Care Home: Cloughton Beeches

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What the care home does well People have a full care needs assessment prior to admission and are encouraged to have day care or respite care at the home to help them to make a decision about permanency. People living at the home tell us that the meals are good. Care plans are a good record of the capabilities and needs of the individual concerned and are kept up to date. The home is well maintained and well furnished; the lounge and dining room have recently been refurbished. We observed that there is a good rapport between people living at the home and staff, and that this creates a relaxed atmosphere. What has improved since the last inspection? No areas for improvement were identified at the last key inspection. What the care home could do better: Any handwritten entries made on medication administration records must be witnessed by two staff to ensure accuracy. Medication administration records should include codes for staff to record when medication is not given, so that recording is consistent. Records evidence that some staff have commenced work at the home prior to the receipt of two written references and a Protection of Vulnerable Adults (POVA) first check. This leaves people at risk of harm. There must be a training and development plan in place that records the training achievements and needs of staff to evidence that the staff group is well trained and able to meet the needs of people living at the home. People handing money to the home for safekeeping on behalf of people living there should be issued with a receipt; this helps to avoid any discrepencies in financial records. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cloughton Beeches Mill Lane Cloughton Scarborough North Yorkshire YO13 0AB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Wilkinson     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Cloughton Beeches Mill Lane Cloughton Scarborough North Yorkshire YO13 0AB 01723870017 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): suepudney@tiscali.co.uk Mr James Pratt Lawson,Mrs Susan Clare Kennedy,Mr Nigel Jeremy Lawson,Mrs Doreen Lawson,Mr Michael Ia care home 8 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Cloughton Beeches is a care home that is registered to provide care and accommodation for up to 8 older people. The home is a semi-detached property that has been extended for use as a care home. It is situated in the village of Cloughton in North Yorkshire. The accommodation for people who live in the home is situated on the ground and first floors. Access to the first floor is facilitated by a stair lift. There is a mezzanine area with three bedrooms that is accessible only by people who are able to negotiate steps. The home is set in a pleasant garden with an abundance of established plants and mature trees. Car parking is available at the front of the property. Care Homes for Older People Page 4 of 28 Brief description of the care home A copy of the service users guide is given to people that wish to consider living in the home and a copy of the latest inspection report is available for people to read. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 8th May 2007, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 10.30 am and ended at 4.30 pm. On the day of the site visit the inspector spoke with people living at the home both as a group and on a one to one basis, as well as to the staff on duty and the registered manager. Inspection of the premises and close examination of a range of documentation, including two care plans, was also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the Care Homes for Older People Page 6 of 28 service. As part of the inspection process we sent survey forms to some of the people living at the home and to staff; six were returned by people living at the home and three were returned by staff. Responses in surveys and comments from discussions with people on the day of the site visit were mainly positive, and some will be included throughout the report. On the day of the site visit the registered manager told us that accommodation fees at the home are currently from £437.80 to £483.00 per week. At the end of this site visit, feedback was given to the registered manager on our findings, including requirements and recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Care Homes for Older People Page 9 of 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a full care needs assessment prior to their admission to the home and are only offered a place if it is considered that their needs can be met. Evidence: Each person living at the home has a full care needs assessment prior to their admission to the home and information is obtained from the local authority when they commission the placement. This information, together with information gathered from family, friends and health care professionals, is used to develop an individual plan of care. On the day of this site visit, two people visited the home to look around - they were looking for a care home for a relative to move into; this was their second visit to the home. The senior carer on duty told us that she and the manager would be visiting this person in their current place of residence to undertake a care needs assessment to confirm that their needs could be met by staff at the home. All of the people living at Care Homes for Older People Page 11 of 28 Evidence: the home told us in surveys that they received enough information about the home before they moved in to assist them in the decision making process. There is no intermediate care provision at the home. Care Homes for Older People Page 12 of 28 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 are a good record of a persons abilities and needs and how these are met by staff, including health care needs. A persons need for privacy and dignity is respected by staff. Evidence: Each person living at the home has an individual plan of care - this is a thorough record of a persons capabilities and needs for assistance. A monthly review is undertaken and a new care plan is produced that includes