Care Home: Cedar Lodge

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What the care home does well New people are welcomed into the home with flowers and a card. People are well looked after by a group of familiar staff that have known them for quite some time. They are treated in a friendly way, and with respect. Arrangements are in place so that people using the service are supported to see health care professionals when they need to and get the advice and treatment they need to stay healthy. Staff are now gathering a ``life story`` about each person during their assessment and after they have moved in, which should help to personalise the care and support they receive to enhance individual`s quality of life. The service is sensitive to people`s cultural needs, and people get the support they need to stay in touch with relatives and friends. Staff encourage people to do things for themselves, so as to promote their independence. They are able to do things they value and go to places they like. People who live in this home are supported and assisted by a stable staffing group which should ensure that individuals care needs are met in a consistent manner. Checks are carried out regularly on equipment around the home, to protect the health and safety of the people living and working there. Staff try to make sure that the house is clean and tidy with homely touches, so that people who live there can feel comfortable and safe at home. What has improved since the last inspection? The deputy manager is working hard to ensure all care plans are rewritten together with maintaining other policies and procedures that have been assigned to them by the manager. We are told that the manager is fully supportive of the deputy manager and can be contacted at any time for advice and support. The manager has shown us documentation which states clear lines of responsibility in relation to the management structure of the home which the manager feels provides staff with clear guidance in relation to responsibilities within the home. What the care home could do better: Information about what the service provides needs to be updated in parts and correspond with other information available. This is so people have current information to help them decide if the service is right for them. The rewriting of each persons care plans must continue so that there are clear sufficient details and plans are ``person-centred``. This means that they should focus more on each individual and what their goals are. It should then be possible to see clearly whether or not people`s goals are being met. This would make sure that people get the support they want in ways that suit them. Plans should also include all of the important information that staff need to know to help people stay safe. `When required` (PRN) medications must have written protocols in place for staff to follow to make certain individuals are protected from harm. All staff should have knowledge in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards so that this can be put into practice, this will make sure individual`s liberties are protected in relation to risk taking and decision making. Staff training programme needs further development to make certain that all staff have the knowledge and skills to meet each person`s needs in a safe manner. The deputy manager must be continued to be supported in their role to make the improvements required and to undertake further training in order to further enhance their management competency, such as, National Vocational Qualification (NVQ) Level 4. We will be reviewing improvements together with the deputy managers management competencies when we next undertake an inspection of the home. There are further requirements and good practice recommendations listed at the end of this report. Key inspection report Care homes for older people Name: Address: Cedar Lodge Main Street Offenham Evesham Worcestershire WR11 8RL     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: Sally Seel     Date: 0 4 1 2 2 0 0 9 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 41 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: Cedar Lodge Main Street Offenham Evesham Worcestershire WR11 8RL 01386446871 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: iansomauroo@hotmail.com A & I Care Home Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: the maximum number of service users be be accommodated is 13. The registered person may provide the following category of service only: Care Home Only - Code PC To service users of the following gender: Either To service users of the following categories: Mental Disorder over 65 years of age (MD)(E) 13 Physical Disability over 65 years of age (PD)(E) 13 Old age not falling within any other category (OP) 13 Date of last inspection Brief description of the care home Cedar Lodge provides accommodation and personal care for thirteen older people who may have a physical disability. The home is situated in a small village outside Evesham town and is on a local bus Care Homes for Older People Page 4 of 41 1 6 1 2 2 0 0 8 0 0 0 Over 65 13 13 13 Brief description of the care home route. It is an adapted country house and has two floors accessible by stair lift. Handrails are appropriately fitted. There are six bedrooms upstairs, five of which have ensuite facilities, and one has its own toilet and washbasin nearby. There are seven bedrooms downstairs, six of which have ensuite facilities and one has its own toilet nearby. There are communal bathrooms on both floors, each with a hoist and one also has a shower. There are separate communal dining and lounge areas and a conservatory looking out onto an attractive garden. Mr Ian Somauroo took over the ownership and management of Cedar Lodge in 2008. Care Homes for Older People Page 5 of 41 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: This fieldwork visit to the home was undertaken by one inspector over one full day and an Expert by Experience spent part of the day at Cedar Lodge. Mr. Richard Hartle, an Expert by Experience is a person who, because of their shared experience of using services, visits a home with an inspector to help them get a picture of what it is like to live in or use the service. The manager and deputy manager assisted us throughout. The management team and staff did not know that we were visiting on that day. There were thirteen people living in the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also Care Homes for Older People Page 6 of 41 reviewed. Random surveys were sent to people who live in the home, their relatives and friends and staff in order to gain their views about the service. Comments about the service provided are included within this report. Prior to the inspection the Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. However, some improvements are required when completing the AQAA which are described in the Conduct and Management standards of this report. