Care Home: Eastwood House

What the care home does well Eastwood House has a warm and homely atmosphere and relatives said they were always made to feel welcome. The district nurse confirmed that staff always follow instructions about treatment, and they are very good at contacting nursing services if they need advice or to ask for early intervention if concerns are raised. People said they liked it at the home, they liked the food and the activities provided. They said staff were always friendly and caring. Surveys confirmed that staff always listen to them and act on what they say. They said staff always respect their dignity and encourage them to make decisions about how they spend their time. They said they liked their bedroom and said the home was always clean and fresh. People told us they were aware of the complaints procedures and would speak to the manager if they had a problem. They said they feel safe at the home and the staff were caring and friendly. What has improved since the last inspection? Care plans have improved since the last inspection. They detail the support people need to take part in leisure activities. Medication records have improved which makes it easier to audit. Medication Administration Records (MAR) were fully completed and they have developed new guidance to ensure staff administer drugs safely. Recruitment procedures have improved which ensure the required employment checks have been aquired prior to new staff starting work at the home. Staff have attended training to ensure they are alert to the signs of abuse and they know the action they must take to keep people safe from harm. They have developed a new induction programme which meets the `Skills for Care` standards. The providers have been undertaking monthly visits (Regulation 26) and they have made the reports available for inspection. What the care home could do better: The service needs to improve care plans to ensure staff have the information to meet people`s mental health needs. Risk assessments need to be agreed and kept under review where bed rails are used, this will ensure people`s needs are best met to keep them safe. Medication stock levels need to be monitored to prevent overstocking of pain relief and medication to help with constipation. The staff must consult with doctors to ensure they review medication they need. The medication fridge should be kept lock and they should review where the fridge is located. The date when eye drops are opened should be recorded so that they are not used beyond the recommended time (28 days). Mealtime could be better managed including arrangement to ensure the food is served from a clean and hygienic area. Staff need to make suitable contingency plans in the event of the lift breaking down to ensure the meal is delivered safely to the upstairs dining area. Arrangements to ensure people have a informed choice of main meal and sweet, as menus only show one main course. The manager must submit an application to CQC to become the registered manager. Key inspection report Care homes for older people Name: Address: Eastwood House Doncaster Road Rotherham South Yorkshire S65 2BL     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: Valerie Hoyle     Date: 2 3 0 3 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 26 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 26 Information about the care home Name of care home: Address: Eastwood House Doncaster Road Rotherham South Yorkshire S65 2BL 01709363093 01709837788 eastwoodhouse@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Nightingale Premier Care Homes Ltd care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category of service only: Care home only - Code 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 Eastwood House is a large converted and extended Victorian house situated close to the centre of Rotherham. It is set back from the main road into Rotherham and it close to the local park. The home is situated near to bus routes. It is a care home, registered to provide care and accommodation for 25 older people and a twelve bedded unit for people who have dementia. The home offers single room accommodation, all of the rooms benefiting from ensuite facilities with the exception of two rooms on the first floor. There is a lift, which give access to the first floor. There are a variety of Care Homes for Older People Page 4 of 26 Over 65 0 37 37 0 Brief description of the care home communal areas and two dining rooms. The dementia unit is on the first floor. The facilities are two lounges, dining room, snack kitchen toilets and bathrooms. There is a secure garden for these People who use the service. The home is maintained to a high standard. There are attractive gardens to the front, rear and side of the property and outdoor seating and patio areas. The gardens are well stocked with various plants, shrubs along with tubs and hanging baskets. The walkways around the home are designed to enable the residents to access all parts of the garden Weekly fees for Dementia Care are £411 and residential £366 as at 23rd March 2010 and additional charges are made for hairdressing, Chiropody, Optical, Dental services, specialised toiletries and magazines, dry cleaning etc at cost. Service User Guides and Statement of Purpose is available on request from the manager, and the last inspection report dated 15th April 2009 is available on request. Care Homes for Older People Page 5 of 26 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 1 star. This means that the people who use the service experience adequate quality outcomes. This unannounced inspection took place over 6 hours starting at 09:00 finishing at 15.00. The visit included a partial inspection of the home. Four people who use the service, the manager, six staff and two relatives were spoken to during this inspection, their views are included within this report. 