Care Home: Deer Lodge

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What the care home does well Feedback from people who use the service was positive about the staff and the care and support that they receive, with one commenting that the staff are friendly and caring. What has improved since the last inspection? At the previous inspection of the service there had been five areas where the service had to improve. The home has taken action on most of these areas which represents a generally positive response to the findings of the previous inspection and developments to the service. In particular, improvements have been made to care planning and the supervision of staff. What the care home could do better: Areas where the service could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include improvements needed to recruitment checks, the environment and policies around handling the monies of people who use the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Deer Lodge 22 Sandy Lane Teddington Middlesex TW11 0DR     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: Louise Phillips     Date: 1 1 0 8 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 27 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 27 Information about the care home Name of care home: Address: Deer Lodge 22 Sandy Lane Teddington Middlesex TW11 0DR 02089433013 02089433013 sylviab_munensa@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr S N Patel care home 14 Number of places (if applicable): Under 65 Over 65 0 14 dementia old age, not falling within any other category Additional conditions: 14 0 The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Deer Lodge is registered to provide residential care to fourteen older people. The home is a three storey building situated on a main road running along the boundary of Bushy Park close to local amenities in both Kingston and Teddington. Accommodation is provided on the ground and first floors. A large, well-kept garden is situated to the rear of the property and there is a patio area with seating, lawns and a variety of mature trees and shrubs. As the home is opposite Bushy Park, a small number of bedrooms have fine views across the nearby parkland. The fees for the service are £750 per week for privately funded residents, and £625 Care Homes for Older People Page 4 of 27 Brief description of the care home per week for those funded by social services. Care Homes for Older People Page 5 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: This inspection took place over one day by one Regulation Inspector, where care records and other relevant paperwork held at the service was inspected. Time was also spent talking to the manager and people who use the service. A period of time was also spent seeking feedback via surveys which we received from two people who use the service and four staff. The responses to the survey are referred to in the report. 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 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 7 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 8 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. People who use the service are appropriately assessed prior to moving to the home. Evidence: Prospective residents to Deer Lodge are appropriately assessed to ensure that the service is able to meet their needs. The manager and deputy manager are involved in assessing them, using the homes own assessment format that provides good information about the persons social and medical history, religious needs, interests, personal care issues and any mobilising needs. Information is also obtained about their specific sleeping habits and what they like to eat. At the start of the assessment the service receives needs assessments and care plans from the local authority and this is used to inform the homes own assessment. As part of the assessment process potential residents are invited to visit the home to Care Homes for Older People Page 9 of 27 Evidence: meet staff, people who use the service and look at the environment. People move in for an initial trial period of six weeks. Prior to the end of the six weeks a review meeting is held between the person using the service, their representative, if necessary, social worker and manager of the home to review their time at the home and for the person to decide if they want to stay. Standard 6 was not assessed during this inspection. Care Homes for Older People Page 10 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. People who use service feel they get good care, and the care planning ensures that their needs are met. Evidence: The responses to the surveys provide a valuable insight into the experience of people who use the service at Deer Lodge, along with the observations of their relatives. Responses from people who use the service are that they feel they get good care and support from the staff, that this is delivered with kindness and with respect to their privacy and dignity. One person who uses the service said that the service is ..good at attending to personal care needs.., whilst another said that the staff listen to what they say, and act upon their requests. Survey responses from staff reflect that they care about the people who use the service and are kept up to date about any changes to their needs. The care plans for three people who use the service were looked at during the Care Homes for Older People Page 11 of 27 Evidence: inspection. They contain individualised information such as communication needs, specific preferences around personal care, likes and dislikes, mobilising, and preferred times of sleeping. The care files are well-maintained, with records to demonstrate that appropriate assessment and reviews are carried out around risks such as moving and handling, dependency needs and falls. Peoples wishes about what they would like to happen when they die are also included in the care files. The manager said that the care plans are written by herself and the deputy manager, with input from the care staff and person who