Care Home: Ecclesholme

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What the care home does well The manager continues to ensure that prospective service users receive information and visits prior to moving into the home to assure she can meet their assessed needs and expectations. This also means that prospective service users have the opportunity of speaking with someone from the service about any concerns they may have and before they make any decisions about their future. Service users, family and staff have the opportunity of meeting together in groups to discuss with the manager all aspects of the service and to share their opinions. Furthermore the organisation ensures that independent quality audits are completed and a report of the outcomes are made available. This means that all those living and working at the home are consulted and able to contribute towards the continued development of the service. A wide variety of activities are provided with most service users being supported to maintain their own interest and hobbies as well as having social events within and outside of the home. What has improved since the last inspection? Improved cleaning schedules and audits have been put into place to make sure hygiene standards are maintained. This includes improved infection control procedures which staff are trained in and follow. New carpets and furniture has been put into lounges and a newly refurbished reception area has provided service users with a nice place to sit and has improved security. What the care home could do better: Inspection of the medication management systems identified that the medication administration records were not maintained correctly and that medication was not always given as prescribed, which mean some service users did not receive their medication. We have made one requirement to make sure practices at the home are improved and that service users receive their medication as prescribed and safely. We have made a number of good practice recommendations which relate to ensuring all parts of the home are maintained in a homely manner, including bathrooms and toilets; making sure staff routines include putting on lights for service users who have restricted mobility and require support; timely attendance to support service users when they summon assistance and a more detailed record of staff members duty rota. Key inspection report Care homes for older people Name: Address: Ecclesholme Vicars Street Eccles Manchester M30 0DG     The quality rating for this care home is:   one star adequate 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: Sylvia Brown     Date: 1 1 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ecclesholme Vicars Street Eccles Manchester M30 0DG 01617889517 01617078296 eccleshm@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution care home 46 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) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: One named service user under the age of 65 is currently accommodated for regular periods of respite within the maximum of 46. Should this person no longer require the service the category will revert to service users over 65 years of age (OP). One named service user under the age of 65 is currently accommodated within the maximum of 46, when this person leaves the category will revert to service users over 65 years (OP). The maximum number of service users who may be accommodated for personal care only by reason of old age is 46. Date of last inspection Brief description of the care home Ecclesholme is a care home that is registered under the Care Standards Act 2000 to provide residential accommodation for residents who require personal care only. The home is situated in a residential area of Eccles and is close to public transport and services. Ecclesholme is owned by the Royal Masonic Benevolent Institution. Places in Care Homes for Older People Page 4 of 28 Over 65 46 0 0 2 Brief description of the care home the home are offered to older Freemasons and their dependent female relatives over the age of 65. All prospective residents are invited to complete an application form and to provide information about their Masonic eligibility. The home offers numerous communal areas that are furnished to a high standard and are pleasantly decorated. Residents spoke positively of the service that they received whilst living at the home. The cost of the service is between 471.00 pounds and 502.00 pounds per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 the people who use this service would experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the last key inspection, which was completed in November 2007. This was a key inspection which included a site visit to the service. The site visit was unannounced which means the manager and staff were not told that we would be visiting. Since the key inspection in 2007 we have completed an annual service review in December 2008. An annual service review (ASR) is a summary of our knowledge of a service that has not had a key inspection in the last year. It helps us decide if a service is still as good as we thought it was at the last inspection or if we need to alter out inspection programme. The ASR concluded that we continued to assess the service as Care Homes for Older People Page 6 of 28 being good and that we did not need to change our inspection plan. For reporting purposes the preferred term to be used for people living and receiving a service is service users. When referring to representatives of the Care Quality Commission the terms us and we is used. As part of the inspection process we gathered information from a number of people which included talking with and seeking the views of service users. Prior to the site visit we also sent out surveys to service users and members of staff. This gave them an opportunity to tell us about their opinions of the services provided at the home. In October 2009 the manager completed a self assessment form, which is called an Annual Quality Assessment Audit (AQAA).This document should tell us in detail what they and the registered provider have done since the last key inspection to meet and maintain the National Minimum Standards. It should also tell us what the manager and the registered provider felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. The AQAA was completed in sufficient detail and provided us with enough information about the service. We also gathered information from general contact with the home through their reporting procedures which are called Notifications and information we may have received from other people, such as the general public and professional visitors. We have not received any complaints about this service The one safeguarding alert that we know about was appropriately investigated by the Local Authority through their adult protection procedures. This report is a public document and should be on display within the home and can be made available for reading upon request. