Care Home: Hawthorns Nursing Home

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What the care home does well The home has a good atmosphere that offers a welcome to any visitors to the home. There is good information available in the homes brochures to help any potential resident make a decision about living in the home. The home has a good Manager who is actively involved and knows the residents very well. Information of care needs are beginning to be written and to be known by all the people involved with the care, to be able to offer a tailored service. The home audit and have a robust system in place for managing medication that ensures the procedures are safe. What has improved since the last inspection? The home has a knowledgeable core of staff who know the residents well and have replaced the use of casual staff who were not so familiar with the residents in the past. This has been identified by GP`s and staff who now pass on relevant information to health professions competently. The home have recruited an activities person who has developed a relationship with all residents by finding the right stimulation/support that person would like. This has improved the well being of the residents with people appearing motivated and as involved as they can be. The environment has a more homely touch with the improvement of the dining room and areas of the home that have been decorated and pictures added. The lounge has been divided by an attractive screen to allow other activities to take place. What the care home could do better: The home needs to ensure that all areas of health and safety are managed correctly and timely and not let areas that have been identified as potential risks be left unchanged such as stated in the fire risk assessment. The heating and ventilation in the home needs to be controlled and held at a suitable temperature that is comfortable for the residents. The access to the garden needs to be changed and made safer for residents to pass in and out as they may wish. So that residents can call for assistance when required the home needs to have some form of call system that can be used by any resident sitting in a chair who may not be close to the call bell wired system. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hawthorns Nursing Home 270 Unthank Road Norwich Norfolk NR2 2AJ     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: Ruth Hannent     Date: 0 7 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 28 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 28 Information about the care home Name of care home: Address: Hawthorns Nursing Home 270 Unthank Road Norwich Norfolk NR2 2AJ 01603452302 01603507523 thehawthorns@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Care Services Ltd Name of registered manager (if applicable) Linda Henden 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 Additional conditions: Twenty-eight (28) Older People may be accommodated. Date of last inspection Brief description of the care home The Hawthorns Nursing Home is situated on the city boundary of Norwich. It is a converted Victorian house with a large extension to the rear of the premises. The home can accommodate 28 older people with nursing and/or care needs. The accommodation is on two floors and consists of 5 double rooms and 18 single rooms, some with en-suite facilities. The communal areas are on the ground floor and there is a passenger lift to the first floor. There are garden areas to the front and rear of the property and off street parking to the side and front of the home. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Hawthorns is one of several homes in Norfolk owned by the proprietors. Care Homes for Older People Page 4 of 28 care home 28 Over 65 28 0 Brief description of the care home The range of weekly fees is from 494 to 753 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: 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 inspection report has been completed following a visit to the home that took place over a period of 6 hours. Prior to this visit the Manager had completed an Annual Quality Assurance Assessment (AQAA) to give a picture of how the service offered had been delivered and how it had improved since the last inspection. Notifications had also been received from the home since the last inspection on any incidents, accidents or unexpected events that have occurred in the home. Surveys sent to residents, relatives, staff and health professionals had been returned to the Commission giving details on the care service offered and these were used to evidence some of the findings for this report. Care Homes for Older People Page 6 of 28 During this visit various records were looked at such as care plans, medication records, health and safety records, minutes of meetings, personnel files, maintenance checks and accident records. Staff were spoken to and time was spent walking the building and observing residents and staff throughout the day. A meal was taken with a resident and a discussion took place around their life at the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 28 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 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 10 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. Potential residents do have the opportunity to visit and look at information that will give them a picture of the service available and are reassured that their needs will be met after an initial assessment. Evidence: The manager explained the process of assessing a potential resident and showed the formats used to carry out an assessment ensuring that the persons needs can be met at this home. The AQAA tells us that the potential resident is visited by either the Manager of the Deputy Manager where an initial assessment will be carried out. If anyone is admitted on an emergency basis an assessment will be carried out within 48 hours. The Manager explains in the AQAA that all potential residents are offered a brochure, menus and an activities programme to help them in deciding if the home can meet their needs. Visits are encouraged and often families come themselves to look around. Care Homes for Older People Page 11 of 28 Evidence: Southern Cross have a contract pre printed that is issued to all new residents with a copy held in the persons own record held in a locked filing cabinet. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans detailing health and social care needs are in place and residents are offered suitable care support in a manner that is respectful and with choice. Evidence: Three care plans were seen during this visit. The content in these documents are beginning to develop person centred information to guide the staff to deliver the care support the person requires. Residents were all observed to be dressed appropriately. All their hair, nails and clothing were tidy and smart. Residents were smiling and appeared cared for appropriately and two were able to tell us that the care is good and that staff do their best to meet some very complex needs. Health support is obtained by many GP surgeries and any interaction between the home and the surgery is recorded. A letter to GPs was in the process of being written during this inspection visit, regarding procedures of homely medications. Regular visits were noted in the records and follow up visits requested had details of the outcomes. One example noted was the person who felt too ill to carry out their appointed care Care Homes for Older People Page 13 of 28 Evidence: plan review. Details seen, showed that later that day the doctor was called and that antibiotics were issued, received and administered. The AQAA tells us that the home uses a number of health professional to support the variety of needs required. Detailed nutritional screening takes place and residents are weighed monthly. The support of the dietician is requested and a planned balanced and suitable diet is put in place. The home also reports the support offered by the continence advisor who will review all needs every two to three months. The details written talk more of prevention by using the correct equipment and aids rather than dealing with the requirements after they are needed. The Deputy Manager was able to give a good account of the way residents are supported with their health needs and how the monitoring, for example, of people with diabetes takes place in the home. The medication for the home is stored in an upstairs office/nurses room. The contents in the locked trolley were in order with all named items dated when they had been opened. The details given by the Deputy Manager shows a good service is offered by the local pharmacy to ensure residents are offered the medication as soon as it is prescribed, such as antibiotics. the fridge temperature was recorded and showed suitable temperatures but the room temperature can vary and records show it can be at the top end of the expected range. Controlled drugs were counted for one person and the drugs registered showed that two people had signed the record and that the balance of remaining drugs was correct. The Manager tells us in the AQAA that a monthly medication audit is carried out by senior management and that the registered nurses carry out a weekly audit. Throughout the day the staff were observed carrying out their daily tasks in a manner that was respectful and all room doors were knocked upon before the staff member entered. Conversations overheard were caring and considerate, offering people choice in all actions taking place such as where would would like to eat to, would you like the window open or closed. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The experiences offered to residents in this home is suitable and enjoyed, from the activities offered, to visitors being involved, to the wholesome meals provided. Evidence: A new activities staff member who appears to be an ideal person for this role, has been recruited. A number of residents spoken to said how glad they are that this person is now in the home. She is ideal for the job. She has just the right approach to encourage participation are just some of the comments made. Recorded in individual residents records were plenty of interaction by residents with group activities, one to one sessions and planned events to match special times of the year. The night before this inspection there had been a cheese and wine evening which, according to two residents spoken to, was a great success. The next event planned is the Easter raffle. One resident was noted to be reading by the use of a special easel to hold the books, one person was doing a crossword, a number of people were listening to the radio and a few were being entertained by the resident cat. The atmosphere was calm and people were smiling. On the day of this inspection visit, a large number of visitors arrived at the home and Care Homes for Older People Page 15 of 28 Evidence: were included and interacting with residents and staff. The greetings were friendly and families have commented in both the surveys sent prior to this inspection by the Commission and notes taken from a relatives meeting how the home has improved and how families feel welcomed. The home has the meals offered to residents displayed on the notice board in the entrance hall. The information is in very small print and very difficult to read and could be displayed in a more suitable format for easy reading. It follows a healthy balanced eating plan that is suitable for older people and comments received from staff who have completed surveys to verbal comments on the day all expressed the quality of the meals provided. Drinks were circulated at regular intervals by the Kitchen Assistant and cold drinks are available at all times. A number of residents are having peg feeds that are offered sometimes, in a way that does not preserve dignity, with the machine and contents on display in the area where the person may sit. Discussions with the Manager took place over ways that the equipment could be disguised so as not to show to everyone the methods used to manage peg feeds. 