25 Surveys (10 for service users, 10 staff, 5 Health Professionals) were sent to the service. 3 surveys were returned from staff 2 surveys were returned from health care professionals and 10 service user surveys were returned. We spoke to the district nurse for their views on the service. Their comments can be found in the health and personal care section of this report. Care Homes for Older People Page 6 of 26 Occupancy at the home on the day of this inspection was 35 (25 residential service users and 10 service users with a diagnosis of dementia). Three peoples care plans were looked at. Policies relating to medication, complaints, protection and handling of peoples money were looked at. Three recruitment and training records were looked at to assess how people were protected from harm. Procedures and risk assessments relating to health and safety were looked at and discussed with the manager. The Annual Quality Assurance Assessment (AQAA) was sent to the home and returned to us in a timely manner, it was comprehensive and told us about how the service has progressed since the last inspection. An AQAA is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their services. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The service needs to improve care plans to ensure staff have the information to meet peoples mental health needs. Risk assessments need to be agreed and kept under review where bed rails are used, this will ensure peoples needs are best met to keep them safe. Medication stock levels need to be monitored to prevent overstocking of pain relief and medication to help with constipation. The staff must consult with doctors to ensure they review medication they need. The medication fridge should be kept lock and they should review where the fridge is located. The date when eye drops are opened should be recorded so that they are not used beyond the recommended time (28 days). Mealtime could be better managed including arrangement to ensure the food is served from a clean and hygienic area. Staff need to make suitable contingency plans in the event of the lift breaking down to ensure the meal is delivered safely to the upstairs dining area. Arrangements to ensure people have a informed choice of main meal and sweet, as menus only show one main course. The manager must submit an application to CQC to become the registered manager. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are able to demonstrate they can meet the needs of people who use the service by carrying out comprehensive assessments. Evidence: All new people receive a full comprehensive need assessment before admission into the home. This is carried out by unit manager. Staff undertaking the assessments have the required skills and competencies to ensure they can meet the persons needs. The service was efficient in obtaining a summary of any assessments undertaken by social services. The assessments looked at were focused on achieving positive outcomes for people and they covered all essential areas of need. The procedures include trials at the home and people could visit before moving into the home. People said they were happy that they chose the home. Relatives said they had looked around a number of homes before choosing Eastwood House. They confirmed they were involved in the admission process and staff were warm, friendly and helpful. Care Homes for Older People Page 11 of 26 Evidence: Surveys returned from people who use the service confirmed they were given enough information so that they could make decisions about the home. They all confirmed they had received confirmation of the terms and conditions of their stay. Surveys received from healthcare professionals confirmed the service have appropriate care assessments so that the right care package can be delivered. Care Homes for Older People Page 12 of 26 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. Medication systems have improved to ensure people received their medication safely, although stock levels need further improvements. People may not receive the care they need as interventions regarding peoples mental health needs to be more detailed. Evidence: A number of care plans were looked at, they mostly contained sufficient information to enable staff to deliver the care people need. However, more detail is required to enable staff to support people with their mental health needs. Risk assessments were in place and included action to reduce risk while helping people to maintain their independence. However, where bed side rails are in situ there should be an agreement with the person on their representative to ensure they are required to minimise the risk of falls. Surveys confirmed people receive the care and support they need and staff are always available when they are needed. One relative told us they were very satisfied with the care his father received. Medication procedures were followed and they have improved the system to ensure Care Homes for Older People Page 13 of 26 Evidence: staff record, store and administer medication as prescribed. The medication administration records were checked and they were an accurate reflection of the medication administered. The Medication Administration Record (MAR) showed that a number of people were regularly refusing pain relief and medication such as lactulose and movicol used to assist with constipation. This means that there was surplus stocks in the store cupboard. The