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. We would like this opportunity of thanking people who live in this home, their relatives and friends, the manager and deputy manager and all staff for assisting us with this inspection and making us feel welcome. Care Homes for Older People Page 7 of 41 What the care home does well: What has improved since the last inspection? What they could do better: Information about what the service provides needs to be updated in parts and correspond with other information available. This is so people have current information to help them decide if the service is right for them. The rewriting of each persons care plans must continue so that there are clear sufficient details and plans are person-centred. This means that they should focus more on each individual and what their goals are. It should then be possible to see Care Homes for Older People Page 8 of 41 clearly whether or not peoples goals are being met. This would make sure that people get the support they want in ways that suit them. Plans should also include all of the important information that staff need to know to help people stay safe. When required (PRN) medications must have written protocols in place for staff to follow to make certain individuals are protected from harm. All staff should have knowledge in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards so that this can be put into practice, this will make sure individuals liberties are protected in relation to risk taking and decision making. Staff training programme needs further development to make certain that all staff have the knowledge and skills to meet each persons needs in a safe manner. The deputy manager must be continued to be supported in their role to make the improvements required and to undertake further training in order to further enhance their management competency, such as, National Vocational Qualification (NVQ) Level 4. We will be reviewing improvements together with the deputy managers management competencies when we next undertake an inspection of the home. There are further requirements and good practice recommendations listed at the end of this report. 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 9 of 41 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 41 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information that is provided to people needs some minor improvements which we are confident that the manager will make. People are given sufficient information about the home with some additional touches that welcome them into the home once their needs have been fully assessed so that there is an assurance these will be met from day one. Evidence: The Annual Quality Assurance Assessment (AQAA) which was completed by the manager told us, Statement of Purpose and Service users guide which is specific to the residents are displayed in each persons room. They consider the accommodation, support system, care principles and all specialist services which compliment our philosophy of care. We found this to be the case as we looked through the statement of purpose and service user guide which give people, who are considering living at the home, information about what the home is like, services on offer, meals, activities, complaints procedure and so on. Care Homes for Older People Page 11 of 41 Evidence: Positively people are able to see that currently care and support is provided to adults over 65 years old who may have a physical disability with recognition that 13 females currently living at Cedar Lodge. It is also made clear that Cedar Lodge is not a nursing home. We were also shown other pieces of information about the home and the way of life within it. People told us that they had sufficient information to help them to make decisions about whether the home was right for them prior to coming to live at Cedar Lodge. The statement of purpose and service user guide could be further improved in the following ways:- To ensure that these information guides are reviewed annually and or more frequently if information about the home changes so that people are guaranteed of up to date information. We saw dates of May 2008 on both the statement of purpose and service user guide - For the statement of purpose to be produced into alternative formats, such as, larger print, audio and pictorial. The information documents we saw were in the written format and there were no details that would inform individuals of any alternative formats so that all people regardless of their abilities would be able to understand them. We do acknowledge that it says in the statement of purpose that staff could explain information as people choose but this should not mean that alternative formats are not also made available. In the statement of purpose we found the fees that are charged by the home but these are different to the fees that are in the other information that we were shown. Also the address for the Care Quality Commission (CQC) needs updating in the main body of the information guides with the former contact details taken out. This further illustrates the importance of ensuring that all information guides are reviewed and do correspond with other details that are provided to people to avoid any confusion. The AQAA tells us, Prospective residents are given the choice to visit and spend time at the Home. We are also told that people who may be considering living at the home are able to spend time with people who are already living at the home to obtain their views about what life is like in relation to living at Cedar Lodge. It is also stated in the AQAA that when people come to live at the home a welcome card and fresh flowers are placed in their bedroom. This is a nice reassuring touch for people when they move to the home. Care Homes for Older People Page 12 of 41 Evidence: Survey responses from people who live in the home and their relatives told us:I am unaware of any deficiencies I am finding my stay here even better than I expected. The home always treats us like family and we are always satisfied. Cedar Lodge has always been a caring happy ship. Happy staff leads to happy residents. When I see all the horror stories in the paper and on TV I feel very lucky to have found Cedar Lodge. We looked at the care records of a person who had moved to live at Cedar Lodge since we last completed an inspection at the home a year ago. We found that an assessment of the persons needs was completed prior to moving into the home. This assessment provides staff with details about what assistance and support the person would need. We saw the persons full range of needs were focused upon and these were detailed as, physical health, mental health, personal care needs, skin care, nutrition, social interest and religion. The acting manager has worked hard since we last inspected the home to improve assessments and care plans to ensure that they have enough details about a persons needs. This practice needs to continue to make sure the services offered and staff skills and knowledge meets the individuals needs before they come to live at Cedar Lodge. Survey responses from staff told us:The home is homely and inviting and feels very warm and friendly. Creates a friendly atmosphere for the service users. Cedar Lodge has always maintained a homely atmosphere. Retains a family environment. The registration certificate and employers liability insurance