Care Home: Down Hall Residential Home for the Elderly

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What the care home does well Residents are happy living at Down Hall. Their comments included `I feel happy and safe here and could not be happier`, `the staff respect my wishes` and `the staff are polite and caring`. The home benefits from having a stable staff team, who know the residents very well and have their best interests at heart. Residents are happy with the food provided at the home and the choice provided. The home has recently been refurbished to a high standard and the residents are very happy with the facilities offered. Residents are consulted regularly about the services provided in the home and their comments are acted upon. What has improved since the last inspection? Since the last inspection the home has undergone a major refurbishment and this has brought the home up to a good standard. The manager has been on extended leave and this has restricted the development of other areas in the home, mainly in relation to record keeping. What the care home could do better: The main area that requires work is the record keeping in relation to the care planned and provided for residents. The records need to evidence a better assessment, planning and evaluation process. In saying this, there are no concerns regarding the standards of care at the home. The activities programme should be developed further in order to optimise residents and ensure their individual needs are met. The storage facilities for controlled medications remains outstanding but a new storage room is in the process of being built. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Down Hall Residential Home for the Elderly Down Hall Road Bradwell On Sea Southminster Essex CM0 7QP     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 Roberts     Date: 2 9 0 6 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: Down Hall Residential Home for the Elderly Down Hall Road Bradwell On Sea Southminster Essex CM0 7QP 01621776509 01621776700 downhallcare@tiscali.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) : Mansion House Retirement Home Ltd care home 34 Number of places (if applicable): Under 65 Over 65 22 12 dementia old age, not falling within any other category Additional conditions: 0 0 Persons of either sex, aged 65 years and over, who require care by reason of old age and dementia (not to exceed 22 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 12 persons) The maximum number of service users who can be accommodated is: 34 Date of last inspection Brief description of the care home Down Hall is a large period detached property set in a rural position approximately a quarter of a mile from the village of Bradwell. The home is set within three acres of private grounds and provides ample space for parking at the front of the property. Down Hall is registered to provide care to twenty elderly people (over the age of sixtyfive). The properties rural location lends itself to providing a peaceful and relaxing environment. A bus service stops close to the home, which provides a link to the Care Homes for Older People Page 4 of 27 Brief description of the care home railway station in Southminster and local towns, including Maldon and Chelmsford. The current fees for the home are from £390.80 to £570.00. Additional charges are made for toiletries, newspapers, hairdressing etc. 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: We visited the home for a whole day and met with the manager. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think they are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to two residents and 3 staff at the home and prior to that we sent out surveys to residents, relatives and staff, asking for feedback on the home. The response was good and these comments are referred to in the report. Whilst at the home we also reviewed a range of records and undertook a tour of the home. During the tour of the home it was possible to meet with the proprietor who was able Care Homes for Older People Page 6 of 27 to update us with regard to the current building and refurbishment works underway. 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 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would be properly assessed prior to admission and have all the information they needed about the home. Evidence: The manager has a welcome pack in place, which at the current time primarily consists of the service users guide. This was reviewed and contained some good details, including local information and maps, which was very positive. There were some gaps in the required information and the manager was aware of this and the need for an overall review. The manager said that all new residents have welcome card and flowers or a plant put in their room when they arrive as a small gift, including respite residents. In reception the service users guide, homes brochure, local information and the last inspection report are available. The manager has a pre-admission assessment system in place. Either the manager or Care Homes for Older People Page 10 of 27 Evidence: her deputy go out to complete any assessments, sometimes they go together. Two recently completed assessments were reviewed. Overall the assessments were completed to a satisfactory standard and contained some person centred information on, for example, social interests and personal preferences regarding personal care. This aspect of the assessment could be developed further to help ensure a person centred approach to the provision of care and care planning. The assessors need to ensure that they sign the assessment to evidence that a suitably experienced person is carrying these out. In some sections more detail is needed, for example under physical health and personal care, one assessor had written Parkinsons disease which does not indicate the residents abilities or the level of support that may be needed. The manager in her AQAA said that they could do better by continuing to ensure that the pre-admission assessment is fully comprehensive and we would concur with this. Records were available to show that prospective residents had been written to prior to admission to confirm that the team at the home would be able to meet their needs. There was evidence in the records that people had been invited to visit the home and that they had visited and spent time, prior to making any decisions. Residents spoken to about their admission to the home said I have settled in well to the home and I have seen a guide in the hallway. Admission assessment records showed that residents had been offered choices regarding, for example, the type of bedding that they wanted. