Care Home: Foxton Grange

What the care home does well We saw staff at Foxton being helpful and friendly to people who live there and treated them with respect. `Staff are friendly and know their jobs`, one relative said. There is a varied activities programme to provide interest and stimulation for residents. Staff said that there were no rules for residents so they were free to pursue their own lifestyles as far as possible - staying in bed, choosing their clothes etc. People are supported to maintain relationships with family and friends. A relative said, `I visit whenever I want to and I can stay as long as I like`. Relatives confirmed that they are always welcomed by staff and said that the care provided was of a high standard. The menu is varied, and the food is well presented. People living at Foxton are largely supplied with home made food. The home is clean and tidy, and good standards of hygiene are maintained. `The home never has any smells, which is a credit to domestic staff`, one relative said. Facilities are signed so that they are clearer for residents to understand and try to direct them effectively around the home - to toilets, their own bedrooms etc. Members of staff have received training in different areas of care practice to help them improve their skills. Management are very supportive of staff so that they can produce a high standard of care to residents. There is a system in place to analyse accidents so they can be prevented in future. What has improved since the last inspection? Relatives said they received enough information about the home`s services before their relative moved in. Staff largely carried out moving and handling procedures in the correct way that safeguarded residents health. There was evidence in the home`s records that medical services were contacted if a resident had a potentially serious injury. The activities programme is now in place to offer stimulation to residents and keep them from being bored. Staff training has taken place since the last inspection to provide staff with skills to be able to offer residents a quality service. The Provider has undertaken an environmental audit of the home to determine how the service can best meet the needs of people with dementia living at Foxton. What the care home could do better: All aspects of residents lives should be included in the Care Plan, including preferred living routines, how frequently to assist residents with their continence and when staff have assisted residents with personal care. Assessments need to include the dates of previous health checks so they can be prompted in a timely manner. Medication must be securely kept at all times to prevent residents taking tablets not prescribed for them and thus harming their health. The Provider needs to ensure staff know all the Agencies to refer to if they suspect abuse has taken place. Proper minimum staffing levels for care and domestic tasks must always be in place to fully meet residents needs. Staff training on residents conditions and challenging behavior needs in place to ensure staff skills in these issues. All, staff need to know the full fire procedure to be able protect residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Foxton Grange 571 Gipsy Lane Leicester Leicestershire LE5 0TA     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: Keith Charlton     Date: 1 6 0 4 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: Foxton Grange 571 Gipsy Lane Leicester Leicestershire LE5 0TA 01162460616 01162766593 linda.gazzard@mha.org.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) : Methodist Homes for the Aged care home 36 Number of places (if applicable): Under 65 Over 65 36 36 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V38468. By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V25523. By agreement one named service user under the age of 65 years can be acommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V32612. No person to be admitted into Foxton Grange in categories DE, DE(E) or MD(E) when 36 persons in total of these categories/combined categories are already accommodated in Foxton Grange Nursing and Residential Care Home. The maximum number of persons to be accommodated within Foxton Grange Nursing and Residential Care Home is 36. Date of last inspection Care Homes for Older People Page 4 of 27 Brief description of the care home The last inspection of the home was on 9/4/2008. Foxton Grange Nursing and Residential Home is a care home offering accommodation for up to thirty-six older people. The home is registered to accommodate older people with dementia and/or mental disorder. The home is divided into two separate units individually named. The home is located approximately fifteen minutes away from the centre of Leicester if travelling by car. Bus services are available near to the home. The home can be easily found just off the outer ring road. The building itself is purpose built and situated in a quiet area. There is parking available at the front of the building. All accommodation is provided on the ground floor level. All areas of the home are accessible to people who use wheelchairs. The home has a secure garden area for residents to walk. The homes fees range from #465 to #716 per week. The Registration Certificate is displayed in the hallway. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. We (the CQC) visited Foxton Grange on the 15th April 2009. The Registered Manager and staff in the home helped us during the visit. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to the people who live in the home and some relatives, - talking to staff and management, Care Homes for Older People Page 6 of 27 - watching how people are given support, - looking at records. We also carried out observation of how staff cared for residents, in communal areas. This lasted in total for an hour and a half. We were not able to speak effectively to any residents due to their dementia. We spoke to three relatives at Foxton during our visit, who told us that staff were very caring and treated their relatives with respect. One person said, staff are always welcoming and know how to deal with everything properly. None of the relatives spoken with had any complaints about the attitude of staff. We spoke with four members of staff during our visit to the home who told us about working in the home and gave us their views. They all were very positive about working there and said they wanted for residents to have a good quality of life. One staff member said:We are properly trained and make sure that residents are treated well. We checked all the standards that the Commission for Social Care Inspection has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 27 All aspects of residents lives should be included in the Care Plan, including preferred living routines, how frequently to assist residents with their continence and when staff have assisted residents with personal care. Assessments need to include the dates of previous health checks so they can be prompted in a timely manner. Medication must be securely kept at all times to prevent residents taking tablets not prescribed for them and thus harming their health. The Provider needs to ensure staff know all the Agencies to refer to if they suspect abuse has taken place. Proper minimum staffing levels for care and domestic tasks must always be in place to fully meet residents needs. Staff training on residents conditions and challenging behavior needs in place to ensure staff skills in these issues. All, staff need to know the full fire procedure to be able protect residents. 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 9 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 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Foxton Grange have had their needs properly assessed before moving into the home. Evidence: Residents were not able to confirm that they had been provided with sufficient written information about the home due to their dementia conditions but relatives spoken with said they had enough information at the time of the admission to make up their minds about the home. Yes, I saw the homes information to see what the home offered, one relative said. We case tracked a person living in the home who had moved into Foxton Grange in the past. We checked that his family had received information to help with the choice of home, and the relative said she had received enough information. We also checked that this person had her needs properly assessed prior to moving in, to ensure that the Care Homes for Older People Page 11 of 27 Evidence: staff at the home could meet their needs and we found that the assessment system was detailed regarding residents needs though past health checks had not been included, which is useful to prompt these checks and improve the health and daily quality of life for people. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Foxton Grange receive good health and social care practice. Evidence: Relatives said that staff provided excellent personal care: Staff are really good. They always are friendly and treat all residents with respect, and I am glad my husband came here. The care is so much better than where he used to be, were some of the many very positive comments that relatives made. No relatives spoken with could recall having a care plan though thought staff knew the care needs of their relative. We checked the care plans of four people living at the home who were case tracked. Plans showed detail regarding the support required by staff to ensure the physical health of people living at the home, and there was information to inform staff of the residents personal history though no information of preferred daily living routines of residents to ensure their social and emotional well being is fully supported. Continence Care Homes for Older People Page 13 of 27 Evidence: information was recorded though this assessment needed more detail to work out the individual needs of a resident so staff could prompt before they needed to go to the toilet. Bathing charts were in place in care plans. One showed a gap of over a month between baths and nine days between washes, though we noticed that the resident in question appeared to be clean and tidy in appearance. The Manager thought that staff had not been recording when they helped with personal care and would be taking this up with staff. There were gaps on health check recording insofar as appointments for sight and teeth had not been recorded so that residents could have waited too long before having these appointments. The Manager said that these issues would be followed up. Staff said they had not read all Care Plans - this is needed so that they can fully understand residents needs. The Manager said this would be followed up. Accident records were checked and medical services were contacted when a resident had a potentially serious injury.There was also a monthly audit in place to review why accidents happened so that preventative steps could be put in place, thus protecting residents health. We checked the medication records, and found that there was generally good recording of the administration of the medicines in the home, though there were some gaps that the Manager said she would follow up and put a system in place so these could be checked on a daily basis. There was good information on medication sheets regarding allergies, as needed medication etc so that residents health is protected. It was found that staff issuing medication went out of the lounge and asked another staff member some distance away to watch the trolley which was left open with the potential that a resident could have helped themselves. Apart from this staff was observed to properly issue medication to residents. Controlled medicines storage was in a secured cabinet. The Manager needs to check that this storage conforms to the latest legal requirements. We spent time watching staff interaction with people living at Foxton Grange. We saw staff being friendly and caring to people throughout the day doing their best to meet the needs of people living at the home and relatives confirmed that staff respected privacy and addressed people by their preferred names, which respected their dignity. Staff were seen to assist residents in various ways - giving choices for breakfast, encouraging residents in activities and to take their medication etc. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for people to take part in activities and have a relaxed lifestyle. Evidence: Relatives said that they were satisfied with the current activities. One relative said, I think there are more activities now. People seem to be able to do a lot of things so they dont get bored. We spoke to the full time Activites Organiser and we saw that there is a current list of activities, including a pat a dogs visit, etc. We saw the Activities Organiser providing a one to one activity for a resident having her nails done and other staff doing activities with residents - playing ball, playing skittles, playing a letter game etc. Residents also watched TV, listened to music and staff said they took residents out to the garden in good weather. The Activities Organiser stated that there are daily activities - this was displayed on a noticeboard with pictures of the activities for morning and afternoon. She said that she was beginning a life history book with relevant photos for each individual resident with help from relatives, and we saw an example of this in one residents bedroom. She was also observed doing the nails for a res who appeared to Care Homes for Older People Page 15 of 27 Evidence: enjoy this pampering. Staff said they took people out to the garden in good weather. We saw that the home produces a regular newsletter to keep people up to date with relevant news about the home. The relations between staff and residents were observed to be relaxed. Staff said there were no rules. People can get up when they like, choose their clothes and food.etc. The home supports residents with dementia with staff training on this having taken place and there was displayed information for the menu, though not for day, weather, place etc. The only suggestions made were for regular outings and for the home to have a snoozelum facility - the Manager said that outings would be offerred this year and the snoolzelum facility to be investigated. Visitors are welcomed at Foxton Grange and we were informed by visiting relatives that they could come at any reasonable time and they were always greeted in a friendly way by staff. Relatives said that residents seemed to enjoy the food: Food looks well presented, one relative said. We observed lunch being served. There was a choice of a hot dinner or alternative. Food was well presented and looked appetising, with good portions being served to each person, followed by a home baked cake. Food records showed a good variety of traditional food served. There were displayed menus on tables to provide infomation to residents and relatives about what food they were getting. We spoke to the cook who said that she was trying to make sure that all food served to residents was home cooked and tasty, and that she met with relatives to get information as to residents likes and dislikes and this would be recorded in the future so the information could be checked and followed up. We recommended that the cook take part in residents/relatives meetings so that she can answer any queries etc. 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. Complaints are taken seriously and residents protected from abuse. Evidence: A relative said she had a complaint and had taken it to management where it was sorted out. Other relatives said that they had no complaints but if they did they thought the staff or the manager would quickly get the issue sorted out. A relative said, I think if I needed to make a complaint it would be quickly put right. We saw that there have been three minor complaints since the last inspection in the complaints book. All were speedily resolved by management though more detail was needed to clearly show what the complaint was and how it was dealt with. We talked to staff to find out how much they knew about protecting people in the home from abuse. Records showed they had received training about safeguarding adults from abuse, and they knew the in house procedure, and Agencies to whistle blow to if the in house procedure failed, except one staff spoken to. We looked at the staff recruitment records to see whether all the proper checks had been made on staff before they started employment at Foxton Grange. We found records which showed staff had started work with written references and legal checks in place to help management reach the judgement that people were safe to start Care Homes for Older People Page 17 of 27 Evidence: employment. Care Homes for Older People Page 18 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. People living at Foxton Grange live in a homely and well maintained environment. Evidence: All relatives spoken with said that bedrooms were clean and tidy: My husbands bedroom is nice. It is a good size and the cleaners do a good job as its always clean and tidy with no smells, one relative said. We saw people at Foxton Grange living in a clean and well maintained environment. The furnishings in communal areas are homely, and people are encouraged to bring their personal possessions into their bedrooms. The service has improved the environment to further help residents with dementia, e.g. colour coding toilet doors, pictures of residents favourite scenes on bedroom doors etc to make facilities clearer to orientate residents to go to their own bedrooms etc. Records show that the home is well maintained, and good measures are in place