certificates which were on display in the hallway of the home near to the front door so are accessible should people wish to read these. Care Homes for Older People Page 13 of 41 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. Care plans that document individuals needs are being developed. This needs to be continued to make sure that peoples needs are met and risks are fully assessed. This will help to ensure that people get the care they need in ways that suit them best, and be supported to stay safe from harm. Some improvements were required in relation to when required medications which the manager has told us have now been resolved. Evidence: We looked in depth at the assessments and care plans of two people who live in the home and a third was partially looked at. Assessments provide details about each persons range of needs that require to be met. This information is transferred into a range of care plans and we saw plans for, mobility, personal care, mental health, nutrition, continence, medical needs and behaviour. Some of the care plans that we saw reflected clear descriptions of the persons needs with instructions of what assistance each person requires from staff to make sure that their needs are fully met. The deputy manager told us that they were in the process of rewriting peoples care plans. We found this to be the case as we saw some care plans that were in the old Care Homes for Older People Page 14 of 41 Evidence: format together with some plans that had been developed into the new format. For example, in one care plan that has not been developed as yet we found that these did not reflect the involvement of the person and or their representative. Also these plans lacked sufficient information for staff to follow to make sure peoples needs were met in the way they preferred with safety in mind. It should now be made a priority for the acting manager to make sure all care plans are rewritten. We saw in one of the new care plans that the persons goals were recorded together with actions for staff to follow to meet the persons needs in a safe way. One care plan in relation to meeting the persons hygiene needs told the staff that the person was able to wash and dress themselves without any help. The goal identified was to, continue to promote independence to ensure she dresses appropriately for seasons and weather conditions. The care plan also noted what help the person required in respect of bathing and hair washing. Positively safety aspects promoted individuals choices and were also reflected in the plans, when X (persons name) is in the bath, call bell is at hand so she can ring when she is ready to have her hair washed and her back. Care plans should be further improved by individuals and or their representatives signing these, days and times people would like to take their baths and or showers. Also times people prefer to get up in the mornings and go to bed at night. This would promote both choices and consistency of care together with individuals acknowledgement of taking part in care planning processes. People appeared to be well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. The Expert by Experience reported, All residents observed today seemed appropriately well dressed, clean with tidy hairstyles and manicured nails. Surveys received from people who live at the home and their relatives and friends told us:Help in every way. Staff very approachable always welcoming and willing to discuss issues. The residents are happy and well looked after. Perhaps advise me when issue like flu jabs...... or has medical visits. Problems with feet or whatever. Perhaps a report once a month would be helpful. Documentation includes a number of risk assessments including, risk of sore skin, Care Homes for Older People Page 15 of 41 Evidence: nutritional needs and moving and handling. It was positive to see in the care plans that we looked at risk areas had been recognised but instructions for staff to follow in managing a persons, behaviour, continence, sore skin and nutrition was variable. Whilst the acting manager is reviewing all care plans and risk assessments they should also consider the following:- if a person requires staff to support them with their behaviour as we saw in one care plan, it would be helpful for all staff to have documented clear strategies for supporting the persons behaviour. In one plan it confirms, If X (persons name) starts to get annoyed just carry on as if she is normal. Do not argue with her as this makes her worse Care should be taken when using words to describe people, we saw, does have a tendency to sulk, she ignores people for days can turn on the tears also shout. Use of terminology to describe people was discussed with the manager as the words used need to show respect to individuals. Positively we saw that daily records are maintained which report on a persons day and reflect any concerns and or issues that need following up, such as, if a person is unwell. We also saw separate records that show when people have taken a bath and or shower, had their hair washed, activities taken place and weight recordings. One daily recording showed large bruise to right elbow also bruise on left arm but no follow up action and or the reasons for the bruising documented. (Further discussed in Complaints and Protection standards. The previous recordings, care plans and risk assessments were loooked at to see if this person was proned to bruising due to skin fargility but no further recordings were found to highlight any previous bruising. We were told that manager audits care records but we could not see that they had picked up on the brusing and recorded any explanation as to actions taken. This was brought to the attention of the manager during the inspection but no explanation was given and or knowledge of protecting people by ensuring all recording and actions followed through. All staff observations and practices should be completed in full to show that peoples wellbeing is being protected at all times even if a person bruises easily which we do not know is the case for this person. We were uncertain as to the specific reasons and risks to individuals that are being checked by staff through the night. Some staff told us that some people who live in the home keep their doors open at night by choice and others close theirs. To make sure peoples privacy is respected and they are not unnecessarily disturbed through the night care plans and risk assessments should clearly show the reasons and risks as to why individuals are checked with instructions for staff to follow. We were told Care Homes for Older People Page 16 of 41 Evidence: this was normal practice but not assessed on an individual needs basis. Healthcare professionals including General Practitioners, social workers, chiropodists, community nurses and the dentist visit the home to give advice to individual people as required. We received two surveys from healthcare professionals and one said, Close phone contact with surgery help with extra information when GP visiting. We saw in some peoples care records that they had visited their surgery to receive their flu injections. We also noticed