uses the service. People who use the service said that they are able to access the chiropodist, doctor or dentist when they need to, and that they feel their medical needs are met. Records are maintained of all appointments and visits by health and social care professionals to the service. The manager said that it is only the duty manager who administers medication at the service, and that training has been carried out in this. The medication is dispensed by the local pharmacist into Dossett boxes that are delivered to the service and checked by the duty manager once they arrive. Records are maintained of the receipt and disposal of medication, as well as the start and end dates for the medication cycle, and any short-term medications prescribed, such as antibiotics. Evidence was shown to demonstrate that the pharmacist visits the home annually to carry out a medication audit, and suggest areas of improvement for the medication systems of the service. We checked the medication system at the service, and a sample of medication records for some people who use the service. Appropriate records were maintained, including details of any allergies and a photograph of the person receiving the medication. Care Homes for Older People Page 12 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. People who use the service have the opportunity to be involved in activities. People enjoy the meals provided at the home. Evidence: Activities at the service are carried out by a member of staff. An activity programme is on display on the door to the lounge at the service, and includes activities such as quizzes, walks, dance sessions, board games and keep fit that people can get involved in. There are also details about an entertainer who recently visited the service, as well as a recent trip to the theatre. Holy Communion takes place at the service, as well as visits by the hairdresser. During the inspection we observed people playing snakes and ladders and also doing some keep fit. The manager said that a keep fit session takes place every day for fifteen minutes before lunch, to stimulate peoples appetite. It was observed that the television was not turned on in the lounge during the morning of our visit where the manager explained that, following consultation with people who use the service, it was agreed that this would not be turned on until the one oclock news, to allow time for people to interact and be involved in activities during the morning. Care Homes for Older People Page 13 of 27 Evidence: People who use the service said that there are usually always activities that they can get involved in, though one person said that they would like more trips out. This was also identified by the manager in the AQAA that she completed for the service. We observed that some people have their friends and relatives to visit, but that the only private area they could go was to their bedroom. The last inspection of the service recommended an extra area/ lounge for people to receive visitors be considered, though this has not happened. The manager informed us that the service did apply for planning permission to provide a second living room but were unsuccessful. People who use the service also told us that they like the food provided by the home. These are cooked on the premises, with a choice of two options for each meal. We observed fresh meats and vegetables in the kitchen area, as well as lists of the preferences of each person who uses the service, regarding portion sizes and how they like to have their hot drinks. Meals are served to people in the dining area of the communal lounge, where the staff join the people who use the service to have their meals, and this was seen happening over the lunch period whilst we were at the home. Care Homes for Older People Page 14 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. There are systems in place to minimise risks to people who use the service. Evidence: The service has a complaints procedure that is available in the Service Users Guide in each persons bedroom. Feedback from people who use the service is that they know how to make a complaint, and they would know who to talk to if they were not happy about something. Survey responses from staff demonstrated that they have a good awareness of how to deal with a complaint should they be approached, where they fedback that they would direct the complainant to more senior staff in the service. The home has a complaints log to record any complaints received. Since the last inspection one complaint was received by the service. It was highlighted to the manager that this was a potential safeguarding issue, and should have been reported as such as the time. Following our visit to the service the manager contacted us to say that this had been referred to the relevant local authority under their safeguarding procedures. Records indicate that staff receive training in safeguarding adults, and the home holds Care Homes for Older People Page 15 of 27 Evidence: copies of relevant local authority safeguarding procedures. Care Homes for Older People Page 16 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. The environment is welcoming and relaxed. The staff help create a calm atmosphere throughout the home. The decor and furnishings are good in most areas, though improvements are needed to ensure that equipment is appropriately stored. Evidence: People who use the service at Deer Lodge comment that the home is fresh and clean. The home accommodates fourteen people, with bedrooms spread over the three floors of the home, which are accessible by a stairlift. The bedrooms seen are each individually decorated, and people are able to bring in their personal possessions to make their room more comfortable and homely. Since the last inspection the carpet throughout the home has been replaced with wooden flooring. Whilst touring around the home it is observed that there is an issue with a lack of space throughout the service. This is identified through the one communal area being used as the lounge and dining area. Also, a