Care Home: Darley Hall

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What the care home does well People told us they always received the care and support they needed at the home. They said "I`m very well looked after here", and, "well satisfied with the care". A relative said that people in the home were "treated with kindness, patience and dignity". Visitors to the home commented on the friendly and welcoming atmosphere. There was a low turnover of staff at the home and many staff had worked there for several years. 9 out of 14 care staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard of 50% of care staff with the qualification. What has improved since the last inspection? The 3 requirements made at the last inspection had been met by improvements to the cleanliness of the home, staff training in first aid, and ensuring the safety of people in the event of a fire. The care plans had been developed to provide more detail of individual preferences and to ensure the privacy and dignity of people living in the home was promoted. A programme of refurbishment had started at the home to refresh and improve the environment for people living there. What the care home could do better: Provide a statement of the terms and conditions of living in the home to each person living there. This will give people more information about the service provided by the home. Provide an area of the garden that is private and well maintained so that people in the home can safely enjoy sitting outside when they wish to. Have a more structured approach to ensuring all areas of the home are kept clean and consider employing staff specifically for cleaning duties. This will help to ensure a safe and pleasant environment for people living in the home. Ensure that all the required information and documents are in place for newly recruited staff, and that new staff are appropriately supervised if they are allowed to start work before a Criminal Records Bureau (CRB) disclosure is in place. This will ensure a more robust recruitment system that protects people in the home. Develop policies to demonstrate how the requirements of the Mental capacity Act 2005 will be implemented in the home, including how staff will become conversant with this legislation and their roles and responsibilities. This will ensure that people`s rights are promoted and upheld. Key inspection report Care homes for older people Name: Address: Darley Hall Park Lane Two Dales Matlock Derbyshire DE4 2SD     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: Rose Moffatt     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Darley Hall Park Lane Two Dales Matlock Derbyshire DE4 2SD (01629)735770 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alison Treasure,Ms Glenis Pamela Wright,Mr A Wright,Mr David John Treasure Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One DE(E) place for the service user named in the notice of proposal letter dated 28 October 2005. The home accommodates one named individual named in the notice of proposal for the duration of their stay. Date of last inspection Brief description of the care home Darley Hall is a converted Georgian building, built around 1796 and set in extensive grounds. This established care home provides accommodation and personal care for up to 22 older people. The accommodation is on three floors, with a passenger lift to the first and second floors. There are 17 single bedrooms and 3 shared. 10 bedrooms have Care Homes for Older People Page 4 of 28 Over 65 22 0 2 1 0 4 2 0 0 9 Brief description of the care home en-suite facilities. There are two main lounge areas and a dining room on the ground floor. The fees are £395 - £410 per week, according to the needs and care required following individual assessment. This information was provided by the acting manager on 14/04/2010. Information about the home, including CSCI/CQC inspection reports, is available in the main entrance area of the home, or from the acting manager. 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: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we Care Homes for Older People Page 6 of 28 have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over 5.5 hours on 14/04/2010. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 4 completed responses. We sent out 10 surveys to staff employed at the home and received 4 completed responses. There were 13 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The acting manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 3 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. Care Homes for Older People Page 7 of 28 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. Care Homes for Older People Page 8 of 28 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 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. There were effective procedures in place and relevant staff training to ensure that peoples needs were properly assessed and could be met at the home. Evidence: People told us they always received the care and support they needed at the home. They said Im very well looked after here, and, well satisfied with the care. Staff told us they always had enough up to date information about the needs of the person, and relevant training to meet those needs. We looked at the records of 3 people in the home. All had assessment information obtained before admission to the home giving details of their needs. People or their relatives were asked if they had a Lasting Power of Attorney or living will/advance directive in place. The capacity of each person to make decisions about their care was not assessed as part of pre-admission or admission procedures. The manager was aware of the Mental Capacity Act 2005 and had copies of the relevant codes of Care Homes for Older People Page 11 of 28 Evidence: conduct, but had not started using these as she and the staff had not had training. People were not provided with a statement of terms and conditions when moving into the home. Standard 6 did not apply as there were no people in the home receiving intermediate care. The AQAA said that information was always obtained from a pre-admission assessment and from the persons care manager to ensure that their needs could be met at the home. They planned to improve by supporting senior care staff to become more involved in pre-admission assessments. Also, by encouraging relatives to be more involved in care planning, and keyworkers to develop stronger relationships with people in the home and their representatives. The AQAA gave the required statistical information about people in the home and their needs. 