any required changes. A formal review is arranged by Social Services when they commission the placement. Daily records reflect the information recorded in individual care plans and are a thorough record of how someone has spent their day, their food intake and their physical and emotional well being. Each care plan includes a record of individual risk assessments - everyone has a general risk assessment for falls, trips and slips and fire safety, and then there are more individual risk assessments for areas such as skin infections. There is currently no key worker system in place at the home. Due to the small number of people accommodated and the small and consistent group of staff, Care Homes for Older People Page 13 of 28 Evidence: this is not creating any concerns. We saw in care plans examined that a record is kept of all contacts with health care professionals, including the reason for the contact and the outcome. We noted that advice is sought from health and social care professionals as needed. When asked what the home does well, a member of staff told us, give a happy, safe and relaxed environment for residents. Showing care and respecting each individuals needs. Medication is received from the pharmacy at the GPs surgery, which is very close to the home. The manager records this information on to a medication administration record (MAR) sheet, as a sheet is not provided by the dispensing pharmacist. MAR sheets are typed and printed, and only entries made when additional medication is prescribed during the week are hand written. Staff were advised that two staff should sign any hand written records to avoid mistakes being made when information is transferred from the original container on the the MAR sheet. Similarly, it would be good practice for a second person to check the information recorded on the MAR sheet by the manager, to avoid mistakes being made. MAR sheets seen on the day of this site visit had been completed accurately, although we recommend that codes should be printed on the MAR sheet to indicate what should be recorded when medication is not given; this would ensure that all staff use the same codes and that the medication records are accurate account of why medication was not given. Medication is stored in a cupboard fixed to the wall in a corridor that leads to the kitchen, the staff area and one persons bedroom. This area is used very little by visitors. Although it would be preferable for medication to be stored out of sight of visitors and others, this is a small home so the current storage arrangements create a minimal risk. None of the residents are currently prescribed controlled drugs; we discussed the storage and recording arrangements that would be needed should these be prescribed in the future. Staff that administer medication have undertaken medication training and the manager told us that a further training course has been arranged for staff this month. On the day of this site visit we observed that staff treat people living at the home with dignity and that privacy is respected. People that we spoke to on the day confirmed this. All residents have a single room so they are able to see visitors in private, and there is a small room at the rear of the property that can be used by people for private meetings. Care Homes for Older People Page 14 of 28 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. Family and friends are made welcome at the home, and people are encouraged and supported to be involved in the local community and to live their chosen lifestyle. Meal provision at the home is good. Evidence: Care plans record a persons family history, previous lifestyle and interests. People living at the home are from the local area and so are most staff that work at the home; this enables people to keep in touch with events in the local community. People told us that they are supported to keep in touch with family and friends, and that their visitors are made welcome by staff, including being offered refreshments. Some people have their own telephone to assist them in keeping in touch with relatives and friends. There are currently only six people living at the home; this gives staff the opportunity to spend one to one time with people, although the manager has recorded in the AQAA that they would like to have more time to take people out individually. The provider takes people out in the car and people told us that they enjoy these trips out. People that returned a survey told us that there are activities at the home that they can take part in, and daily records detail such activities as manicures, foot spas and outings. Care plans evidence that people are supported to be as independent at possible and Care Homes for Older People Page 15 of 28 Evidence: that they are encouraged to exercise personal autonomy and choice. People are able to bring personal possessions (including items of furniture) into the home. There is information about advocacy services displayed on the notice board - access to this information without having to ask for it enables people to retain independence and choice. There is a four week menu in operation and staff told us that this is sometimes changed following suggestions made by people at the residents meeting and to reflect the seasons. The menu was displayed on the notice board. Staff told us that they know the likes and dislikes of people so they provide an alternative to the main meal on offer when this is appropriate, rather than having an alternative meal recorded on the menu. Six people returned a survey to the CQC; when asked if they like the meals at the home, three people responded always and three people responded usually. One person added, Sunday lunch is the best meal of the week - always good. Meals during the week tend to be mediocre. We noted that two people chose to take their meals in their room and that the other four people sat together at the dining room table; they told us that they had enjoyed their lunch and that meal provision at the home was good. The menu was displayed on the notice board. Care Homes for Older People Page 16 of 28 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. People