Care Home: Clifftop

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What the care home does well The people who live at the home are provided with a contract that identifies their room number and gives a complete costing for the service offered. The people who live at the home inform us that staff are kind to them and treat them well. They said that their individual rooms meet there needs and that the food is home cooked and of good quality. People important to those who live at the home say they can visit at any time within reason and consider that the staff at the home keep them informed of significant events as appropriate. Staff are on duty throughout the day and night in numbers that are sufficient to ensure the safety of those who live at the home. Staff training is provided to a satisfactory level. Staff are safely recruited into positions at Clifftop, the process ensures that all relevant checks are carried out with regard to a potential employees suitability. What has improved since the last inspection? There has been some improvements with regards to aspects of the giving of medication at the home with regards to recording when a variable dose of medicine is given. The management have improved its recruitment procedures, there has also been improvements in the way that peoples moving and handling needs are recorded and reviewed. What the care home could do better: The home needs to improve its medication administration procedures to ensure the protection of those who it assists. The management need to improve the infection control procedures within the home and to ensure that the practices within the laundry area comply with infection control policies for the safety of those who live and work at the home. The management need to ensure it carries out environmental risk assessment to ensure the continued safety of those who live at the home. Finally the home needs to establish and maintain a register of all of the substances hazardous to health that are kept on the premises so that staff are clear about the safe use of such substances. Key inspection report Care homes for older people Name: Address: Clifftop 8 Burlington Road Swanage Dorset BH19 1LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: John Hurley     Date: 2 0 0 7 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 27 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 27 Information about the care home Name of care home: Address: Clifftop 8 Burlington Road Swanage Dorset BH19 1LS 01929422091 01929424299 charrison@talk21.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Christine Harrison care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Room Nos. 2 and 3 may be used as doubles. Date of last inspection Brief description of the care home Clifftop Care Home is a large detached Edwardian property set in its own grounds, overlooking the sea, on a prominent cliff top position in a quiet residential area of Swanage in close proximity to the town and local amenities. The home has been registered to Mrs Christine Harrison since 1996 and is personally run by her, together with registered manager Mrs Trish Pride. Clifftop is registered to accommodate a maximum of 32 elderly persons in 28 single rooms and 2 double rooms. All rooms have en-suite facilities and there is a passenger lift serving all floors. The home caters for residents with varying general needs related to old age, but does not provide nursing care other than that which can be met by the District Nursing Service. There are attractive views of Swanage Bay from the communal lounges and some bedrooms. The current weekly charges at Clifftop range from £420 - £525. 0 Over 65 32 Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was undertaken over the course of one day in July 2009 by one inspector. The focus of the inspection was to look at relevant key standards under the Commission for Social Care Inspection (now the Care Quality Commission) Inspecting for Better Lives 2 Framework. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good adequate and poor. The judgment descriptors for the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. The home completed an Annual Quality Assurance Assessment( AQAA) and information provided in that is also referred to in this report. We also sent out questionnaires to those who live and work at the home. Where appropriate the comments received have been included in this report. Care Homes for Older People Page 5 of 27 We looked at three selected care files in detail, the staff files, undertook a tour of the building and looked at all the documentation relevant to the running of a care home. Care Homes for Older People Page 6 of 27 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. Care Homes for Older People Page 7 of 27 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home information to prospective residents gives them enough information to make an informed choice as to whether the home can meet their needs. The home has developed good assessment tools and records interactions with prospective residents well. Evidence: We looked at the documentation of a person who had recently moved into the home. The recording evidenced that an assessment of need had been made prior to the person entering the home. This covered areas such as self medication, falls risk assessment and outlined a reviewing process. There was an initial care plan that had been generated from the assessment that set short term goals and stated tasks that the staff would assist with. The documentation identified peoples likes and dislikes and began to document some of the life history of the person. The person had been provided with a contract that identified their room number and gave a complete Care Homes for Older