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. There was a focus on the delivery of individual personal care so that people received the care they needed in the way they preferred, and their dignity was promoted. Evidence: People told us they always had the care and support they needed, including medical care. People said they had access to their GPs when necessary and to other healthcare services, such as the District Nurse and chiropodist. People said their privacy, dignity and personal choices were respected by staff. A relative said that people in the home were treated with kindness, patience and dignity. We looked at the care records of 3 people. Each had an individual care plan that had details of the action required by staff to meet the persons needs. Two of the care plans lacked detail in some areas and none had specific details of the care required by the person during the night. The care plans had all been regularly reviewed. Each person had assessments of their needs regarding manual handling, nutrition, risk of falls, and risk of developing pressure sores. A mini mental state examination Care Homes for Older People Page 13 of 28 Evidence: assessment had been carried out for each person, though there was no assessment made of their capacity to make decisions about their care. Records showed that health concerns were promptly referred to the persons GP and their subsequent treatment and progress were noted. The daily records were generally informative and showed that peoples needs were met, though some entries about night care lacked detail and were repetitive. Record keeping did not always follow current good practice guidance. Medication was stored securely in the home. The medication administration records we looked at were correctly completed. Staff who administered medication had all received relevant training. The AQAA said that particular emphasis is given to the personal care needs of the service users and also to providing maximum dignity and independence. 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. There was a suitable range of activities offered, flexible routines, and wholesome meals provided so that the lifestyle in the home met the needs and expectations of people living there. Evidence: Most people told us there were activities arranged in the home that they could take part in if they wanted to. People told us they could follow their preferred routines, such as getting up and going to bed when they wanted to. Most people said they always enjoyed the meals at the home. The care records we looked at had details of the persons family and social history, plus information about their likes and dislikes and preferred daily routines. The manager said they had started to compile a This is my life booklet for each person to give more detail. Activities offered at the home included local trips out over the summer months, visiting musicians, arts and crafts, and games. A local vicar visited the home every 2 weeks. The children from a local school were involved in fund raising for the home. Care Homes for Older People Page 15 of 28 Evidence: People in the home and their relatives told us they would like to be able to make more use of the grounds of the home, but were restricted by lack of safe and easy access. People could choose to use the dining room for meals or could eat in the lounges or their own rooms. The dining room appeared dull as it was not well lit and there were overgrown shrubs outside the window. The manager said that the shrubs were due to be cut back and the dining room was to be redecorated in a lighter colour. The menu for the day was on a large whiteboard in the main lounge. The meal served during the inspection visit appeared appetising and people said they had enjoyed it. We observed that people were given appropriate help by staff with eating and drinking. The AQAA said that people in the home and/or their representatives were consulted about what activities and meals they would like. They said they had improved by having a member of staff taking responsibility for organising activities. 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. There were suitable systems in place and good staff awareness so that people were protected and their complaints effectively dealt with. Evidence: People told us they knew who to speak to informally if they were not happy and they knew how to make a formal complaint. People said they would take any concerns to the staff or the manager and were confident that appropriate action would be taken. The complaints procedure was displayed in the main entrance area and was also available in the Service User Guide. No formal complaints had been received by the home or by CQC since the last inspection. The complaints records showed that one verbal complaint had been received and appropriately responded to. There were suitable policies and procedures in place regarding safeguarding vulnerable adults. Most of the staff had received relevant training, except for 2 newly recruited staff. Staff knew the correct procedures to follow if abuse was suspected or alleged. The AQAA said the complaints procedure was explained to people and their relatives when they first moved into the home. The AQAA said the home planned to improve by ensuring that all staff had update training about safeguarding vulnerable adults. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although improvements had been made, there were some lapses in cleanliness and no safe, private area of the garden for people to use, which impacted on the quality of life of people in the home. Evidence: People told us the home was usually fresh and clean. People said they liked their bedrooms and were pleased they had been able to bring in their own furniture and other items. People said they would like to see improvements to the decor inside the home and to enable them to have safe use of the garden. A programme of improvements to the home had been started since the last inspection. This included the installation of a permanent ramp to allow easier access to the front door, redecoration of the ground floor hallway and main lounge, and refurbishment of some bedrooms. Further improvements were planned. The entrance hall of the home was used as a smoking area for people living in the home. This did not comply with smoke-free regulations. The bathrooms were in need of refurbishment. There were toiletries, disposable razors and prescribed topical creams left out in 2 bathrooms. These were removed during the inspection visit when brought to the attention of the manager. There were toilet Care Homes for Older People Page 18 of 28 Evidence: brushes and holders in several bathrooms and toilets that appeared to be contaminated by faeces. The home was free from offensive odours on the day of the inspection visit and generally appeared clean. The windows appeared dirty and some higher areas were dusty and cobwebbed. Although no cleaner was employed, care staff had been able to take on more cleaning duties since the employment of a full-time cook. Staff had received training about infection control and were aware of correct procedures to follow to reduce the risk of spreading infection in the home. The AQAA said that the home was