are protected from harm by the policies and procedures in place and by staff training. People tell us that they know how to make a complaint and that they are confident any complaints would be handled professionally. Evidence: All of the current residents returned a survey and all told us that they know how to make a complaint. When asked if they know who to speak to if they are unhappy, three people responded always and three people responded usually. People that we spoke to on the day of the site visit told us that they are confident that any concerns or complaints expressed by themselves would be dealt with well by staff at the home. All of the staff told us that they know what to do if anyone has any concerns about the home; one staff member added, We have policies in place to deal with any concerns or complaints. We examined the complaints log and noted that there had been only one complaint made to the home in the last ten years. The complaint recorded was recent and records evidenced that it had been dealt with well by the registered manager and that the complainant was satisfied with the outcome. The manager told us that everyone who enquires about the home is given a brochure and a copy of the complaints procedure. We suggested that a copy of the brochure (including the complaints procedure) could be placed in each bedroom so that everyone living at the home and their visitors have access to this information. Most staff at the home have undertaken training on safeguarding adults from abuse, Care Homes for Older People Page 17 of 28 Evidence: either as part of NVQ Level 2/3 training, induction training or specific training on the topic. The manager told us that all staff will be doing this training again this year i.e. Level 1 Alerter training provided by North Yorkshire County Council. Discussions with staff evidenced that they understand the principles of safeguarding adults from abuse and would not hesitate to take action if they observed or suspected an abusive situation. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained in a clean and hygienic condition and is well decorated and furnished. Staff follow good hygiene practices. Evidence: The home was clean and hygienic on the day of the site visit and we noted that there was a notice to inform people about the importance of infection control at the entrance to the home. All of the people living at the home returned a survey and they told us that the home is fresh and clean; one person added, the home is cleaned very well daily and is kept up to date as much as possible. We saw that bedrooms were well furnished and were a reflection of the person occupying the room. The home was generally well maintained; the living/dining room has recently been refurbished and is now decorated and furnished to a high standard. We noted that all windows had window boxes filled with spring flowers - the manager told us that people living at the home help to choose the plants and then plant up the window boxes. One member of staff recorded in a survey when asked what the home does well, We really try to make it a real home from home. There were slight odours in one or two bedrooms but it was evident that these issues were being dealt with by staff. There were no unpleasant odours in communal areas of the home. There was a notice about infection control at the entrance to the home as well as a container of disinfectant for people to use. We observed that staff followed Care Homes for Older People Page 19 of 28 Evidence: good hygiene practices on the day of this site visit. Laundry facilities are domestic in nature and suitable for the number of residents currently living at the home. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive various training opportunities but there is no training and development plan to record the training achievements and needs of the full staff group. Some staff have commenced work at the home before all safety checks are in place and this leaves people living at the home at risk of harm. Evidence: We saw the staff rota on the day of this site visit. This evidences that there are always two staff on duty; during the night this consists of one waking member of staff and one sleep in member of staff. The registered manager is on duty in addition to the two care staff. Staff told us in surveys that they think that there are enough staff on duty to meet the individual needs of the people living at the home. There are no ancillary staff employed at the home so care staff are responsible for domestic and catering duties in addition to care duties. Extra care should be taken with managing the risk of cross infection in these circumstances. The recruitment records for three members of staff were checked on the day of this site visit. Appropriate application forms are completed by staff but some other information was missing from staff records. Two people had only one written reference in place and there was no evidence of a POVA first check or CRB check in place for two of these staff members. The manager assured us that this information had been obtained and agreed to forward the information to the Care Quality Commission. Care Homes for Older People Page 21 of 28 Evidence: However, no information has been received as yet. In the case of the other person, records evidenced that they commenced work prior to safety checks being in place. The manager was advised to record start dates for new staff. This will make it easier to confirm that information to verify a persons suitability for their post is in place prior to them commencing work. Three of the ten care staff have achieved National Vocational Qualification (NVQ) Level 3 in Care and two care staff are currently undertaking NVQ Level 2 in Care. Records are held of the training achievements of individual members of staff but there is no training and development plan in place that records the details of the training achievements and needs of the full staff group, including induction training and NVQ training. Although some Induction training does take place, there is no evidence that this meets the Skills for Care requirements. The manager told us that