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. The home does manage complaints correctly and in a timely manner, reassuring residents and their families that they will be listened to and that their concerns will be acted upon. Residents are protected from abuse. Evidence: The Manager has a complaints folder held in the office which was seen on the day of this inspection. The details were explained to us and the action taken following the complaint was dealt with correctly and timely. The residents and their families have the opportunity to voice comments and concerns via comment cards left in the entrance hall and also by regular meetings for residents and families that take place regularly. The Manager tells us in the AQAA that she has an open door policy and anyone can see her at anytime. The staff are trained in the protection of vulnerable adults as part of their induction that is updated regularly. Training statistics were seen that show staff are trained and 97 are up to date with their knowledge . One staff member spoken to understood the whistle blowing procedures and said she was given a copy of the homes policy on how and when to blow the whistle. The Manager also tells us in the AQAA that staff found unsuitable to work with vulnerable adults would be referred on and may be Care Homes for Older People Page 17 of 28 Evidence: added to a register that will exclude them from working with vulnerable people in the future. 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 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 a clean and well maintained building that has some improvements to do to ensure it is of a high standard and safe for the residents living there. Evidence: This is a clean well presented home. Due to it being a conversion of an older style property it is not ideal and some bedrooms are small, especially when dealing with large profile beds in a single room. The nurses station is not ideal and their is limited space for staff to work in. The maintenance and servicing of the home and equipment appears up to date with some servicing records seen such as the boiler serviced on the 08/08, legionella testing on the 05/08 and fire equipment on the 03/09. The Home is extremely hot in certain areas and although this inspection day was a pleasant day and not too hot outside the inside temperature felt extremely high. The thermometer in the conservatory measured 90 degrees, with two residents sitting in the heat and looking quite flushed. One comment from a family member prior to this inspection was the concern of residents not being able to call for assistance if required as no radio style call system Care Homes for Older People Page 19 of 28 Evidence: was available. This was evident in the conservatory were it was too hot and residents could not call for help. Due to the frailty of these people and the inability to get up and call for assistance a nurse call system should be introduced that is safe for the type of residents cared for and the heating in the home needs to be adjusted. The water temperature was tested in two areas and each showed a thermostatic control system was in place and hot water felt suitable to the touch. Hoists are labelled with a date to show servicing taking place every six months. A recently completed dining room gives a fresh and more interesting environment for residents to sit in and enjoy their meals. Cloths with matching napkins were in place and the tables looked fresh and inviting for people to be able to choose where they eat. Bedrooms have been decorated and more pictures and homely touches have been included to offer a cosier appearance to the home. The main lounge has now been divided by a modern screen allowing some different activities to take place away from the television. Fresh flowers are in the entrance and comments have been made by families and health professionals on the improvement in the way the home looks. The back garden is pleasant and used by the residents. The door used mainly to access the garden is via the conservatory which has quite a lip in the threshold and a steep ramp. This could be considered a risk and action must be taken to ensure entrances in and out of the home are safe for residents to pass freely in and out as they wish. The laundry is situated in the middle of the home and is managed by a staff member who, throughout conversation, takes pride in her work and enjoys what she does. She has recently received a heated roller for ironing bed linen and has two washing machines and two tumble dryers. There were no unpleasant odours and the housekeeper spoken to gave a clear picture of the cleaning routine that is carried out. 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. The staff are competent, capable, suitable and trained to carry out their jobs in sufficient numbers to meet the needs of the residents who have high levels of need. Evidence: The home has 24 residents at present as some double rooms are not being used. The registration of the home is still at 28. On the morning of this inspection there were 4 carers and 1 nurse on duty. In the afternoon there were 3 carers and one nurse and for the night the rota states 2 carers and 1 nurse. There were a number of anxillary staff in the home that carry out domestic tasks, administration and maintenance, and on this day the Deputy and Manager were extra to the hands on care. The residents all presented well. Everyone looked clean, tidy and comfortable. A number of residents were spoken to who all felt that the staff help them at suitable times and that they do not have to wait too long if they require assistance for non planned care. The staff on duty on the day of this inspection appeared to be working as a team and were using the Deputy and Senior Carer to support them with the care required. A staff member spent some time with us, talking about the home and the staff training and support offered to the staff team to enable them to carry out their duties. The NVQ qualified staff, out of 14 carers employed, show to date only 3 holding the qualification