that the care records we looked at confirmed where people had been visited by the chiropodist. This shows that external professionals visit people so that they receive specialist advice when required. The management of medication was reviewed and people had identity photographs to minimise the risk of a drug error. We checked some peoples Medication Administration Records (MAR) charts against the monitored dosage system (MDS, this is where medications are provided by the pharmacy in individual packs). The quantities of the medicines had been recorded enabling audits to take place and we were told that the deputy manager audits medication weekly. Medicines that we checked had been administered as prescribed and records reflected practice. However, as discussed with the manager there were no individual protocols in place for as required (PRN) medications. Therefore it is a requirement that this should be done to ensure consistency in staff practices in giving these types of medications to protect people from harm. Since the inspection took place we have been notified by the manager that four people who live in the home were prescribed PRN medications, two were taking these medications regularly and the other two people had never needed to take any at all. Discussions have taken place with each persons doctor. Two people have had their prescriptions amended to regular daily administration of their medications and the other two people have had their medication stopped as they had never been administered it. It still remains the case that if any person living in the home is prescribed PRN medications in the future protocols must be in place so that people living in the home are protected by robust medication procedures. We saw that prescribed creams had the date that the cream was opened to make certain that manufacturers guidelines are maintained when storing those types of medications. We were told that some people have cream in their rooms and we were told that this is kept in peoples drawers and not left on show. Also whilst discussing prescribed creams with a member of staff we explained that on the creams there should be a note describing to staff which parts of the body these need to be applied as a cream we looked at did not confirm to this. These actions will make certain safeguards are in place to keep all people fully protected from any harm. Care Homes for Older People Page 17 of 41 Evidence: A staff member that assisted us in looking at peoples medications had a good understanding of medication administration. We observed that two staff members administer medications so that all medications are checked and given as per the prescribers instructions. Staff who administer medications are trained to undertake this task and the staff training matrix told us that ten staff have completed medication training, three staff in 2006, three in 2007 and four in 2009. Staff training is discussed further in the staffing standard of this report. The Expert by Experience reported:- I observed positive care and consideration towards Residents. - All Residents spoken to say that they were well treated and given respect at all times. - We are always treated like ladies. - I spoke to eight Residents who all spoke highly of the staff.The staff are all wonderful one said. Another told me We are really well looked after. Staff were observed using the preferred term of address to people and we observed staff knocking on individuals door before entering. People can have their own telephone line installed at an additional cost so that they can make and receive calls in private. Personal care was delivered in the privacy of peoples own bedroom or a bathroom. These examples show that peoples privacy and dignity appeared to be maintained, good interactions between staff and people living in the home were also noted. Staff survey responses told us:Peoples health, personal and social care needs are met and all residents treated with respect. Owners and manager committed to ensure that staff and residents needs are met. Care Homes for Older People Page 18 of 41 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel happy with the activities and lifestyles they lead whilst living at Cedar Lodge. Individuals lives are celebrated and acknowledged to make sure all people are valued whilst their independence is retained in their daily experiences. Meals are flavoursome and nutritious. Evidence: Events designed to provide interest and stimulation was on display near to the front door of the home in relation to Music for Health and Sing-a--ong with dates to remind people when these would be taking place. We also spoke to some staff about activities and people having the opportunities of following their interests. Staff told us that activities that people had participated in were crosswords, afternoon quizzes, hand massages and Christmas card making. The Expert reported:- During the morning some Residents chose to stay in their rooms, reading or watching television, while nine were in the lounge reading newspapers, listening to music or talking to each other. Care Homes for Older People Page 19 of 41 Evidence: - Activities are organised by care staff, two of which were undertaking a guessing game in the afternoon. Due to the nature of the one and only small lounge, it must be a challenge for most types of activity to be undertaken, especially as there are not enough seats for all 13 Residents, should they wish to be present, without overcrowding the room. The alternative would be to use the dinning room in addition. Responses gained from surveys that people who live in the home and their relatives and friends:Satisfied. Staff warm and friendly and personal with residents making them feel more at home. In the AQAA it tells us, Fresh fruits in the form of apples, bananas and grapes are displayed daily in the lounge alongside fresh diluted juices in a jug for the residents to access at their leisure. Residents have requested a social drink of cider, sherry or red wine in the evening once a week and this is being implemented form September onwards. This shows that the manager is listening to the views of people who live in the home and we certainly saw fresh fruit on display on the day we inspected the home. One staff members survey responses informed us, The home provides home cooked food which is appreciated by everyone. Those records sampled showed good assessment information which included looking at the identity of a person, their faith, their interests, and experiences, and any particular social or cultural interests the person has. It was particularly positive to hear from a member of staff that they had been helping a person who lives at the home complete their life story. The member of staff had found this invaluable in celebrating the persons experiences and interests. This information can then be used as a talking point and in offering activities to a person. This practice will also help the acting manager and staff to include individuals preferences within care planning, such as, whether people enjoyed an alcoholic drink, whether they wished tea or coffee in the mornings and what size meal people preferred. Exploring