Care Home: Greenford Care Home

What the care home does well Greenford Care Home provides accommodation and support for up to 18 people with dementia care needs. The needs of prospective service users are assessed prior to admission and the information received forms the basis of the service user plan. Service users are able to choose how they spend their time and are supported in their decision-making based on individual preferences. Service user`s friends and relatives are welcomed into the home. Theres a good programme of activities in place organised by the part-time activities co-ordinator. Residents are able to choose the level at which they wish to participate and both individual and group activities are arranged. The service provides a healthy and balanced diet with choices available and positive comments were received about the quality of food. The organisation provides a good training programme covering all mandatory topics. Care staff commented that they have benefited from an improved level of training. Recruitment issues are well managed and all new staff work through an evidencebased induction programme. Health and safety issues are well managed and all certification was in place and up to date. Policies and procedures are in place promoting safe working practices. What has improved since the last inspection? There have been a number of changes since the last inspection. Following visits by the Kent Health Protection Unit the service has reviewed and improved infection control procedures in line with advice received, consequently receiving a green award in this area. A new manager has been appointed who has identified a number of areas for improvement and development. The organisation has invested in an improved training programme for staff and over 50 percent of the team have achieved a National Vocational Qualification in care at level 2 or above. Work has been on-going to improve the environment and a new medication room has been created. Medication issues in general have also improved such as administration records. What the care home could do better: 1 requirement and 5 recommendations have been made as a result of this inspection process. A number of environmental issues throughout the service require addressing, most notably improving the kitchen and redecoration and refurbishment of communal areas and some bedrooms. The home has an improvement plan in place addressing the majority of these issues and is required to ensure that these improvements are carried out as per the action plan. Greater levels of detail in service users plans and risk assessments to promote consistent practice are amongst the recommendations made. It is also recommended that at least senior care staff in the team attend advanced dementia care training courses to support good practice. The medication room would also benefit from being audited and reorganised. At the time of the site visit the manager had been in post for just over 1 week. She needs to apply for registration with the Commission following completion of her probationary period. Other issues were also discussed including minor updates to the service user guide and statement of purpose and the possibility of creating an access point for service users with staff support to be able to enjoy the public park at the rear of the home. Key inspection report Care homes for older people Name: Address: Greenford Care Home 260-262 Nelson Road Gillingham Kent ME7 4NA     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: Joseph Harris     Date: 2 2 1 0 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 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) 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 26 Information about the care home Name of care home: Address: Greenford Care Home 260-262 Nelson Road Gillingham Kent ME7 4NA 01634580711 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: donna.h@charinghealthcare.co.uk Purelake (Greenford) Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 18. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Greenford is home to 18 service users with dementia. The home is situated in Gillingham close to the town centre and adjacent to Gillingham Park. The main town of Gillingham offers High Street shopping and a mainline railway station. The home itself is on a bus route. There is limited parking to the rear of the home, but street car parking is available in front of the building. The home is set out over two floors with a range of communal space and a small patio area to the rear. Four of the bedrooms have en-suite facilities. The current scale of charges are summarised in the service user guide and are available on request from the home manager. 0 7 1 0 2 0 0 8 18 Over 65 0 Care Homes for Older People Page 4 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: This unannounced inspection process culminated in a site visit to the service on 22nd October 2009. The site visit commenced at 10:00 hours and lasted for approximately 6 hours. The pre-inspection planning prior to the site visit included the review of documents and information received by us since the last key inspection. The service submitted an Annual Quality Assurance Assessment (AQAA) that summarised the progress made over the past 12 months, issues that have been identified for improvement and numerical and statistical information about the service. The AQAA focused well on the outcome for service users and contained all the information that we requested in good detail. We also looked at any concerns, complaints or allegations that we have been notified about and how the service have managed any such issues. The last key unannounced inspection report and the results of any other visits conducted were reviewed as well as any notifications received from the service telling Care Homes for Older People Page 5 of 26 us about untoward incidents. Information received from other sources was also considered and reviewed. During the course of the site visit we were assisted by the newly appointed manager and senior manager from the organisation. Discussions were held with service users and staff. A tour of the premises was conducted and staff practices were observed. A range of records were examined including those relating to service users, staff, training, medication and health and safety issues amongst other things. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 1 requirement and 5 recommendations have been made as a result of this inspection process. A number of environmental issues throughout the service require addressing, most notably improving the kitchen and redecoration and refurbishment of communal areas and some bedrooms. The home has an improvement plan in place addressing the majority of these issues and is required to ensure that these improvements are carried out as per the action plan. Greater levels of detail in service users plans and risk assessments to promote consistent practice are amongst the recommendations made. It is also recommended that at least senior care staff in the team attend advanced dementia care training courses to support good practice. The medication room would also benefit from being audited and reorganised. At the time of the site visit the manager had been in post for just over 1 week. She needs to apply for registration with the Commission following completion of her probationary period. Care Homes for Older People Page 7 of 26 Other issues were also discussed including minor updates to the service user guide and statement of purpose and the possibility of creating an access point for service users with staff support to be able to enjoy the public park at the rear of the home. 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 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 9 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. Service users and their representatives are able to make an informed choice about moving into the home and their needs are assessed prior to admission. Evidence: A statement of purpose and service user guide are in place. The guide is provided to service users/representatives at the point of referral and contains all the required information. A discussion was held with the manager regarding the layout of this document and how it could be made to be more user-friendly. All prospective service users needs are assessed prior to admission. The home gathers information from other sources including care managers and relatives where appropriate. An assessment is completed prior to admission covering all of the key aspects of care and support. Two examples of these were examined which had been completed in good detail and were linked to the plans of care. Prospective service users are offered trial visits to the home prior to choosing whether or not to move in. it was reported that these are arranged flexibly dependent on the Care Homes for Older People Page 10 of 26 Evidence: needs and wishes of the individual and their representatives. The home does not offer intermediate care. Care Homes for Older People Page 11 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. The health and personal care needs of service users are met. Evidence: Three individual service user plans were examined during the course of the site visit. A range of assessment information had been completed including moving and handling, pressure area care and nutrition amongst others. There was evidence that these assessments have been updated, but the last review was documented as August 09. This was addressed with the manager at the time of the inspection. Plans of care were in place addressing all key areas of need. The manager stated her intention to review and update all care plans as one of her priorities since starting in post 1 week previously. It was identified that of the plans examined the guidance and actions to enable staff to meet needs was limited. The plans of care need to be developed in greater detail therefore promoting consistent, individualised support. Similarly, risk assessments are in place, but lack sufficient detail. There was evidence that both care plans and risk assessments are reviewed on a regular basis. The home maintains healthcare records ensuring that any issues of concern are reported to appropriate professionals. The outcomes of any appointments are Care Homes for Older People Page 12 of 26 Evidence: recorded and plans of care updated accordingly. All service users are registered with local GPs and it was reported that good support is received from local community health and social care services. There is evidence that service users have access to complimentary healthcare services such as chiropodists, dentists and opticians. Medication records and facilities were examined. Records of administration were up to date and well maintained. The home keeps records of medications that have been received, returned and destroyed. There is a dedicated room for medication storage, which is suitable for purpose. It was noted that some of the cupboards storing medication were somewhat disorganised and would benefit from being reorganised. A number of sharps boxes were in use or needed to be returned to the pharmacy for disposal. It was also advised that protocols for the use of as required medication should be developed to ensure that these medications are used appropriately. All staff administering medication have received suitable training. A number of staff on duty were spoken to and practices observed throughout the course of the site visit. Care staff demonstrated a good understanding of individual needs. Staff were observed to treat service users with dignity and respect and demonstrated that they have developed good interpersonal relationships with the service users. One staff member said, I think we provide really good care, we always treat everyone as individuals. Their needs are the most important thing. One service user said, All the carers are lovely. I like living here. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have a lifestyle that suits their needs and wishes. Evidence: There is a good range of activities available in the home. One member of staff has been appointed to co-ordinate activities and has developed a programme that takes account of the individual and collective needs of the service users. This includes outside entertainers visiting the home, parties and seasonal events and trips out using the homes minibus. Organised activities take place on a daily basis such as arts and crafts sessions, cooking and exercises amongst other things. Staff were observed interacting with residents in a relaxed and friendly manner and service users were engaged in pastimes of their own choosing. The home maintains records of activities provided and those that have participated to ensure that everyone receives opportunities to get involved. It was not possible to speak to any visitors at the time of the visit, but staff and the manager reported that visitors are welcomed into the home. There is space for people to meet in private should they wish to do so. Evidence was available in the form of satisfaction surveys to demonstrate that relatives feel welcome and the home liaises appropriately. A discussion was held with the cook. She stated that the quality of food supplied to Care Homes for Older People Page 14 of 26 Evidence: the home is good, which was evident by the stocks available at the time of the visit. Menu records are maintained which demonstrate that a healthy and balanced diet is provided. Special diets are catered for, but at the present time, with the exception of diabetic diets, no specific diets are required. The home monitors the nutritional needs of the service users. The lunch time service was observed, which was a relaxed and sociable affair. Service users requiring support were assisted sensitively. One service user said, the food is very nice. One member of staff said, we have the best cook that we possibly could have, she is excellent. Care Homes for Older People Page 15 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. Concerns and complaints are managed well and service users are protected from forms of abuse. Evidence: There is a complaints process in place, which is summarised in the service user guide and displayed within the home. The complaints policy promotes any issues being dealt with on an informal basis in the first instance, but also includes information about how to make a formal complaint should this be required. A complaints book is maintained and the outcomes of any concerns raised are recorded. It was reported that no complaints have been received over the past 12 months. No complaints have been received directly to the Commission in respect of the service since the last inspection. Staff have received training covering adult protection and abuse awareness. Information and training regarding the Mental Capacity Act is also provided. Staff spoken to demonstrated a good understanding of issues connected with adult protection and responsibilities in this area. One adult protection alert was raised by the service since the last inspection. Records and correspondence relating to this were reviewed and this demonstrated that the home managed the issues well. As a result a member of staff had their employment terminated and were referred to the POVA register. This issue also demonstrated that the home and organisation followed their whistle blowing policy. The adult protection alert has subsequently been closed. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for purpose, but further work is required to update the environment. Evidence: A tour of the premises was conducted and a number of issues were identified that are required to be addressed. The home is located close to the centre of Gillingham on a residential road within easy access of public transport links. The house backs onto a large park and there is street parking available. There is a small terraced area to the rear of the house with garden furniture. This area would benefit from being tidied and tended to. The manager identified this as an area earmarked for improvement. The back gate to the park is inaccessible and it was suggested that this could be rectified to enable service users to benefit from the space more readily. There is adequate communal space within the home consisting mainly of a large open plan lounge/dining area and additional smaller, quiet rooms. The furnishing and fittings in these areas are suitable for purpose, but the renewal of some items of older furniture and on-going redecoration would be beneficial. There is also a stair gate at the foot of the stairs, which needs to be subject to a risk assessment and review of use. The office area is small and relatively disorganised. This room would benefit from refurbishment and redecoration ensuring suitable storage space. Care Homes for Older People Page 17 of 26 Evidence: A number of bedrooms were viewed all of which were suitable for use and personalised according to taste. 