but 7 more carers have now been put forward and are starting the Care Homes for Older People Page 21 of 28 Evidence: programme shortly or have already started. All the staff personnel files are held in a locked cabinet and the recruitment process for carrying out all checks is done by the administrator. The two personnel files looked at showed that all the paperwork held was at the required standard with 2 references, a CRB clearance, 2 forms of identification, a contract and a completed application form. The staff member spoken to said that no staff member can start work until the home has the returned CRB. The home has training statistics that were printed off and given to us to show the number of staff who have received all the required statutory training. The percentage of staff who have completed compulsory courses is very high but improvements could be made in the areas of pressure care, care planning and dementia awareness. The statistics do not show training for the Mental Capacity Act or Deprivation of Liberty which is now a recommended course and of which the Manager is aware of and who is planning the training for staff shortly. The staff spoke of the good support they get for completing training and are encouraged at all times to develop and improve their knowledge. 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. The manager is a suitable and competent person who is able to manage this home that benefits the residents and ensure that all practices are carried out safely. Evidence: The manager has been at this home for the past 6 months and is now registered with the Commission, having completed her interview the month before this inspection. She has been a Manager at another home within the company and has many years of experience managing services for older people. The staff, residents and families all commented in both the surveys received prior to this inspection, on the day of the inspection and by telephone how improved the home is and how accessible the Manger now is. Meetings are regularly held for all interested people and minutes are on display in the entrance. The quality of the home has been commented on by all the 9 surveys received from Care Homes for Older People Page 23 of 28 Evidence: relatives. The details in the recent (12th March) relatives meeting minutes states The home has greatly improved in the last six months and We are very happy with the way the home is run are just two of the comments made. The Manager reports in the AQAA that an effective quality assurance and monitoring system is in place and that surveys are given to relatives, residents, GPs and Social Workers to feedback how the service is performing. The senior management of the company visit the home on a monthly basis to audit and monitor the various areas of the service to ensure the policies and procedures are being carried out correctly. The residents money is managed in the home if the person or their family do not wish to take responsibility. The money is placed in the safe after a receipt has been issued. All transactioned are double signatured (see) and all purchases are accompanied with a receipt. The home only holds a small amount of money in the office safe and the remainder is banked. All residents are issued with monthly interest of money that is deposited. This procedure is checked monthly by a senior manager and all signed for as correct. Staff supervision is held regularly. The staff spoken to said they are beginning to have one to one sessions. The AQAA tells us that the home Seniors take responsibility for supervisions and appraisals and that they are planned for the year with their designated staff and carry out in a timely manner. The records of some supervision and the regular staff meeting minutes was seen. The home is up to date with all health and safety training for all staff. The one induction pack Skills for Care seen, showed a slow progress for one person who needs to go through the process at a pace that suits the individual to ensure understanding and competencies are in place. Regular health and safety meetings are held with topics sent from head office on areas that may need refreshing are discussed. Minutes are kept and staff spoken to said that these meetings are held. The AQAA tells us that all accidents are recorded and the Commission has received notifications on incidents that are required. An area of concern has been identified with the non completion of the items highlighted in the fire risk assessment that are still to be completed, with some requirements showing as outstanding. This was discussed in full and will be addressed. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23 (2)(p) Ventilation and heating within all parts of the premises must be suitable for the assessed needs of residents. 30/06/2008 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 20 23 The home must ensure the access in and out of the garden is suitable. To ensure residents can move in and out of the house safely as and when they wish. 01/06/2009 2 22 23 The home must ensure the residents have access to a call system that will maximise their independence To ensure that residents can call for assistance when required in any areas of the home. 01/06/2009 3 25 23 The home must ensure that all rooms are held at a suitable temperature and correct ventilation is in place. To ensure that residents are cared for in suitable and comfortable temperatures. 01/06/2009 Care Homes for Older People Page 26 of 28 4 38 23 The home must ensure that 01/06/2009 requirments made in the fire risk assessment document is completed and all requirements are up to date. To ensure adequate precautions against the risk of fire is in place. 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 15 15 It is recommended that meals are on display in a suitable and easy read format. It is recommended that items of intrusive equipment such as peg feed machines are hidden or disguised to preserve dignity. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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