and recording peoples life stories are areas that are being improved since the last inspection visit. In some of the care plans we looked at we found that there were some good details for staff to follow to make certain individuals lead lifestyles that matched their wishes and retained their independence where possible. For example in one we saw, I love to help some of the other ladies especially at lunchtime showing them where they are sitting. Care Homes for Older People Page 20 of 41 Evidence: Actions to provide guidance to staff were noted as could lay the tables do some folding or anything else that might make her feel useful. We were told that there are separate files where staff record and allow staff to monitor whether these activities were being offered or taken up by individuals. It was positive to see that people were enjoying meaningful activities, some people were relaxing in their rooms, or chatting in the lounge, and a sing-a-long took place later in the afternoon on the day we inspected the home. Contact with family and visitors are known and respected. We saw daily records which reflected when people had received family and friends and or had gone out with them. Menus showed that a variety of meals are offered to people with the main meal of the day being served at lunchtime. We saw on information that was shown to us that, Menus available on request. We were told that people are offered an alternative if they do not like and or want a particular meal on the day it is served. It would be good practice if people who live in the home become part of the menu planning process as this would further promote peoples preferences and dislikes. The Expert reported:- I sampled the lunch, which was very well cooked, served hot and was tasty and wholesome. There was only one choice for each course Fish in breadcrumbs, mash and peas with trifle for pudding. Most Residents finished all they were given and seemed to enjoy the meal. The food is always well cooked and presented, one Resident said. Another said, I enjoy the food but wished that there were snacks throughout the day. - The staff serving the meals from the kitchen to the dinning room did not wear protective aprons. - The dinning room can seat 12 and on the day of the inspection there were 10 Residents present. Others eat in their rooms. - Hot and or cold drinks were served at several times during the day. - A soft food option is given to one resident and I observed the meal, which was served on a plate in separate portions. This Resident chose to eat in her room. Records were seen to show that food and fluid intake is monitored where concerns Care Homes for Older People Page 21 of 41 Evidence: regarding weight loss are evident. It was positive to see that discussions take place with individuals about how they can make sure their diets are nutritional and people are given advice about how to manage their weight gains to remain healthy and well. Some care needs to be taken when discussing information with people who dont work at the home, such as, shopkeepers, as this needs to be agreed with the person it concerns. This is due to one care plan confirming that the shopkeeper helps a person who lives in the home to choose items that contain less fat but it does not confirm how the shopkeeper had gained this knowledge. Therefore it needs to be made clear in care plans whether the person themselves gave the shopkeeper information so that all staff can be seen to uphold individuals confidences even if it is done with the persons best interests at heart. Care Homes for Older People Page 22 of 41 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their views and concerns are actively listened to by staff who will take action to make sure all people are fully protected abuse, neglect and self-harm. All staff should have up to date training in protecting vulnerable people with some knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards. Evidence: The complaints procedure is displayed in the home and is included in the statement of purpose and service user guide so that people know how to make a complaint if they need to. The new address for CQC needs to be placed in the main body of the homes information guides where the complaints procedure is being explained. We saw the Commissions former contact details are showing in this section. We are aware that a note is made of CQCs correct address is on the bottom of the first page of the information guides but it needs to be prominently placed in the appropriate complaints section so that people can see this at a glance. Also the AQAA confirms, The Complaints Policy has been updated to reflect the CQC address. We were shown the complaints log and one complaint has been received in November 2009. This was documented clearly with details of the nature of the complaint, who had dealt with it, the date resolved and the outcomes and action taken. The CQC has not received any complaints. The surveys returned to us by people living in the home indicated that people had been informed about how to make a complaint if they Care Homes for Older People Page 23 of 41 Evidence: needed to. The Expert reported:- No abuse, verbal or physical was observed on the day of inspection. - Staff seemed to treat all Residents with dignity. A Resident said, The staff have never been unpleasant or rude. Another said, We are all treated like family. - Comments reported by a visitor interviewed: I think the staff are lovely and I believe my friend is very well treated. I enjoy coming here. - Most Residents spoken to felt they could approach the management if they were unhappy about anything. The home had an adult protection policy in place this ensures that staff has guidelines to follow in the event of an allegation being made. There have been no allegations of a safeguarding nature made at the home since our last visit. The information supplied in the AQAA also confirms this to be the case. As previously stated in this report we saw in a persons daily bathing records that they had some bruising on their body but it was not clear from reading these notes what action staff had taken in relation to this. Therefore a requirement has been made to make certain all documentation and procedures are followed to the latter in safeguarding people who live at Cedar Lodge even when it is deemed a person may bruise easily. The management were made aware of this at the time of inspection. In the AQAA it tells us, Staff have undergone training with the Local Authority in relation to Protection of Vulnerable Adults (POVA). The training matrix showed that seven staff has completed training in the POVA. Two staff in 2005, one in 2006 and the other four staff in 2009. The other eleven staff identified on the training matrix has boxes that have not been completed with any dates to show when their training will be planned and or when they last received this training. At the last inspection it was noted that training for all staff would be completed in 2009 but this is not confirmed on the training matrix which will be discussed further in the staffing standard of this report. Staff responses and surveys told us that staff would be