ground floor bedroom, that whilst in use, was being used to store four tables and five zimmer frames of the people who were sat in the lounge. There appeared to be no area in the home for the storage of such Care Homes for Older People Page 17 of 27 Evidence: equipment, and the manager said that storage areas are an issue. The manager informed us that there is a storage area in the garden, however, on the day we visited we observed the objects listed above being stored in a residents bedroom. As identified earlier in the report, there is also no separate lounge area where people who use the service can receive their relatives and friends who visit. A recommendation has been carried forward from the last inspection of the service, whereby consideration needs to be given to finding ways to ensure more privacy for people who use the service and their relatives and friends who visit through the provision of a separate lounge. In addition, a requirement has been made for the service to provide an appropriate storage area for the table and zimmer frames, as bedrooms must not be used for this purpose. Care Homes for Older People Page 18 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 service needs to demonstrate that thorough recruitment checks are carried out to minimise risks to people who use the service. Staff receive training to enhance their skills and knowledge to meet the needs of people who use the service, though it is unclear if this is funded by the service. Evidence: Deer Lodge has a consistent staff team, some whom have worked at the home for a number of years, and who have a good understanding of the needs of the people who use the service. People who use the service were positive about the staff at the home, where they said that there are always staff available when they need them, and that they are ..helpful and supportive... Feedback from staff was also positive, where they said that they feel well supported in their work, that all staff are aware of their responsibilities, and that there is good teamwork at the service. The manager said that the home has a full complement of staff, with two care workers, plus a duty manager working each shift. The home holds recruitment information on each member of staff. We looked at the Care Homes for Older People Page 19 of 27 Evidence: files for three staff who currently work at the service. The staff files contain relevant information such as copy of application form, proof of identification, photograph and a Criminal Records Bureau (CRB) check. However, one file was found to only contain one reference for a staff member working at the service, whilst another contained two references, neither of which related to their previous employment. A requirement has been made to ensure that all appropriate recruitment information is obtained for all staff prior to their starting work. Two of the files checked did not contain a record of the interview with the staff member, and it is recommended that these are held on their file. All new staff receive an induction to the service which covers areas such as the service policies, health and safety, moving and handling and introduction to the staff and people who use the service. New staff also shadow more experienced staff for the first week of their work. Staff who responded to our survey said that they feel the induction prepared them well for their role at the home. The staff said that they get enough training to support them in their role, and that they have the right experience and knowledge to meet the needs of people who use the service. Training records indicate that staff have training in moving and handling, basic first aid, health and safety and infection control. Training in fire safety and basic life support is planned for, and evidence of this was shown to us during the inspection. A number of care staff have also achieved their National Vocational Qualification (NVQ) level 2 in Care. Each staff file contains a document titled Training Costs Agreement that details that if staff leave their employment in any period of time up to four years of having received training, then they must reimburse a percentage of the cost of this. The manager told us that this is for longer term courses only, such as a Diploma or NVQ. However, this is not indicated on the form, and the form needs to be made clearer so that staff have a clear understanding of what they are agreeing to. Care Homes for Older People Page 20 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 home is run in the interests of the people who use the service. However, the service must ensure that clearer procedures are in place for the managing of monies held for people who use the service. Evidence: There has been an acting manager at the service since August 2007 who informed us that she is now the manager and has started the process of becoming the registered manager for the home. The manager said that she is undertaking the NVQ Level 4 in Management training, and hopes to complete this by the end of the year. The feedback we received about the manager from the staff was positive, where they say that they feel well supported by her, and that this enhances the good team working at the service. One added that this is good because ..it benefits the residents... They also say that they are kept informed of any changes that affect them. Care Homes for Older People Page 21 of 27 Evidence: The manager described that the service carries out quality assurance through regular health and safety checks and reviewing of care plans. She said they also have regular meetings with residents and relatives, and staff meetings occur approximately every three months. Visits by the Responsible Person are carried out monthly, and a report maintained of these. The home holds a personal allowance for a number of people who use the service, which is funded by themselves or their family. This money is used for when the person needs to pay for chiropody or following visits by the hairdresser, etc. We were not able to properly inspect the procedures for managing