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive an individual approach to their care and generally experience good outcomes. Evidence: The manager has a care planning system in place. Two care plans were reviewed in full and discussed with the manager. Overall the care planning system requires work and the manager and the care staff are fully aware of this. However, from discussion with residents, staff and from surveys, it is clear that outcomes for residents are generally good and that they are happy with the care provided. Whilst the care planning system overall, contains insufficient information about the residents at the current time, the staff spoken to knew the residents very well, spoke in a person centred way about them as individuals and were very focused on their welfare. Assessment information gave a generally good picture of their needs and abilities but actual care plans outlining the actions to be taken or support given to address these needs were not all in place, for example for nutrition and weight loss management, Care Homes for Older People Page 12 of 27 Evidence: diabetes and pain management. Consideration should be given to updating the assessment information as some residents had assessments in place that had been completed in 2007. Those care plans seen need to contain more detail to sufficiently guide staff and be more person centred in their approach. The assessment information often contained some management advice which should be outlined in the actual care plan. Staff also need to be aware in the care records and planning, of identifying residents abilities more and promoting independence and, the retention of skills and therefore self worth, although they do discuss this verbally. From discussion with staff on the care needs of residents, it was also clear that some of the care plans did not accurately reflect the current needs of the residents, for example, one care plan stated that a resident needed pureed food when in fact they were now able to manage a soft diet. Where possible care records showed that residents had been involved in some aspects such as completing their own priorities for care, should they become seriously unwell.This was seen as positive for recording residents wishes around such matters. There was also information outlining residents preferences regarding food, personal care and how they wanted to be cared for at night. In some cases reside ts had signed this aspect of the record. Personal profiles were also completed, some better than others, which generally give staff a good picture of the individual and their past career, family and social history. Developing this document further was discussed with the manager as a fuller picture could be beneficial to further developing a person centred approach to care management. The manager in her AQAA said that each resident has an individual care plan outlining their health, personal and social care needs. We would not fully concur with this statement at the current time. Residents had a range of risk assessments in place. Some of the assessments were up to date and kept under review whilst others were not, for example, on resident identified as at risk of developing pressure sores, had not had the risk assessment reviewed since 2008 and there was also no information of what action had been taken to reduce the risk. No residents in the home have pressure sores or any other wounds at the current time and sufficient pressure relieving equipment was seen around the home. Residents did not have nutritional risk assessments in place but records showed that residents were being weighed regularly. Assessments for nutrition should be in place to give a full picture of any risk so that a suitable care plan can be put in place if needed. Records show that residents see the GP when required in a timely manner and also receive visits from other health care professionals such as chiropodists and opticians. It was also clear that concerns over residents health were being followed up by seeing specialists. Care Homes for Older People Page 13 of 27 Evidence: The team primarily use a nomad system to administer medication. This was reviewed and found to be in good order. Medication administration sheets were clear and staff had recorded any administration fully. Medication is checked into the home and information is available on residents and medication in order to guide staff. Dates of opening are recorded on boxed and liquid medications, enabling them to be audited if needed. At the current time the manager does not have medication audit system in place. This should be considered especially if the home increases its bed numbers. Records showed that residents medication had been reviewed on a regular basis. There are no controlled medications in use at the home. There is no proper storage for controlled medication and this should be addressed as a priority as they may at any time require storage. We appreciate that the medication storage room is currently being fitted out as part of the refurbishment of the home. This was discussed with the manager. It was noted that residents who had been self medicating satisfactorily prior to admission were not once living in the home. This should be reviewed and residents independence and therefore feelings of self worth promoted. Residents spoken to said positive things about the care staff team and how they supported residents. Comments included they respect my wishes, they are very caring and polite and I feel happy and safe here and could not be happier. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to experience choice within their daily lives. Evidence: From discussion with the residents, staff and from records it is clear that the routines of the day are primarily resident led. Residents said that they had choice in their daily routines and that they could spend their time how they wished, doing what they wanted to do. Staff spoken to said that they would always ask residents, for example, if they wanted to get up or go to bed. Staff need to work on developing social care plans for residents living in the home that assesses their needs with regard to entertainment and any therapeutic activities in both a group and individual way. At the current time these records are limited and residents cannot be assured that their social needs are being met. Under hobbies and interests, in one case staff had recorded social life. This has no meaning. Staff spoken to knew the family and social histories of the residents well. Residents spoken to were able to have social interests and were possible had maintained social links in their previous communities. Residents were happy with the social life at the home but they often wanted to get out more to local places of interest. Some said that they chose not Care Homes for Older People Page 15 of 27 Evidence: to take part in activities other comments included we dont do much really, the staff put videos on. Staff spoken to gave accounts of what they do with regard to activities. They said that they may put some music on or sit and chat to residents, if there was nothing else to be done in the morning. In the afternoon they may play bingo, have a quiz, do some exercises, put a film on, play games or sometimes sit outside. Staff spoken said that these are the activities that we think they will enjoy. Staff need to see activities more as a key part of their caring role and this basic programme needs to be developed to also address individual needs and interests. It is positive to see that residents are taken out with individual staff and six recently went out to the promenade at Maldon. The manager said that they hope to employ an activities officer when the new wing of the home opens, which will help with the development of the activities programme at the home. The the local church holds one of their evening services at the home and this is attended by local parishioners, helping to make the home a part of the local community. The manager said that the local WI were supporting the home by making activity items for the residents at the home. The manager in her AQAA said that they plan to improve by helping residents to pursue their interests and goals, plan more outings and promote more links with the local community. Lunch was observed and residents were seen to be being helped sensitively by the care staff. The tables are nicely laid and condiments are available. Nutrition records show that residents have plenty of choice regarding their meals and there is a good overall variation in the set menu. One resident said that they had a cooked breakfast every day and that was their choice. Other comments included I eat when I feel like it, sometimes I choose to eat in my room, there are plenty of drinks available, You get a choice and I get what I want, the food is more than ample and always hot. Staff and residents both identified mealtimes but also felt that there was flexibility within the identified times. Staff said that the cook is on duty at breakfast time and will make the residents whatever they want. They also said that fruit was available and residents spoken to confirmed this. Residents preferences regarding food are recorded on a board in the kitchen so that all staff are aware. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns would be listened to and that they would be protected, as far as possible, from abuse. Evidence: The manager has a complaints procedure in place that includes a recording system. There has been one complaint since the last inspection and records were in place to show that this had been dealt with appropriately. Staff should use the form fully and complete the outcome section. The complaint related to a premises issue. Residents spoken to said that they would be very comfortable to raise any concerns that they had with either the manager or her deputy and felt that both were approachable. Comments included I see the manager a lot to talk to, shes always about and I am very happy and satisfied but would be confident in raising anything with the manager. Staff spoken to were aware of adult protection procedures and were able to locate the local authority guidance on the subject. Staff confirmed that they had attended training on the subject. Records showed that compliance with staff training on this subject is good, with the majority of staff trained. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, safe and well maintained home. Evidence: Since the last inspection at the home the proprietors have undertaken a major refurbishment of the older part of the home and have added a new wing specifically for the care of people with dementia. Much consideration has been given to the design of the new wing and the needs of people with dementia. The whole home has been upgraded or built to a high standard and the application for the registration for the new beds is underway. This will increase the number of beds available at the home significantly and the proprietors hope that these will be available in July 2009. It was possible to walk around the home with the provider and whilst there are still smaller pieces of work to be undertaken, we are reassured that these will be completed and to a similar standard. Overall the home was seen to be very clean and no odours were noted. Residents are clearly able to personalise their rooms in the way that they would wish and those spoken to were very happy with the facilities at the home. Since the new owners and manager have started working at the home they have also purchased, for example, all new beds and bedroom furniture, carpets, bed linen, curtains, communal furniture for lounges etc. and installed a new call bell system and passenger lift. Care Homes for Older People Page 18 of 27 Evidence: The manager has a fire safety risk assessment in place and the records show that she has kept this under regular review in light of the ongoing building work at the home. Other records relating to fire safety, such as equipment maintenance certificates, were also checked and found to be in good order. The manager reports that she plans to employ a full time maintenance man when the building work has been completed. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a stable and generally well trained staff team. Evidence: The home benefits from a stable staff team and there is a very low turnover. No agency staff are used. For 16 residents the current staffing levels are three staff morning and afternoon and two at night. During our visit the staff were very welcoming and friendly and the interactions noted between them and the residents was seen and heard to be caring and respectful. Residents spoken to said that the staff were very helpful and came quickly if you used the call bell. Other comments included the staff are lovely and I get on well with all of them and The staff are very helpful. Records show that out of the 18 care staff working at the home 8 have achieved an NVQ qualification and 2 are working towards this, which would take the home over the desired 50 trained staff standard. Recruitment procedures at the home were reviewed and it was noted that this needs to be more robust. One staff member commenced work without a POVA First or current police check (CRB), although one was completed later. The manager looked Care Homes for Older People Page 20 of 27 Evidence: into this and felt it was an oversight. Other files seen were in good order and contained the required documentation and checks. New staff had evidence of induction on their files. Training records showed that there are good compliance levels with mandatory training such as fire safety, adult protection, food hygiene and manual handling etc. Staff have also been attending training on caring for people with dementia. Consideration should be given to providing staff with training on medical conditions associated with old age, for example, diabetes, Parkinsons disease and on current thinking around mental capacity and equality and diversity. The manager in her AQAA says that she plans to provide training for staff on nutrition. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home where they are consulted on things that may affect them. Evidence: The manager has nine years experience in the management of residential care homes. She has been working at this home approximately two years and is recently back from maternity leave. She has completed the Registered Managers Award and has NVQ levels 2 and 3 in care. Records show that she is keeping herself up to date with current training and plans to undertake a further course in the care of people with dementia in the future. Regular meetings are held with the staff and minutes show that a range of subject are discussed including care standards and procedures etc. As part of the managers quality assurance programme, satisfaction questionnaires are sent out to residents and relatives. These have just been completed and they are collating the returned questionnaires. It was possible to review the results from August Care Homes for Older People Page 22 of 27 Evidence: 2008. Residents liked living at the home, relatives felt that their family members were well cared for and residents were positive about the food and activities. Any action points were noted and addressed. Resident meetings are also held regularly and show that they are consulted regarding activities, the food and any changes that may affect them in the home. The manager says that she undertakes other internal auditing check but does not have any written evidence relating to these. This was discussed. Relatives comments from our surveys included comments such as well run home, always very clean and all the staff are very kind and helpful to everyone including visitors. The team hold small amounts of personal monies on behalf of residents. There is a double signatory system in place and evidence of regular audits to check that all is in order. Accident records were reviewed and found to be completed fully and followed up where necessary. On touring the home no health and safety issues were noted. 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 9 13 (2) The home must ensure that 30/09/2007 controlled medicines are stored safely and securely, to ensure that residents are adequately protected. 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 7 15 Residents must have care plans in place that cover all thier require needs and these must be kept under review. So that the management of the residents is sound and provided in a way that they would wish. 14/10/2009 2 8 13 Residents must have all the 30/09/2009 risk assessments in place that they need and they must be kept up to date and linked to care plans. So that any risks to residents are reduced as far as possible and managed well. 3 12 16 Provide an activities programme that meets both the group and individual needs of residents. 14/10/2009 Care Homes for Older People Page 25 of 27 So that residents social care needs are met and their independence and self worth is promoted. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 3 Undertake a review of the service users guide to ensure it contains all the information that people may need. Consider a review of the pre-admission assessment so there is a more person centred approach and monitor to ensure it is fully completed in sufficient detail. Continue to develop a person centred approach to care planning and the delivery of care. Introduce a nutritional risk assessment into the home as part of the care planning system Promote residents independence through supporting self medicating. 3 4 5 7 8 9 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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