able to state the correct actions to take to ensure that people would be safeguarded from harm in the event of an allegation being made. We were told that some people who live at the home experience some memory loss Care Homes for Older People Page 24 of 41 Evidence: and confusion. Therefore to make sure all peoples needs are met effectively all staff should have knowledge in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). This examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. The training matrix informs us that two staff members have completed MCA training one of these being the deputy manager. Care Homes for Older People Page 25 of 41 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 excellent 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 home where improvements are ongoing to make it both comfortable without losing the homely touches which people can identify with. The creation of some quiet spaces would further enhance and give choices to people. Evidence: Access to the home is via a bell and a coded door and this ensures that staff know who is entering the building. The hallway area is pleasantly decorated and has information displayed as well as pictures. The home has a small lounge which had homely touches and on the day we visited we saw that it had been decorated for the Christmas festivities. We were told that people who lived in the home had chosen to place the Christmas tree prominently in the window area of the lounge. We saw items displayed such as, clocks, pictures and other ornaments that reflected the people who lived in the home. There are assisted bathing facilities and shower to meet the needs and personal choices of the people living in the home. The AQAA confirms this is the case, The bathrooms are homely and include aids and adaptations to meet the needs of the residents, and all the residents have their own toilet facilities either within or just outside their bedrooms. Care Homes for Older People Page 26 of 41 Evidence: The atmosphere in the home was friendly, calm and relaxed. People living at the home were engaging in conversation with each other and it was clear that they felt this was their home. One survey returned to us said, Smaller cosy place easier for X (persons name) as she has memory loss and is less confused here. The Expert made further observations and reported:- Cedar Lodge is a small Home on two floors including two single storey ground floor extensions and with 13 bedrooms, eleven of which are en-suite. A lift serves the upper floor. It has a small lounge with seating for eleven and a separate dinning room, which had three tables with four chairs each. There is a small but enclosed garden in which is a temporary building housing the office and there is a small conservatory. - There was no gel for hand cleansing evident in the common areas for visitors to use. - The Home is generally well presented in keeping with the age of the property. It is clean but showing some very minor signs of wear. There was no evidence of odours anywhere in the Home on the day of the inspection. - Some Bedrooms are personalised and residents are able to bring in their own possessions and small items of furniture if desired. En-suites inspected were clean and well stocked. - Cleaning of common areas and bedrooms was observed in the morning. The furniture in the lounge and dinning room was functional and appropriate. There were spare chairs in the bedrooms visited. - The kitchen is small but clean, and well organised. A storeroom nearby houses the food supplies and also includes two fridges and a freezer. - The laundry is also small but has appropriate machines and one sink. Soiled clothing is collected in separate red bags before washing. There is no separate hand washing facility. Since the inspection the proprietor has sent us a schedule which documents all of the improvements made to both internally and externally to the home. This shows that continual improvements are being identified and action taken so that people live in a well maintained home. One improvement for people who live in the home could be to loo at creating some quiet spaces for people to choose to use in addition to Care Homes for Older People Page 27 of 41 Evidence: individuals bedrooms. The AQAA confirms that twenty- three staff has received infection control training. However, the training matrix tells us that thirteen staff has completed infection control training, two staff in 2004, one in 2005, two in 2006, one in 2007, five in 2009 and two staff marked to complete this training in 2010. The staff training matrix will be discussed further in the staffing standard of this report. It was confirmed to us that the environmental health officer in 2008 had completed an inspection and awarded three stars, good, for food and kitchen hygiene practices. Care Homes for Older People Page 28 of 41 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 supported by a stable staff team that have knowledge of individuals needs and are able to respond to these in a timely manner. In the main staff recruitment procedures are robust and with some auditing mechanisms in place this should ensure they remain so. Evidence: The AQAA informs us that there are currently twenty-three staff who are permanently employed at the home. We were told that there are always two care staff to cover all shifts. Through the night period there is a member of staff who remains awake should anyone need assistance through the night with a sleep in staff member who may be called upon if extra assistance is required. In addition to care staff the home has domestic and kitchen, staff to meet all the needs of the people living there. The staff rota confirms the staffing structure that was explained to us and we did recognise that the proprietor is on shift on Sundays through the night undertaking sleep in duties for the three weeks of the rotas that we were shown. From speaking with some staff and looking through staffing files we saw that a core group of staff are maintained by the home, which means that people know who will be assisting them to meet their needs. Also there is a key working system in operation at the home which means that staff build up close relationships with individuals who they assist and support which can be reassuring for people. All of the care staff are female and this reflects the people who live at the home who are also females. Care Homes for Older People Page 29 of 41 Evidence: We were told by some of the staff that we spoke with that in their opinion there are sufficient staff on duty at all times to meet individuals needs. On the day we visited we did not observe individuals waiting for staff attention for long periods. The AQAA also confirms this to be the case, The Home is innovative in its management of staff. When residents are taken on outings in the Home car, the escorting staff are superrnumery to the daily staff ratio. And The Home has engaged in recruiting staff on the Bank system so that it is never left depleted of staff in instances of authorised and unauthorised absences. Bank staff can be called upon to work at short notice. Survey responses from relatives and friends told