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are offered the opportunity of visiting the home and meeting with others before they make any decisions about their future. They receive information about the services offered and have their needs assessed and recorded. This means prospective service users are able to make informed choices and decisions about the suitability of the home or moving in. Evidence: The home has a sustained history of having good pre admission procedures in place. Policies and procedures are in place which ensures all prospective service users are visited by the manager. This gives them the opportunity to discuss any concerns they may have before they make any decisions about moving in. The visit also enables the manager to consult with the service users and people close to them about the service users care and support they may need and how they would like the support to be provided. This means the manager can assure herself that the services offered at the home are suitable to meet the specific needs and requests from the service user. Care Homes for Older People Page 10 of 28 Evidence: We looked at the care file for one service user who had gone through the pre admission process recently. We found that they and their family had been provided with information about the home and the services offered. They had also visited the home to have a look round and meet with others who live there before they made any decisions about their future. Intermediate care is not provided at Ecclesholme Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have their health care needs assessed, recorded and met. Medication administration processes were not always completed correctly this means service users were at increased risk of not receiving their medication as prescribed. Dignity and respects was not always shown to service users because some basic routines for staff were not in place. Evidence: All service users had written care plans in place. We looked at three care files, two of which were in depth. We found that all service users had had their needs assessed and how they would like to receive support was recorded in detail for some. The manager informed us that person centred care planning is to be introduced once staff training has been completed. This means all records relating to service users will have detailed records about their individual preferences for care and support rather than generalised statements such as requires assistance with dressing etc. Care records we looked at detailed medical services such as GP and district nurse Care Homes for Older People Page 12 of 28 Evidence: services so we could see how their general health care needs were supported. Records also contained information about dental checks, optician and hearing tests and appointments. We could also tell that routine chiropody treatments were provided . Risk assessments were in place but they needed to be developed to fully identify individual risks, what is required to minimise the risk and how the service user should be supported. The new person centred care plans should record information this way. Records contained assessments in relation to skin care and pressure sore prevention, mobility and nutrition. Service users weights were also monitored and recorded. The home has extensive policies and procedures including the safe management, recording and administration of medicines. We looked at a sample of medication administration records and found they were not well maintained. Signatures were unclear and did not correspond with the signature reference record, there were signature omissions and oversigning on some records. This means a signature had been made to confirm administration had taken place and then a second code or signature added on top. When we cross referenced one persons medication we found that where a signature omission was evident the medication remained in its container. This means the service user did not receive their medication as prescribed and when required. We looked at staff training records and could see that all staff who administered medication had received training. Members of staff on duty were informed by the manager of their failings and action was taken immediately by the manager to audit all the records and stock levels to make sure that all service users had received their prescribed medication. We sat and shared a meal with one service user and sat with others as they relaxed in a lounge areas. The service users spoke well about their care and told us that whilst staff were not perfect they felt they were looked after well. We were able to observe members of staff supporting service users on a number of occasions. Whilst we saw that direct support provided to service users by members of staff was done so discreetly and in a respectful manner, some routines were not. We could heard the call system ringing for some considerable time, as a consequence we monitored how long it took members of staff to attend to service users who had used the call system when seated in their own rooms. We saw one service user who was not independently mobile, sitting in the dark for some considerable time even though they had called for assistance. When staff arrived they were heard to make comment about this and stated it gets dark quickly now. On another occasion we Care Homes for Older