this Induction training information is going to be used in the future. Staff surveys and discussions with staff evidence that they feel that they receive adequate training that enables them to carry out their role effectively. We saw evidence that some training had been booked via the University of York and that this was due to take place in May 2009, i.e. First Aid, Medication and Moving and Handling. The manager told us that she and a senior carer had attended training on palliative care at the end of last year and that they planned to cascade this training to the rest of the staff group. The manager agreed to forward a copy of a training and development plan to the CQC but this has not been received. Care Homes for Older People Page 22 of 28 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 home is well managed and there are systems in place to protect the health and safety of people living at the home as well as staff and visitors. The quality assurance systems in place allow people to affect the way in which the home is operated. Evidence: The manager has achieved National Vocational Qualification (NVQ) Level 3 in Care and is working towards a NVQ Level 4 qualification. She told us that she has started this training programme on several occasions but each time the training company has gone out of business. The manager and a senior carer have recently attended training on palliative care and intend to cascade this information to the rest of the staff group. To keep her practice up to date, the manager uses the CQC website, attends the PCT Care Forum bi-monthly and attends Care Group meetings. On the day of this site visit we observed that there was good rapport between the manager and the staff group. The home previously achieved the Investors in People award but they have not renewed this due to the high cost involved. There is a quality assurance system in Care Homes for Older People Page 23 of 28 Evidence: place that includes surveys being sent out to the people living at the home and their relatives. In addition to this the manager met with all relatives individually when the accommodation fees were last increased and used the opportunity to update them on their relatives well-being. The manager told us that information received in surveys is collated; any action points are dealt with and people are given feedback. This information should be used to formulate an annual development plan that records future plans for the home. Residents meetings are held and the minutes of the last meeting evidenced that activities and the provision of meals were discussed - changes were made to the menu as a result of suggestions made. Staff meetings are held every month and minutes evidenced that the care provided to all people living at the home is discussed; minutes are then signed by all staff working at the home. We saw that the home had received letters from relatives thanking them for the care provided, especially in respect of end of life care. Money is held in safekeeping for people - we examined some of the monies held and the associated records. We noted that receipts are obtained for any purchases or expenditure made on behalf of residents. We recommend that, when relatives hand money over for safe keeping, they are given a receipt to evidence this. We checked the fire safety records held in the home. In house tests take place consistently on a weekly basis and we noted that these tests include a check on automatic door closers. An annual fire safety test had been undertaken by a qualified contractor. All mobility equipment had been tested in September 2008. Water temperature tests take place on a regular basis and we noted that water temperatures are maintained at recommended temperatures. Accidents are recorded in the accident book appropriately and we advised the manager that any accidents that require medical intervention should be referred to the CQC under Regulation 37 of the Care Homes Regulations 2001. Staff have received some training on safe working practice topics and some refresher training has been booked for May 2009 i.e. moving and handling and first aid. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 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 26 19 Staff must not commence work until all safety checks are in place i.e two written references and a Pova first check or CRB check. This is to ensure that only people considered safe to work with vulnerable people are employed. 30/06/2009 2 26 18 There must be a training 30/06/2009 and development plan in place that records the training achievements and needs of the full staff group. This is to ensure that staff have the skills and competencies to meet the needs of the people living at the home. 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 Care Homes for Older People Page 26 of 28 1 9 Codes should be printed on the MAR sheet to guide staff on the information to be recorded when medication has not been given. This will result in an accurate record of why medication has not been given. Two staff should sign the Medication Administration Record (MAR) sheet to record that the information transferred from the original packaging to the MAR sheet by the manager is accurate. Similarly, two staff should sign any hand written entries made on MAR sheets to reduce the risk of mistakes being made. It would be good practice to place a copy of the homes brochure (including the complaints procedure) in each bedroom so that everyone living at the home and their visitors always have access to this information. The manager should continue with National Vocational Qualification (NVQ) training at Level 4. Information gained from quality assurance surveys should be used to formulate an annual development plan for the home. This allows people living at the home and others to affect the way in which the home is operated. Receipts should be issued when relatives or friends hand money to the home for safe keeping. This protects all parties concerned from any misunderstandings about finances. 2 9 3 16 4 5 31 33 6 35 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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