us:The staff are very caring. Continuity of staff is very important this makes residents feel comfortable and safe. Total care and consideration by staff. A number of staff personnel files were reviewed to determine recruitment practices. It was found that all necessary checks are carried out and two satisfactory written references are obtained before a position is confirmed. This indicates that peoples safety is paramount. We were told that monthly audits of staff files are in place. This should ensure that people who live in this home are protected by a robust staff recruitment process. It is clear from the documentation provided by the deputy manager that an area that still requires some improvement is the staff training programme to make certain that all mandatory training is planned in a timely manner. This should show (for each member of staff) training completed and qualifications gained (with dates), gaps in training including refreshers, and dates when outstanding training is to be delivered. It was suggested that doing this could provide the deputy manager with an effective tool for monitoring and updating the training and development needs of the staff team. Dates noted upon the training matrix ranged from 2004, 2005, 2006 and 2007 but no refresher courses were indicated, annually and or as per the accredited training courses taken by staff. The training matrix provided showed that there were some gaps in the training and Care Homes for Older People Page 30 of 41 Evidence: this has been reflected in other areas of this report. This is the information that the training matrix provided to us in connection to mandatory training:- Ten staff have completed first aid - Eleven staff have completed manual handling with two staff marked as undertaking this training in Jan 2010 - Eleven staff have completed food hygiene - Nine staff have completed fire training with one marked as completing this in January 2010. Other training courses were listed on the training matrix as, dementia, death, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). Two staff have completed the MCA and DOLS training in 2009, one being the deputy manager. It was noted at the previous inspection that staff training was out of date from the previous management and the deputy manager was making sure all staff will have most of their training by the end of March 2009 and the rest by the end of 2009. The training programme needs to be made a priority to make certain staff are provided with the knowledge and skills to meet peoples needs in a safe manner and refresher courses are not overlooked. We are informed in the AQAA that eleven staff have completed National Vocational Qualification (NVQ) Level 2 or above. It also says in the AQAA that, on top of the 65 per cent trained staff to NVQ 2 and 3, more staff are undergoing their NVQ level 2 this year which makes the establishment aiming for 75 per cent NVQ trained this year. However the training matrix provides a different picture as it documents that eight staff have completed NVQ Level 2 with three staff marked as completing this qualification in 2010. Also two staff have completed NVQ Level 3 with one of these being the deputy manager. Following the inspection the provider has confirmed that 75 of staff have completed their NVQ Level 2. However a training programme needs to be developed so that training can be seen at a glance and it shows a factual account of training needed together with what has been completed. The Expert reported:- I spoke with the Manager (Ian), the Deputy Manager (Sue), four care workers, the part time cook, who was filling in for sickness, and the cleaner. All impressed me with their caring attitude and commitment to the smooth running of the Home. Care Homes for Older People Page 31 of 41 Evidence: Staff responses to surveys told us:The staff and residents get along very well with good interaction between them as most staff has been here for years. I think the home could be better if we as the carers spent less time on the paperwork and spent that time with the ladies. I feel there is still an at home feel in Cedar Lodge and the ladies are insured to feel safe and secure rather than feeling they are in a home. Sometimes we could do with bank staff to cover sickness and holidays. Care Homes for Older People Page 32 of 41 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. The Manager and deputy manager are eager to make improvements and they must now ensure that necessary improvements are continued with and put into practice. This will ensure that the home operates in the individuals best interests, and that everyone is supported to stay healthy and safe. Evidence: As reported at our last inspection the deputy manager has taken on responsibility for some of the management tasks and is supported by the manager who is also the proprietor of the home. The deputy manager has completed their NVQ Level 3 and has stated on the training matrix is going onto NVQ Level 4. We were told that the deputy manager has a lot of experience in care work and, as previously mentioned in this report, is working hard to ensure all care plans are rewritten. The manager and deputy manager assisted us in undertaking the inspection of the home. At the time of our last inspection it was reported that it was the managers intentions to be the full time manager of the service from January 2009. We were told Care Homes for Older People Page 33 of 41 Evidence: that the manager is fully supportive of the deputy manager and can be contacted at any time to provide support and advice to them. The manager has also put in place a member of staff who is recognised as a team leader and deputises for the deputy manager in their absence. Support for the deputy manager needs to be continued as they try to make improvements to some of the areas that have been discussed in this report. We recognised and observed that the deputy manager is still learning and gaining experience within their management role. For example, we discussed the idea of care staff and key workers completing all life stories with individuals together with taking part in care planning as this would assist the deputy manager from some of these tasks so that they could concentrate upon other management tasks. There is a commitment to improving the quality of the service. Previous inspection requirements have been addressed and this report includes references to future plans to develop the service, such as, care plans are being rewritten, environmental improvements and there are now clear lines of responsibility within the management structure are just three examples. The AQAA was completed well in parts because it showed how the manager understands their responsibilities and can assess the performance of the services people who live at the home receive. Other sections hadnt been completed and contained Not known. One example, no information supplied in relation to What we could do better in the Health and Personal Care section of the AQQA stated Not known but we clearly saw that all care plans have not as yet been rewritten together with medication PRN protocols. The Key Lines of Regulatory Assessment (KLORA) should