kept clean, tidy and free from smells. The AQAA acknowledged that further work was needed to improve the decor and furnishings of the home. Care Homes for Older People Page 19 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 recruitment procedures were not sufficiently robust to ensure that people were protected. Evidence: People told us staff were always available when needed. They said that staff usually listened to them and acted on what they said. People said the staff were always patient and kind. Visitors told us I never hear a raised voice or harsh words from staff, and, theyre friendly, were always made welcome. We looked at the records of 2 members of staff. Both records were missing some required documents and information. The manager was able to give verbal explanations to fill some of the gaps, but this information had not been recorded in the staff files. There was no formal system in place to supervise new staff who had started work before a Criminal Records Bureau (CRB) disclosure was in place. The induction programme for new staff had not met Skills For Care standards, but the manager said she was about to start a new induction programme that did meet these standards. Care Homes for Older People Page 20 of 28 Evidence: Staff training was mostly up to date in required areas, such as fire safety, manual handling, and health and safety. Most staff had received training in safeguarding vulnerable adults, except for newly recruited staff. Staff had received training to meet the specific needs of people in the home, such as training about dementia, challenging behaviour, and falls awareness. 7 out of 10 care assistants had achieved a relevant National Vocational Qualification (NVQ) at level 2, and 4 of these had achieved NVQ level 3. The AQAA showed there was a low turnover of staff at the home. The AQAA said the home could do better by employing a cleaner so that care staff would have more time to spend with people living in the home. Care Homes for Older People Page 21 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 was effectively managed and there were satisfactory systems in place so that the health, safety and welfare of people was promoted and protected. Evidence: People told us they were well satisfied with the home and had no complaints about the service they received. A relative told us The manager is hard-working and efficient and always ready to discuss matters relating to (person in the home). The manager had been in post for about 4 years and was suitably experienced and qualified to run the home. She had recently started the application process for registration with CQC. As reported at previous inspections, the manager was allowed little supernumerary time to fulfill her managerial responsibilities as she was usually included in the staffing levels. The manager had completed the AQAA. The information in the AQAA gave a reasonable picture of the current situation in the home. More detail would have been Care Homes for Older People Page 22 of 28 Evidence: useful of how they were planning to improve the service provided. The data section of the AQAA was fully completed and showed that maintenance and servicing of equipment and systems was up to date. Annual quality assurance surveys were given to people in the home and their representatives. A report had been compiled by the manager of the analysis of the surveys from 2010 and the action taken to meet issues raised. The report showed that people were generally satisfied with the service they received. The report had not been made available to people in the home and visitors. The personal money of people in the home was securely kept with records of all transactions. Since the last inspection, most staff had received training in first aid. Staff training in health and safety and manual handling was mostly up to date. We found that accident records were completed as necessary. Appropriate action had been taken where a person had frequent falls reported. There was no formal audit of accidents in the home. Care Homes for Older People Page 23 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 24 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 2 5 Each person living in the 30/06/2010 home must be provided with a statement of the terms and conditions of living at the home. This will ensure that people are fully informed about the service provided. 2 29 19 The required documents and 31/05/2010 information must be in place for each person employed at the home. This will ensure a more robust recruitment system that protects people living in the home. 3 29 19 Where new staff are 31/05/2010 permitted to start work before a Criminal Records Bureau (CRB) disclosure has been obtained, there must be a system in place to ensure new staff are properly supervised. Care Homes for Older People Page 25 of 28 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 This will help to protect people living in the home. 4 30 13 All staff must have training 30/07/2010 to ensure they understand how to safeguard vulnerable adults. This will reduce the risk of abuse to people in 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 1 19 There should be an external area that is private and well maintained so that people in the home can safely enjoy sitting outside when they wish to. There should be a more structured approach to ensuring all areas of the home are kept clean with consideration given to employing staff specifically for cleaning duties. This will help to ensure a safe and pleasant environment for people living in the home. The acting manager should have sufficient supernumerary time to ensure she can carry out the necessary administrative and managerial tasks for the smooth running of the home. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. The quality assurance report compiled by the home should be made available to people living in the home and their Page 26 of 28 2 26 3 31 4 33 5 33 Care Homes for Older People 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 representatives. This will ensure that people know their views are taken seriously and appropriate action taken to address any issues raised. 6 37 Records should be kept in line with current good practice guidance. This should include leaving no gaps between entries in daily reports. This will help to protect people in the home. Guidance should be sought from the local authority to ensure that the home complies with smoke free legislation. This will ensure a more safe and pleasant environment for people living in the home. There should be a regular audit of accident reports to find any trends or patterns in the type and frequency of accidents. This would highlight issues and show where action was needed to reduce the risks to people in the home. 7 38 8 38 Care Homes for Older People Page 27 of 28 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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