peoples whilst we were at the service as we were informed by the manager that there were no monies held in the home for individual people who use the service. The manager said that residents monies are held at the head office, with cheques sent directly to the hairdresser, etc. for each person who has received their service. The manager said that she was unsure if the money is pooled into one account, whether the account(s) is interest bearing, and how this is calculated for each person. The manager provided us with a copy of the contract that people who use the service sign. Part 12 of the contract states: ..Deer Lodge will make a cheque for managing residents petty cash equal to any interest that may be earned on the petty cash were it is placed in a deposit account, ie, no interest will be paid to the resident in exchange for Deer Lodge not making a management charge for the petty cash... It would therefore appear that any interest made on peoples money is kept by the provider of Deer Lodge. It is not clear why this happens, as the Care Homes Regulations 2001, 16(2)(l) requires that services must have a place where the money and valuables of people who use the service can be deposited. A charge should not be made for this service as it is part of the services that must be provided by the Registered Person. A requirement has been made to address this. Following the service receiving our draft report the manager provided us with further information about the systems for managing residents monies. She stated that residents send cheques for the amount of petty cash they require to be held at Deer Lodge. She said that these cheques are cashed by the head office and the amount in cash put into separate accounts at Deer Lodge in a locked security cupboard. The manager stated that no charges are made for this service, and the residents do not earn any interest as the amounts are small and need to be immediately available at Care Homes for Older People Page 22 of 27 Evidence: the home. She said separate records are held for each person to record debits and credits. She stated that no cash is received as petty cash, and that staff are accountable for every credit and debit. She said that the system is as secure as possible and provides a complete paper trail that is open to scrutiny. However at the time of the inspection, and as highlighted above, we were unable to properly inspect the procedures for managing peoples monies at the service. Therefore the requirement made at the last inspection, around money not being pooled, and separate accounts to be held for each person has been restated. During this inspection we were also unable to properly inspect peoples monies held by the service and a requirement has been made to ensure that accurate records are maintained of each persons money held at the service, of all transactions and receipts maintained to evidence this. The last inspection required that staff receive individual supervision at least six times a year. Of the three staff files that we looked at one had received supervision three times during 2009, another twice and the other staff member had received this once. The manager said that supervision takes place approximately every 6-7 weeks. It is recommended that supervision is planned to take place at least every other month to ensure that staff have regular supervision, at frequently spaced intervals. The service maintains records to demonstrate that appropriate health and safety checks are carried out on the fire system and equipment, electrical installation, gas safety and Legionella testing, etc. It was observed that wedges were being used to prop open doors around the service, and it is recommended that magnetic door guards are installed to promote the safety of people who use the service. The last inspection recommended that a dishwasher be purchased for the kitchen. This has not taken place yet, and the recommendation has be restated, to ensure that crockery and cutlery is washed at suitable temperatures. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 35 16 (2) (l) Residents finances must not be pooled and the home must look at organising separate accounts for them. 01/12/2007 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 18 13 Any allegations of abuse must be reported to the local authority immediately. To ensure that people who use the service are safeguarded from any abuse. 10/09/2009 2 22 23 The service must not use peoples bedrooms for the storage of furniture and zimmer frames, and alternative storage facilities must be used for this purpose. To ensure the privacy and dignity of people who use the service. 10/09/2009 3 35 16 The service must ensure that people who use the service can deposit their money and valuables in a safe place without a charge being made for this service. 10/09/2009 Care Homes for Older People Page 25 of 27 To ensure people who use the service have what they are entitled to. 4 35 16 Accurate records must be maintained of each persons money held at the service, and of all transactions and the receipts maintained to evidence this. So the service can demonstrate that they are handling peoples money properly 10/09/2009 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 Consideration should be given to finding ways to ensure more privacy for people who use the service and their relatives and friends who visit, through the provision of a separate lounge area. The manager should submit a full application to be registered manager to the Commission. Supervision should planned to take place at least every other month to ensure that staff have regular supervision, at frequently spaced intervals. Consideration should be given to the purchase of a dishwasher to ensure crockery and cutlery is washed at suitable temperatures. It is recommended that magnetic door guards are installed to promote the safety of people who use the service. 2 3 31 36 4 38 5 38 Care Homes for Older People Page 26 of 27 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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