be referenced because they provide guidance for identifying future aims and objectives for a service as some other sections of the AQAA, such as, Our plans for improvements in the next twelve months stated Not Known as well. On the day we visited there was a planned community meeting where people who live in the home can attend to share their view points about services offered in the home together with how the home is run. For example, we saw that people who live in the home would like a weekly social drink and the manager has acknowledged this which will now be actioned. We saw that the time and day for this meeting was displayed in the hallway of the home so that people were reminded of it. We saw that staff meetings are held so that people have the opportunity to discuss any concerns or ideas about the home. The proprietor visits the home each month and writes reports about the quality of service being provided. These were made available to us at the time of our visit and reflected that the environment was inspected, people who live in the home were spoken to and staff and records were checked. Care Homes for Older People Page 34 of 41 Evidence: In the AQAA it tells us that the deputy manager has efficient systems to ensure effective safeguarding and management of the residents money and record keeping. We did not review the system for the safekeeping of peoples money but we were told that this is robust and we have not received any concerns. It will be looked at when we next inspect the home. Incidents that may affect the wellbeing of people who live at Cedar Lodge are reported to us and where we did not receive a recent notification of an incident the manager sent this to us immediately which shows they want to work with us. There are appropriate arrangements to ensure the health and safety of both people who live in the home and staff. For example, appropriate maintenance and inspection certificates for all appliances were seen. The deputy manager now needs to prioritise their work in the areas we have identified in this report so that there is certainty that safe working practices are in place to meet each persons individual needs. There needs to be a training programme that identifies that all staff has received appropriate training with certificates in place within a timely manner. This should include refresher courses so that people who live in the home are not placed at risk. Also the deputy manager needs some time to further develop within their role. As previously mentioned information supplied to us informs us that the deputy manager is going to complete NVQ Level 4 which should provide them with some further knowledge and skills. This should enable the deputy manager to fulfil their role with confidence and this will be reviewed further when we next complete an inspection at the home. Care Homes for Older People Page 35 of 41 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 36 of 41 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 7 12 Continuation of the rewriting 22/01/2010 of care plan must continue and hold sufficient details so that staff have the instructions and guidance to meet each persons needs in the way they prefer, acknowledging all risks to individuals health and wellbeing to ensure that these are minimised. This must include all appropriate behaviour support strategies to aid staff practices in these areas. This will ensure peoples needs will be met in a consistent and safe manner. 2 9 13 Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required, medication. 22/01/2010 Care Homes for Older People Page 37 of 41 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 ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. 3 18 13 All daily records including bathing and showering records must document clearly any actions and or conclusions in relation to bruising found upon individuals bodies. To ensure that to make certain people are being protected at all times by staff practices and documentation. 4 26 13 Separate hand washing 22/01/2010 facilities in the laundry room must be provided for staff to wash their hands as the same hand wash basin should not be used due to cross infection. This will ensure people are protected by robust infection control measures. 5 33 24 That greater care should be taken when completing the Annual Quality Assurance Assessment in order that it remains factual with clear 22/01/2010 22/01/2010 Care Homes for Older People Page 38 of 41 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 practices and procedures examples provided in all sections. This will ensure that the home is beiing run in the best interests of people liviing there. 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 1 Written information in the statement of purpose and service user guide should be reviewed and updated regularly. This will make sure that any changes in the service are reflected so that people can make an informed decision about the home. The registered person must ensure the statement of purpose and service users guide includes all relevant information in a format accessible to people, so that they can make an informed choice. All care plans should be signed by individuals whilst they are taking part in completing these and or their representative to confirm their agreement to how their needs will be met. It would be good practice for the service to ensure that staff are familiar with the Mental Capacity Act and Deprivation of Liberty Safeguards so people can be confident that decisions are being made in their best interests. All prescribed creams must have instructions for staff to follow on their containers in relation to which part of the persons body these need to be applied so that there is consistency of care and individuals receive their medications correctly. 2 1 3 7 4 8 5 9 Care Homes for Older People Page 39 of 41 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 6 7 10 10 For good practice purposes all words used to describe individuals should reflect respect is given to all people. Staff practices in relation to checking people through the night period should be clearly documented upon individuals care plans and risk assessments to reflect the reasons and risks to each person which should then provide directions as to why this is practised together with agreements from individuals. Care plans should be clear in relation to recording how people who do not work at the home have gained information about individuals who live at the home. This will ensure individuals rights to confidentiality are maintained at all times. Consideration should be given to people taking part in the menu planning so that they are able to influence all meals offered. All staff should have knowledge in relation to the Mental Capacity Act and Deprivation of Liberty Safeguarding to ensure that this informs their practice when meeting individuals needs and be able to put this into practice. It would be good hygiene practice for hand gel to be on offer for visitors use in the home. 8 10 9 15 10 18 11 26 Care Homes for Older People Page 40 of 41 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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