manger should ensure a review of these types of medication is undertaken by the doctor to prevent over stocking. Four lots of eye drops did not have the date when commenced and the labels were difficult to read. This means they may continue to be used past the recommended date. The store was tidy and controlled drugs were recorded accurately. The medication fridge was checked each day and recorded to ensure medication was stored at the correct temperature, however it is located in the staff room and this was not locked. This means medication is not stored safely. The manager undertakes monthly audits and he also has some responsibility for ordering medication. The supplying chemist also supports the home by giving advise and undertaking audits. Health and medical records confirm people receive the support they need to maintain their health and wellbeing. The home had good records to demonstrate they use assessment tools to help maintain healthy skin and meet peoples nutritional needs. Surveys received confirmed that people receive the medical support they need. A visiting district nurse said staff were good at contacting nursing services for advice and support. Surveys from healthcare professionals confirmed peoples social and healthcare needs were properly monitored, and reviewed. Staff were observed interacting with service users throughout the day. Staff spoke in an appropriate manner and they encouraged people to make choices about food and drinks. People were moved and handled correctly and they maintained their dignity when attending to personal care. People were addressed using their first name and people were happy with the arrangements. Care Homes for Older People Page 14 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to socialise with family and friends. Mealtimes were unorganised and people lacked informed choice about meals provided at the home. Evidence: There was a warm and friendly atmosphere on entering the home and people appeared comfortable sitting in the various lounges and bedrooms. The home has employed a activity coordinator who works in both units (residential and dementia). She has attended training workshops to give her new ideas about activities for the elderly. There was evidence that people can access activities and posters around the home told people about forthcoming events, which included Easter activities. She told us that they raise funds to help pay for entertainers. Surveys received from people told us they enjoyed the activities provided at the home, although some said they would like to get out more. People are able to have visitors at any time and visitors to the home told us they were always made to feel welcome and enjoyed joining in to raise funds for the home. One relative said he was always made to feel welcome and he was able to have some quality time sitting in a quiet lounge. We observed lunch being served in the two dining areas. The lunch in the upstairs lounge was unorganised. The lift had broken and the staff delivered the meal on trays, Care Homes for Older People Page 15 of 26 Evidence: which was put on the floor as there was no available space on the tables. Staff appeared to have little awareness of the health and safety issues created by their actions. We looked at menus which were balanced although there was no choice of main meal. The cook told us that people could choose an alternative meal, but this was not fully communicated to people. People seemed unaware what was on the menu for lunch, although they said they had enjoyed the meal of meat pie and fresh vegetables. Care Homes for Older People Page 16 of 26 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. Complaints and safeguarding procedures were followed which ensures people feel safe and protected. Evidence: The home has a complaints procedure that is available to people and visitors to the home. The procedure is also referred to in the information given to new people, identifying the steps to follow, including the timescales for responding to complaints. The AQAA told us that there has been one complaint received in the last twelve months. The complaint record was looked and discussed with the manager who confirmed the outcome of the complaint. Surveys told us they know who to contact if they had a problem and they were confident that their concerns would be listened to and would be acted on. The home has a robust safeguarding adults procedure which would be followed if any incidents of abuse was raised. The AQAA confirmed that there has been one referral to the safeguarding adults team. The manager holds regular discussion with staff to ensure they are alert to the signs of abuse and the action they must take if they suspect an incident has occurred. The manager is aware of his responsibilities with regard to the Mental Capacity Act 2005 and the Deprivation of Liberty safeguard, although formal training is still to be arranged. Surveys returned from staff confirmed they know what to do if they have concerns and staff interviewed were able to confirm the action they would take. People said they feel safe at the home and would tell the Care Homes for Older People Page 17 of 26 Evidence: manager if they were worried about anything. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides a safe, comfortable environment for people who use the service. Evidence: The home was clean and fresh and people told us the home was always tidy and their bedroom was clean and tidy. Communal areas were bright and cheerful and there is a programme of refurbishment. Bedrooms had been personalised to reflect peoples taste and people told us they were encouraged to bring in personal items to help them feel at home. People told us they were able to lock their bedroom door and treat the room as their own home. Care Homes for Older People Page 19 of 26 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. Staff have the skills and competencies to meet the needs of people who use the service, and recruitment procedures are robust which helps to keep people safe from harm. Evidence: The home has robust recruitment and selection procedures that ensures people who use the service are safe and protected. A number of staff recruitment files were looked at and they included all the required employment checks including two references, application form, and Criminal Record Bureau (CRB) check. The files were organised and could be easily audited. Staff rotas and observation during this inspection confirmed there was sufficient numbers of staff to meet the needs of people who use the service. The manager was responsible for completing rotas and staff tend to work on each of the two units, to ensure they know the needs of all people who live at the home. There is a stable staff group and most staff have worked at the home for a good periods of time. There is a comprehensive induction programme which meets the Skills for Care standards. Staff are only confirmed in post when they have completed their induction. Staff have the required skills and competencies to meet the needs of people, and they have sufficient numbers of staff (12 of the 25 staff employed) that have been awarded a National Vocational Qualification (NVQ) to Level 2 standard. Care Homes for Older People Page 20 of 26 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. People were protected by sound management practices. Peoples views are actively sought to improve the service. Their financial interests were safeguarded and there is good health and safety procedures which ensure people are protected from harm. Evidence: The manager has the required experience and skills to manage the home to a good standard. She has been in post since January 2009 but has not submitted an application to CQC for registration. She has submitted her NVQ level 4 folder for verification and also attends training as required by the organisation. She operates an open door policy to ensure she is accessible to staff and people that use the service. Relatives and staff spoke highly of the manager. Surveys returned from staff said the manager is supportive and we can go to her if we have any concerns. Staff and group meetings ensure that staff are informed about training opportunities and the day to day running of the home. People who use the service were able to make decisions about how they want to Care Homes for Older People Page 21 of 26 Evidence: manage their personal money, although some choose to let the home manage their money due to their limited capacity. Records were looked at and they were a true reflection of the money kept in their savings. The organisation has developed good quality audits which the manager and her team have to complete. They also actively seek the views of people and other stakeholders, and surveys are sent out to people yearly. A selection of the outcomes from the last surveys were looked at, and they showed good satisfaction levels in all areas. The manager has responsibility for addressing areas requiring improvement. Accident and incident reports were analysed by the manager to ensure risk assessments are developed where required. Maintenance and service records were looked at in the AQAA returned to us they were up to date and current to the service provided. The manager has the required health and safety policies and procedures and displays the relevant notices. Fire safety procedures were in place and service records were looked at in the AQAA and were up to date. Staff have received training in all areas relating to health and safety to ensure they can keep themselves and people who use the service safe from harm. Surveys returned confirmed staff receive training which is up to date, and enables them to understand and meet the needs of people who use the service. Care Homes for Older People Page 22 of 26 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 23 of 26 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 Care plans must detail the intervention required to support people with their mental health. So that staff know action they need to take to manage challenging behaviours. 03/05/2010 2 7 13 Risk assessments on the use 03/05/2010 of bed rails must be fully discussed and an agreed with the individual of the representative. To ensure they are appropriately used to minimise the risk of falls. 3 15 13 Staff must ensure the meal is safely delivered to the dining area. To reduce the risk of accidents and prevent contamination from unclean surfaces. 05/04/2010 Care Homes for Older People Page 24 of 26 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 9 The medication fridge should have a lock fitted to ensure medication is correctly stored. Dates of first opening should be marked on eye drops, to ensure they are not used past the manufactures recommended 28 days after opening. Stock levels of pain relief and movicol and lactulose should be reviewed with the doctor to ensure people receive the medication they require. People should be given a choice of main course and sweet. Records should demonstrate meals provided to people who use the service. The manager must submit her application to CQC to be the registered manager. 2 9 3 15 4 31 Care Homes for Older People Page 25 of 26 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. 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