4 rooms have en-suite facilities and all are single occupancy. There are suitable numbers of easily accessible toilets and bathrooms throughout the house. It was stated that these facilities are suitably adapted to the needs of the residents. The kitchen area is in need of refurbishment and deep cleaning. The storage areas and cupboards require replacing and shelves in the larder area treated to ensure the control of infection. The cooker is old and represents a potential health and safety hazard. The installation of a dishwasher would also be beneficial. A new clinical room has been created providing an improved and secure space for storing medication and related equipment. The laundry facilities are suitable for purpose and contains an industrial washing machine with a sluice facility. A hand washing basin is located in the room. Parts of the laundry area have been upgraded including the surface of the walls. It was noted that the flooring may also benefit from upgrading to ensure the potential for cross infection is minimised. Concerns had been raised in the past about infection control measures in the service. Three inspections were carried out by the Kent Health Protection Unit. A report made following the final inspection in July 2009 stated that the service has addressed all of the issues raised and gave the service a green rating signifying good standards of infection control. Subsequent to the site visit the home has compiled an action plan addressing the majority of the issues noted above providing realistic timescales for action. It is required that the organisation updates and follows this action plan. Refer to requirement 1. Care Homes for Older People Page 18 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. There is a competent and well trained staff team in sufficient numbers. Safe recruitments practices are in place. Evidence: The staffing rotas for the current period and future weeks were examined demonstrating that sufficient numbers of staff are on duty at all times. The service operates with three care staff throughout the day in addition to the manager who generally works office hours. There are two waking staff at night. The home employs a cook, three domestics and a part-time maintenance man. Staff were observed to be relaxed in their work and unhurried in their duties. They confirmed that enough people are on duty at all times to meet the needs of the service users. One staff member said, It would always be nice to have more people on duty, but we manage well. It was evident through discussion with staff members that there is a good awareness of issues affecting service users throughout the team. Staff were observed to treat people with respect and sensitivity. Over 50 of the staff team have achieved a National Vocational Qualification at level 2 or above in care. Two staff personnel files were examined, both of which contained all of the required information including CRB and POVA first checks, two written references and proof of identity. The staff training matrix was examined and cross-checked against certificates on file. This provided evidence that the majority of staff have received training in all required Care Homes for Older People Page 19 of 26 Evidence: areas as well as service specific training such as dementia awareness. All staff have had training in adult protection issues and infection control. It was recommended that senior staff should also complete advanced dementia care training. All new staff work through an induction process based on the Common Induction Standards and also have an induction specific to the home. One staff member said, the training is very good with the new organisation. 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. The home is run in the best interests of the service users. Health and safety issues are monitored and maintained. Evidence: The present manager had, at the time of the site visit, been in post for a week. Therefore she was still in the process of developing an understanding of the issues that need to be addressed in the home. Care staff spoke positively about her initial impact on the service. She has previously managed care services of a similar nature and has achieved her Registered Managers Award/NVQ level 4. In discussion she demonstrated a clear sense of direction and had already established good relationships with service users. She is currently being supported by a senior manager within the organisation. It was stated that there are plans for her to register with the Commission following a successful probationary period. Quality monitoring processes are in place, which include regular visits and monthly monitoring reports conducted by a senior manager. Annual surveys are sent out to relatives, staff and visiting professionals the results of which are collated into a report Care Homes for Older People Page 21 of 26 Evidence: and any action points taken forward. A new survey format has been developed for service users to promote feedback. The area manager also carries out 3 monthly audits of health and safety practices and other key areas. The service does not act as a financial appointee for any service users; people independent of the service take on this role. The home does have a facility for safekeeping and any financial transactions are records and receipts retained. A range of records relating to health and safety issues were examined, all of which were up to date and maintained. These included service safety certificates such as gas and electrical wiring, fire safety and accident records. Staff receive the training that they require to carry out their duties safely and safe working practices are underpinned by policies and procedures. 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 19 23 1) Subject to regulation 4(3), the registered person shall not use the premises for the purposes of the care home unless a) the premises are suitable for achieving the aims and objectives set out in the statement of purpose. To complete identified aspects of renewal and refurbishment in accordance with the service action plan. 04/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 1 7 9 To review and up date the service user guide. To continue to update care plans and risk assessments ensuring clear guidance for staff. To ensure that medication storage is well organised and maintained. 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 4 5 30 31 To provide staff with advanced training in dementia awareness and other service specific topics as necessary. The manager to progress with registration with the Commission. 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. 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