People Page 10 of 27 Evidence: costing for the service being purchased. We spoke to one person who had recently taken up residency and one who was resident at the home on a respite basis. The first person explained that they were very happy with the move and that they felt safe at the home. The informed us they had been involved in the assessment process and considered that they had been given all the information they required with which to make a decision to move in. The second person told us when they first arrived and walked down the drive they were very anxious and did not want to go in. After getting into the home the staff and residents had made them so welcome they felt completely at ease and now looked forward to coming again, this being their third time they had been to the home for respite care. We looked at this persons care file and found that as with permanent stays the documentation was in good order. However it could be improved by recording if any of the persons needs had changed in between stays. At the time of the inspection we were informed that there was no one receiving an intermediate care service. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans illustrate peoples needs enabling staff to meet them. The home has systems in place for managing peoples medicines but some aspects must improve to protect those who live at the home from harm. People are treated with respect and dignity Evidence: The care plans that we observed were generated from the initial assessment and developed over a period of time. There were found to be comprehensive and informative enabling staff to meet the needs of those who live at the home. Issues relating to the individuals medical needs such as the condition of peoples skin in relation to pressure ulcers are being fully assessed. The results of assessments are being recorded and action taken to ensure a proactive stance to care is made. Daily fluid and food intake charts are regularly maintained where appropriate. We noted that it is standard practice to check people on an hourly basis throughout the night. As this may not be necessary for all who live at the home it would be helpful if it was Care Homes for Older People Page 12 of 27 Evidence: recorded that this is what the person wished or through assessment model it was established that this is what the person needed. We noted several areas of good practice in relation to meeting health care needs for example, one person was noted as having lost weight established through monthly monitoring. The response was to start food and fluid charts to monitor the persons well being and to consult the doctor. The feedback we received from those who use the service by way of questionnaires also confirmed that health care needs are met in a proactive way many comments received stated the staff treat me very well and meet all of my needs. Records evidence visits by doctors and other health care professionals further demonstrating that the home works with other healthcare professionals to meet peoples needs. We looked at the Medication Administration Records (MAR) sheets and found that the systems in place for the administration of medication require to be improved. We looked at the Controlled Drugs register and found that for a number of days staff who had administered medication had not kept the balance up to date. This undermines the ability of the home to accurately audit the register and is considered to be poor practice. One persons MAR sheets were all handwritten and did not record the amount of medication received. The register manager informed us that this was because the family had given the medication to them in a home prepared dispensing system and the records used were set up from the information the family had provided. This should not be accepted as all medication that is to be administered on the persons behalf must be in the packaging it was dispensed in and with the associated instructions. This prevents maladministration of medication and eliminates the risk of harm to the individual. The MARs contained many references to people being administered medication on a Per Required Needs (PRN) basis but it was found that in a significant number of cases it was always given as if prescribed to be given daily. Staff need to have clear instructions for giving any medication on a PRN basis to ensure that it is given appropriately. The reviews that had been carried out need to consider having a medication review with regards to the issue of always given medication on a daily basis that has been prescribed on a PRN basis. Care Homes for Older People Page 13 of 27 Evidence: We discussed with the people who live at the home how they considered they were treated by staff. They informed us that staff treat them well and are always available to help. They said that staff always knock before entering their personal rooms. They said that they get their mail unopened and staff will help them to read it should they wish. One visiting relative informed us that they considered the service given to be fantastic and the staff were very caring and considerate. They informed us that the staff will respond to any little thing that may be wrong and try and put it right. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pace of life appears to suit those who live at the home expectations and aspirations. Visitors are welcomed and individuals are assisted with maintaining contact with relatives and friends. The food is home cooked and appears to offer a balanced diet to those who live at Clifftop Evidence: People who use the service were observed in a number of different locations. They choose when to get up and when to retire. They have free access to their bedroom and communal facilities. Those who use the service are able to meet privately with visitors either in their rooms or in a designated lounge. Those who were spoken with indicated that they were happy with their life in the home and confirmed that the staff support them in following their preferred lifestyle Care Homes for Older People Page 15 of 27 Evidence: The people who live at the home informed us that there are things to do and the pace of life suits them, but at the time of the inspection no activities observed . Through discussion with people they informed us the home meets their needs, some said they enjoyed the extensive views across Swanage bay, some went out into the wider community, some enjoyed the gardens. We were also made aware that staff bring daily newspapers to the peoples rooms who wish for this service. All of the people spoke with wanted us to know how kind staff were to them and they felt confident that any assistance required would be forthcoming. One person who had just moved in expressed satisfaction with their accommodation and felt that they had started to make friends with both staff and residents of the home. Visitors were observed entering and leaving the home. All visitors were warmly welcomed. We spoke with one relative who spoke highly of the home. Peoples records and the visitors book in the entrance hall demonstrate contact with family and friends as well as visits by professionals. People we spoke with informed us that the food is home cooked and of good quality. They further informed us that there a plenty of choices with regards to food and that staff inform them of what is on the menu. Special diets are catered for where appropriate and food supplements are used where this is a recognised cause for concern. We noted that in the dining room there was a number of special sets of cutlery for those who need them along with other adaptations to make meal times as comfortable and dignified as possible. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to protect the residents living at the home. Evidence: The people who the inspector spoke with informed them that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the management and staff are very approachable and will deal with any issues, no matter how minor, there and then if they could. The management confirmed that an adult protection policy is in place with procedures detailed for contacting the appropriate authorities should any concerns or allegations be made. This policy has not changed since the last inspection, so it is advised that the policy is reviewed to ensure that it reflects the expectations of the local authority with regards to this matter. We looked at the missing persons procedure which we found to be both well thought through and informative. The staff and management who we spoke with were clear about their responsibilities with regards to adult protection and were able to identify who they should inform about any suspicions. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from comfortable and well maintained surroundings. Improvements need to be made in relation to infection control practices to ensure the safety of those who live and work at Clifftop. Evidence: Clifftop provides people who live there with comfortable, warm surroundings with a domestic, homely feel albeit a large home. We toured the premises accompanied when they first entered the home inspecting a number of communal areas. We found that the home was generally clean in all areas observed. It was noted that most toilet and bathrooms were found to be clean and hygienic. One bathroom and one toilet was not to the standard of the other facilities, the responsible individual informed us that the toilet was due to be upgraded to accommodate those with disabilities, the bathroom would also be considered for improvements in light of the inspection. In most of the bathroom areas it was noted that flannels, bars of soap and towels were available. These need to be removed and should only be brought into the bathroom whilst the person is using the facility and removed afterwards to ensure good infection control practices. It was noted that liquid soap and paper towels were available in these areas. It was further noted that the waste paper bins were not foot operated and so may also undermine infection control Care Homes for Older People Page 18 of 27 Evidence: and put people at risk of cross infection. There is evidence of investment around the home with regards to the general maintenance and decoration. One main area that has been recently refitted is the top floor communal bathroom. This area is bright and clean and contains the necessary aids to assist people when necessary. We observed that two of the fire escapes from the upper floors lead onto flat areas which had been covered with wooden decking tiles. These were in poor condition and posed a significant risk of harm in relation to slips and trips. One area above ground height appeared to be used as a roof type garden but no risk assessment was available to consider its use for that purpose. Whilst looking around the upper floors of the building it was noted that not all windows had a restricted opening and so may pose a risk of harm through people climbing out of the windows. The homes laundry provides adequate facilities but improvements need to made in order to establish good infection control practices for example the floor covering needs to be replaced so that the floor can be effectively cleaned. The home needs to review the way the laundry operates as we found areas of practice that were poor for example staff informed us that they soak soiled items in the sink, later explaining that this sink is also used for hand washing. Bedrooms are situated on all floors. There is a passenger lift to the upper floors. There is a dining room, large lounge and also a large conservatory all of which are well furnished and equipped. Aids and equipment are available for residents who may have disabilities, to help promote independence. People informed us that they are able to bring personal possessions with them into the home. We looked at a sample of the bedrooms used by people who use the service and found that they had been personalised with pictures, furniture and photographs to reflect the individuals taste. People said they enjoyed living at the home and found it to be warm, safe and comfortable. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team are knowledgeable with regards to the needs of those who use the service. There are sufficient staff on the rota to meet the current needs of the people who live at the home. Evidence: We talked with the staff on duty that were knowledgeable with regards to how to meet the needs of the people who live in the home. People who live at the home told us that staff meet their individual needs in a way that suits them. The staff files that were sampled contained sufficient detail with which to establish the prospective employees suitability for the job. These files indicate that staff have undertaken mandatory training in areas such as Moving and Handling, Food Hygiene, Infection Control and general vulnerable adults issues. Some staff have also attended various day courses and are undertaking the NVQ Award in Care at varying levels. There is evidence that staff have a formal induction into the home and its care practices. Staff stated that they enjoyed working at the home, and received appropriate support. Care Homes for Older People Page 20 of 27 Evidence: Through discussion with the staff group and by observing the people who use the service it is reasonably clear that the staff team have empathy for the people who live at the home. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team at the service provide good leadership. Opportunities for developing the staff team, through formal supervision, and in turn improving the outcomes for those who use the service are not being taken up. Environmental risk assessments need to be made to ensure the safety of those who live at the service. Evidence: The registered manager has been in post for some time now and continues to provide positive leadership within the home. The records at the home continue to be updated and kept in good order. Records inspected included care records, the complaints log, accidents, medication, staff files, rotas and the fire logbook, training records, safety checks and maintenance. Care Homes for Older People Page 22 of 27 Evidence: A tour of the premises found a generally safe and comfortable home. Fire safety equipment has been serviced and tested as required. Equipment servicing records have been appropriately maintained. However there was no environmental risk assessment. Following discussions with regards to this issue the registered manager agreed to carry out a assessment without delay. The feedback from the people who use the service confirmed that they continue to feel a sense of belonging living at the home and gave examples of how staff do that little bit extra to help out. They informed us that they can raise issues with the management, can identify who the manager is and are confident that issues are dealt with promptly and effectively. We looked at the staff files to establish the frequency of formal staff supervision and found this was erratic. The manager acknowledged that more time needs to be allocated to ensuring staff have the opportunities to discuss their own development and work. During the tour of the building it was observed that not all substances that could be potentially hazardous to health are handled and stored safely. The management acknowledged this at the time of the inspection. The records relating to what is on the premises requires to be updated to ensure that staff are clear with regards to the dangers that the substances pose. As already discussed under the environment section the home needs to ensure it keeps an up to date risk assessment of the premises Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To ensure the safety of all of those who live at the home 28/09/2009 2 26 13 The management must complete a risk assessment in relation to any unrestricted window and take appropriate action as necessary To ensure peoples contiuned safety at all times 30/09/2009 3 26 13 The management must ensure that people are not put at risk from poor infection control practices. To ensure peoples contiuned safety at all times 30/09/2009 Care Homes for Older People Page 25 of 27 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 4 36 38 The management must establish and maintain a COSHH register. To ensure the safety of those who live and work at the service. 30/09/2009 5 38 38 The management must carry 30/09/2009 out a comprehensive risk assessment of the premises and take action to minimize any established risk. To ensure the safety of those who live and work at 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 The management should ensure it records discussions regarding re-assessment of needs prior to each period of respite care. The management should consider reviewing the adult protection policy to ensure that it reflects the expectations of the local authority. The management should consider reviewing how the laundry operates to ensure peoples safety The management need to consider introducing formal recorded supervision for all staff. 2 18 3 4 26 36 Care Homes for Older People Page 26 of 27 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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