People Page 13 of 28 Evidence: observed a service user waiting in a toilet area for over eleven minutes before assistance arrived. Though the toilet light was on their main room was also dark. When we spoke with staff about routines for putting lights on and we were told there were no set routines for turning on lights and lamps in service users rooms before it went dark, rather they just did it when they supported the service user or at their request. Systems need to be put into place to make sure staff attend to service users in a timely manner when summoned and that they make sure lights are turned on in all rooms used by service users before it goes dark particularly if the service users is immobile. In one lounge we saw a sling to a hoist on a coffee table. When asked about this, the staff member present identified the service user within the room for whom it was for. This means that there was less room on the side table and gave the room the appearance that someone within the room required a hoist. It also made the room appear less homely. We saw that most toilets had plastic jugs on display which stated urine and in one bathing and toileting area there were two large packs of continence support aids on view. Both bathroom and toilet walls contained a number of health and safety instructions for staff to follow. This means that parts of the service users home were not treated respectfully, appeared less homely and institutionalised. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are given opportunities to continue with their own interests and hobbies. They are also able to meet regularly with each other to socialise. This means they are able to choose how they spend their leisure time and meet with others if they wish Evidence: The service users have an extensive and varied selection of social activities made available to them. A service user told us that they had enjoyed growing some vegetables in the summer and enjoyed many of the activities provided whilst another stated they liked the option of not having to have to join in if they didnt want to . We were provided with two months records of activities and could see that service users had the opportunity to join in a daily activity We looked at the care files of two service users and found that they had joined in most daily activities. Records demonstrated that the individual needs of service users were recognised and that entertainment and social outings were reflective of a wide social group. Some service users enjoyed going swimming and continued with their interest with the Freemasons. An independent audit of the service was completed in March 09. The report of that Care Homes for Older People Page 15 of 28 Evidence: audit stated that 21 of those service users responding to the surveys stated that they felt there was not enough activities whilst 79 there were enough activities. The manager told us within the AQAA that she recognised that some aspects of the activities programme could be improved for some service users and that plans were underway to do this. We sat with one service user at a tea time meal and observed others as they received their meal. Generally we saw that service users were able to make individual choices and decisions about what they wanted and received second helpings as they desired. No service users made any complaints about the meals served. The independent audit report stated that all aspects of catering received a very good score with only one service user making comments about improvements that could be made. The manager told us within the AQAA that improvements to the menu are to be made to make sure that all service users have options available which they like. Records of service users and family group meetings discussed menus, menu planning and checks of service users satisfaction with the meals provided. Some service users had their own teapots and other items on their table. This means that their independence was promoted and that they were able to serve and support others if they wished. The service has a sustained history of providing an excellent standard in relation to activities and meals served. We have found nothing to indicate standards have deteriorated. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If service users have complaints about their care, there are people close to them who know how to complain. The manager takes appropriate action to look into and investigate complaints that are made. This means people can have confidence that their complaints will be taken seriously Evidence: We had the opportunity of speaking with a number of service users and their families, without exception all spoke positively about the care and support they received. We have not received any complaints about this service, however the completed AQAA identified that three complaints had been received at the home. Inspection of the complaints record identified that the manager had followed procedures correctly and had recorded and investigated them correctly. The home has a comprehensive complaints policy and procedure that is readily available in the home. The independent audit of the home identified that 94 of people would recommend the home. Policies on the protection of vulnerable adults were in place and was made readily available to staff along with a copy of Local Authority safeguarding procedures . Information on staff files demonstrated that members of staff had received awareness training in adult protection. The manager of the service has experience in referring concerns relating to adult protection to the Local Authority. The AQAA identified that one safeguarding referal has been made to the Local Athority which was investigated Care Homes for Older People Page 17 of 28 Evidence: under their procedures. The manager had received some information about the Mental Capacity Act Deprivation of Liberty Safeguards and was awaiting information about when training about this was available so she could arrange for staff to attend. At the present time no one in the home was subject to an application made under these requirements. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean home which is comfortably furnished. This means service users live in a homely environment. Evidence: Accommodation is provided over three floors. There are two lifts available for users which means service users can reach all parts of the building. Whilst the home was generally clean and maintained there were signs that some upgrading was required in some parts. In some toilets and bathrooms we found broken toilet roll holders and marked cabinets and as stated previously within the report we found toilets contained plastic jugs with urine detailed on them. We also saw in one toilet two packs of continence support aids and walls that displayed information about health and safety procedures and routines. All this means that the homely environment seen in other parts of the home was not promoted. The home has a number of lounges which are situated on several floors. We observed that the lounges generally appeared nicely presented with ample comfortable seating available. Care Homes for Older People Page 19 of 28 Evidence: All bedrooms were en-suite and were furnished to a good standard. Service users have access to an outside courtyard where seating was available, however we saw that one rear external door remained open which means the risk of someone entering the home undetected was increased. The manager stated that this was left open for members of staff to go outside during their breaks and should have been closed. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive care and support from staff who are appropriately recruited and trained. This means service users receive support from people who can meet their individual support requirements. Evidence: We looked at a sample of staff records and found that the manager operates and follows good robust recruitment procedures. All applicants complete application forms, provide references, have statutory checks made and attend for a face to face interview before offers of appointments are made to successful applicants. The records we looked at identified that staff completed thorough induction procedures which meet Skills for Care standards. Staff files contained staff appraisals, supervision, training and development records. The AQAA identified that 60 of staff have completed NVQ training at level 2 or 3, this means the the home exceeds the target to have 50 of its workforce trained to NVQ level 2 or 3. The rotas of hours worked by all members of staff was provided to us. We found that we could not always tell the full name of staff or their staffing position, furthermore their start and finish times were not recorded rather codes such as N E L. We could not find any definitive code for this therefore the service could not demonstrate they Care Homes for Older People Page 21 of 28 Evidence: had sufficient numbers of staff on duty at all times. During the inspection we observed that additional staff may be needed or be deployed differently particularly around tea time. This is to make sure service users in their room receive support in a timely manner. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a home which is well run and managed. This means that they can have confidence that their health and safety is prioritised. Evidence: Since tha last key inspection a new manager has been appointed. Even though she held the position of deputy manager at the home, the organisation completed robust recruitment procedures which meant the manager attended two interviews before she was appointed. The manager has yet to submit an application for registration with us. We have been informed that a management induction procedure will be completed by the manager to make sure she is aware of the roles and responsibilities of being a homes manager. We have been informed that the recruitment process is underway to appoint a new deputy manager to make sure that the home has a full management team in place. Service users have regular meetings which gives them the opportunity of discussing Care Homes for Older People Page 23 of 28 Evidence: any concerns they have as a group with someone in a management position. The operations manager visits the home each month to completed statutory visits. During these visits they look at records, speak with service users and staff, walk around the home to make sure it is maintained correctly and discuss any matters with the manager. The visits are statutory under Regulation 36,. A report of each visit is made and were made available to us during the inspection. The records we looked at confirmed that staff receive supervision, appraisals and had their training and development records in place. The organisation has extensive policies and procedures in place. We looked at a sample of servicing records to make sure all equipment is in good working order and fit for purpose. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangement must be put into place for the safekeeping, management, administration, recording and disposal of medication. This is to make sure service users receive their medication as prescribed and safely. 13/11/2009 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 9 Effective auditing processes must be put in place to ensure that managers are confident that medicines procedues are being followed safely. Systems should be in place which makes sure service users receive timely support when they summon the assistance of staff. Systems should be put in place to make sure rooms used by service users are well lit at all times particularly their bedrooms. 2 10 3 10 Care Homes for Older People Page 26 of 28 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 4 21 Action should be taken to ensure that toilet and bathing areas are presented in a homely manner as other parts of the home, this includes the removal of notices and discreet storage of continence support aids. The staffing rota should clearly identified that full names of staff, their staffing positions and duty times to be worked which includes the start and predicted finish times. An application for the registration of the manager should be submitted to us without delay. 5 27 6 31 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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