information on how to care for and support people with their personal and health care needs. Where people are identified as being at risk for example from self neglect the care plans show what action staff should take to deal with this. There were risk assessments in place for areas of potential risk such nutrition, falls, aggression and smoking. We saw evidence that peoples capacity to make decisions is recorded. There was evidence that people are involved in planning Care Homes for Older People Page 11 of 25 Evidence: their care. The care records showed that the home works closely with other professionals to make sure people are getting the right support. At the last inspection in May 2009 we recommended that information about advocacy services should be available in the home. This has been done and we saw evidence in peoples care records that they have access to advocacy services. We saw that peoples weight is monitored. Staff told us that when people are at risk because of low weight or weight loss they check their weight every week and make sure they monitor what people are eating. The acting manager told us the home has purchased a new scales to make it easier to record peoples weight and training on nutrition is taking place. She told us that the home provides people with a fortified diet when necessary so that they do not rely on prescribed dietary supplements. We looked at how peoples medicines are managed and overall they were satisfactory. There were some occasions when medicines had not been signed for to show they had been given. A check of the stock balances showed they had been dispensed. Care should be taken to make sure medicines are always signed for to reduce the risk of mistakes. The manager monitors the medication systems and when concerns have been identified they have been dealt with appropriately. People living in the home told us they are well cared for. One persons visitors told us they are satisfied that their relative is well cared for. During the visit we saw that staff interacted with people in a kind and respectful way. Care Homes for Older People Page 12 of 25 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. There are limited opportunities for people to take part in social activities and follow their personal interests. More needs to be done to make sure people get the right support to make the most of their abilities. Evidence: The home has a mixed client group of older people with dementia and younger people with long term mental health care needs. Broadly speaking these two groups of people have very different needs and the home appears to be having difficulty providing people with the right support. We spent most of the morning in the front lounge where some of the younger people were. There were no activities and most people spent the morning sleeping in their chairs. The TV was on but only one person seemed to be interested in it. Staff had very little time to spend with people and their interactions were mainly task led, for example giving people drinks. People told us there is not very much going on. They said they used to have entertainers and play bingo but have not done this for some time. Visitors also said there seemed to be nothing much for people to do, they said the TV is always on. Care Homes for Older People Page 13 of 25 Evidence: They said staff used to put music on and get people singing along but that doesnt seem to happen any more. The home is not particularly well equipped to support people in maintaining or developing life skills. For example, there is nowhere for people to make a drink or to do their own laundry. During the visit we saw that people had to wait for staff to let them in and out of the front door. It was a nice day and one person went outside several times and on each occasion had to wait for staff to open the door. The manager explained the door is kept locked for security reasons. This should be reviewed to find a better way of maintaining security without compromising peoples rights. The home is set in a quiet residential area and there is no easy access to public transport or local amenities. This makes it difficult for people to go out without staff support. Before we visited people told us they were concerned that there was no transport at the home. When we visited a new car had been provided. However, the home has been having a lot of staffing problems and this means staff dont have much time to go out with people. Two people told us they enjoy going shopping with staff. The home has very nice grounds but most of the garden area is not enclosed. There is one enclosed area where people with dementia can go outside without being at risk of wandering away but the surface is uneven which means that it is not safe for people to be outside unless they are accompanied by staff. This in effect means that for some people access to a safe outside area is limited. During the visit we observed the meal service at lunch time. The food looked appetising and people said they enjoyed it. People are offered a choice of meals and the cook confirmed that staff have access to the kitchen and snack food at any time. The cook does a lot of baking and people said they enjoyed the home baked food. The cook is aware of peoples dietary needs and preferences. One person sometimes has Kosher food and this is bought in so that it is available when they want it. Care Homes for Older People Page 14 of 25 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. There are systems in place to make sure that complaints are dealt with. There are systems in place to make sure people are protected, however more staff training is needed to make sure staff are fully aware of the different ways in which they can raise concerns. Evidence: The company has a complaints procedure and the acting manager told us they have had 2 complaints in the last 12 months. She confirmed that records are kept of all complaints. We have received a number of concerns about the service in the last 2 months, some of these were anonymous and raised concerns about staffing levels and the well being of people in the home. In line with our safeguarding procedures we have referred these concerns to the local authority safeguarding procedures. There are policies and procedures in place to make sure people are protected from harm. The manager is familiar with the safeguarding procedures and reports concerns. Approximately half of the staff have attended training on safeguarding (adult protection). The staff we spoke to were aware of how to report concerns within the company but were less sure about what external agencies they could contact. Care Homes for Older People Page 15 of 25 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. The home provides a clean and comfortable place for people to live. Evidence: The home was clean and generally free of unpleasant odours. There is an ongoing programme of refurbishment and we saw evidence of this when we visited. The acting manager told us they are looking at how they can improve the environment to make it more enabling for people, for example by providing somewhere for people to make their own drinks. We saw that people are encouraged to have personal belongings in their rooms to help them feel more at home. The home has a handyman 2 days a week and maintenance issues are not always dealt with as quickly as they should be. For example, when we visited the lock on the front door was broken and we were told it had been for several days. This was discussed and was dealt with. The home only had one cleaner when we visited, this means that on his days off care staff have to attend to housekeeping duties. The home does not have a laundry assistant at present, this is done by the cleaner when he is on duty and by care staff Care Homes for Older People Page 16 of 25 Evidence: when he is not. Care Homes for Older People Page 17 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff to meet peoples needs and more training is needed to make sure staff have the knowledge and skills to meet peoples needs. Evidence: There were 16 people living in the home when we visited. The acting manager