to keep the home hygienic. There were no odours in general apart from a low level odour in one bedroom. There are no radiator covers. The Manager said that the thermostatic radiator valves Care Homes for Older People Page 19 of 27 Evidence: have been fitted to ensure that residents are protected from burn risks. Care Homes for Older People Page 20 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 needs are met by a well trained and competent staff group though staffing levels need to be reviewed and increased as needed and more staff training in place to ensure residents needs are always met. Evidence: Relatives and staff generally said that there were enough staff to meet residents needs regarding personal care though there were also comments that as the staffing ratio also drops to five care staff in the afternoon/evening periods - two staff on each side plus a floating staff member (plus a nurse on each side) then staffing could be low to deal with high dependency residents, a number of whom have challenging behavior and need close supervision. One relative stated in the Quality assurance survey that staffing could be low at the weekend. We spoke with the Manager about the staffing and asked her to review this situation if bank staff are not available to cover shortfalls then the employment of Agency staff will then be needed. As regarding domestic staff they are shown in the staff rota, seven days a week though only for the morning period. This needs to be reviewed as it means that care staff have to deal with accidents/spillages in the afternoon/evening when care staffing levels are at their lowest. Care Homes for Older People Page 21 of 27 Evidence: A staff member said that although she had only been working at the home for six months she had been encouraged by management to do the NVQ 2 course and had already completed a number of training courses and a thorough induction. We found that staff have been on a number of training events to help update their practice on areas such as Moving and Handling, Fire Safety, Infection Control and Dementia, though some issues regarding residents health conditions were missing - e.g. Sight and Hearing Impairment, Stroke, Parkinsons Disease, Mental Health conditions, Diabetes etc. The Manager said that these would be added to the training programme. Staff records showed that proper checks had been carried out to protect residents from unsuitable staff. Care Homes for Older People Page 22 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. There are management systems in place to protect the health and safety of residents. Evidence: Lin Gazzard is the Registered Manager of the home. Lin is a Registered Nurse and has completed the NVQ 4 Award in management skills. She has been updating the staff with training, and this was confirmed by the staff spoken with. Satisfaction questionnaires were sent around the home last year, and the results were seen to be generally very positive. They contained an analysis of the results to see if improvements in the service were needed. There was one aspect in the survey that was not included in the analysis regarding staffing levels being low at times, especially at weekends, which should have been recorded to show how the home dealt with this issue. Written records regarding finances for residents are properly in place though need a Care Homes for Older People Page 23 of 27 Evidence: second signature to witness the transaction is correct, and monies were checked for two residents and totals were found to be correct. There was evidence of residents/relatives meetings discussing relevant issues activities, food etc, which showed involvement in the running of the home. Safe working practices were observed as we went around the home - e.g. e.g. tongs used when giving residents biscuits, alcohol liquid gel when coming into the building, instruction to wash hands in the staff wc etc. Staff informed us that they were able to tell management of the problems they were facing and there were regular meetings and supervision to support them, which we saw as being detailed and well kept. There are proper Health and Safety systems in place in the home. We saw risk assessments for safe working practices and COSHH assessments to keep residents and staff safe. Proper fire records were in place with regular fire drills. Staff were asked about the fire drill procedure and they all knew what to do except one staff member. There was a Health and Safety folder with Risk Assessments completed in a systematic preventative way. The Manager was asked to review the Risk Assessment on window restrictors to ensure intruders cannot enter the building. Hot water is regularly tested to meet the National Standard so that residents are not scalded. Care Homes for Older People Page 24 of 27 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 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 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 3 The admission sheet needs to include when health checks have occurred so that there is prompt referral if needed for dental, optical etc checks, so that residents health is improved. All aspects of residents lives should be included in the Care Plan, including preferred living routines and how frequently to assist residents with their continence. Staff need to read the Care Plans to ensure they know of all relevant aspects of residents lives. Medication needs to be kept fully securely at all times to protect residents from dangerous substances. Complaints need to be detailed to show what the complaint was and show it was dealt with. The Provider needs to ensure all staff know the Agencies to refer to if they suspect abuse has taken place. All staff need to be aware of the fire procedure in order that residents safety is fully protected. 2 7 3 4 5 6 9 16 18 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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