said there have been problems with staffing over recent months. This is in part due to the fact that a lot of staff left with the previous manager. This has resulted in staff shortages and existing staff working longer hours. The deputy manager told us she had been mainly working on night duty since she started to cover a nurse shortage. This means she has not been able to properly take on the role of deputy manager. The home told us they are trying to recruit new staff but are finding it difficult for a variety of reasons. One of the difficulties is that the home is not easily accessible by public transport. Staff told us they are often not enough of them on duty to meet peoples needs. They said they do not feel the company is acting quickly enough to deal with staffing issues. The home does not use agency staff to cover absence or vacancies. One person is the home is funded to have one to one care for a number of hours everyday. Staff told us Care Homes for Older People Page 18 of 25 Evidence: there is not always an extra member of staff to provide one to one which means that it has to be covered by the staff on duty. The home only has one cleaner which means that when they are not on duty care staff have to carry out cleaning duties. The acting manager told us there are usually 4 care staff and 1 nurse on duty in the morning. In the afternoon there are usually 3 care staff and 1 nurse and an extra extra carer for the person who is funded for one to one care. The home provided us with copies of the duty rotas for the month of May. The rotas showed that there were usually 4 staff in the mornings, there was one weekend when there were only 3 staff on duty on both Saturday and Sunday morning. The rotas confirmed that there was not always an extra member of staff to provide the one to one support and showed that on some occasions there were only 2 care staff for the afternoon and evening and on other occasions one of the 3 care staff finished at 8:00pm instead of 9:00 pm. Staff told us that they had not had some mandatory training for example moving and handling for some time. They said they had not done any training mental health related issues despite the fact that the home provides care for people with mental health care needs. Some staff said they used to INTERNET to look up information about peoples conditions. We saw that some training on nutrition had taken place and more is planned. Some staff were booked on training about Parkinsons disease however there is no one in the home at present with this condition. The training matrix confirmed that some mandatory training is overdue. One of the senior managers was in the home during our visit and said the company is currently reviewing the way they provide and record training. When we inspected in May 2009 we found that the home had the right recruitment procedures in place to make sure staff were properly checked before they started work. During this visit staff told us they had to provide two written references and have a CRB (Criminal Records Bureau) check before they started work. One of them said they had received good induction training when they started, another said they had received very little induction training. They said the manager is aware they need training but it has not been arranged as yet. Care Homes for Older People Page 19 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More needs to be done to make sure people are given opportunities to share their views and contribute to the development of the service. This will help to make sure they experience good quality outcomes. Evidence: The acting manager has been in post since December 2009. She has not yet applied for registration and this was discussed. Although a deputy manager has been appointed she has been working as a nurse on nights therefore unable to properly take on the role of deputy manager. The home does not have meetings for people using the service or their representatives. This means that there are limited opportunities for people to share their views of the service and make suggestions for improvement. Some visitors told us they had not met the new manager or deputy manager. They are regular visitors to the home. Care Homes for Older People Page 20 of 25 Evidence: Staff told us they thought there had been two staff meetings since the new manager started. The manager said she used to also have weekly team meetings but these have lapsed since May. The home told us seven staff meetings were documented between January and May. Feedback from staff varied, some said the new manager is very supportive and has had a difficult time since she started because of lot of staff left with the previous manager. Others said they did not think the manager listened to or acted on their concerns. The company sends questionnaires to people using the service once a year. They told us questionnaires were sent in May this year. Since the inspection the home told us that six people completed and returned questionnaires. A senior manager from the company visits the home at least once a month to provide support to the acting manager and audit the service. We saw in peoples care records that assessments of their capacity to make decisions are recorded in line with the requirements of the Mental Capacity Act. The home holds small amounts of money for some people. We looked at this when we visited in May 2009 and saw that peoples money is managed appropriately. The acting manager confirmed that one of the senior managers audits the system to make sure peoples money is properly accounted for. There are systems in place to make sure health and safety is managed and the home provides a safe place for people to live and work. However, when issues are identified they are not always acted on as quickly as they should be. For example the service report on one of the hoists dated 23/03/10 identified a problem with the wheels and this had not been resolved when we visited. Since the inspection we have received confirmation from the home that it has been dealt with. Care Homes for Older People Page 21 of 25 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 22 of 25 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 27 18 The numbers and skill mix of 30/07/2010 staff on duty at all times must be reviewed and adjusted to take account of the needs of people living in the home. To make sure people get the care and support they need when they need it. Staff must be provided with training which is relevant to the needs of people living in the home. To make sure they have the knowledge and skills they need to understand and meet peoples needs. 30/07/2010 2 30 18 3 33 24 More must be done to give people using the service opportunities to share their views of the service and contribute to the development and improvement of the service. 27/08/2010 Care Homes for Older People Page 23 of 25 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 To make sure the home is run in the best interests of the people using the service. 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 9 12 More care should be taken with the recording of medicines to reduce the risk of mistakes. More needs to be done to make sure everyone living in the home is given the support they need to follow their personal interests and make the most of their abilities. More attention should be given to making sure staff are aware of the multi agency safeguarding procedures. The maintenance systems should be reviewed to make sure that routine maintenance issues are dealt with without undue delay. More should be done to make sure the facilities are appropriate to the needs of people using the service, for example, there should be a safe outside area so that people can go outside without always having to be accompanied by staff. The acting manager should apply for registration with the Commission. There should be more frequent staff meetings so that staff are able to share their views of the service and put forward suggestions for improving the service. 3 4 18 19 5 19 6 7 31 33 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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