Care Home: Hazelhurst Nursing Home

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What the care home does well The home provides sufficient information to help people decide if they wish to move into Hazelhurst. The home carries out assessments of people`s needs before they move in, so that people can be confident that the home can meet their needs. People living at the home are well looked after by staff and have their health care needs attended to. People can be confident that their privacy and dignity will be respected. People can join in a wide range of activities, and the home supports people to take part in local community events. People who live at the home told us "there`s always something to join in with" and "I really like the exercises we do". The home provides meals which are varied and nutritious. People can be confident that any concerns will be taken seriously and will be resolved. Staff recruitment procedures protect people who live at the home by making sure that only suitable staff are employed. The home provides a safe and comfortable environment for people to live. The staff have a good understanding of infection control. Staff are kind and caring, and have the skills and knowledge they need to support the people who live at the home. People commented positively on the staff and described the staff as "very kind, very good girls" and "lovely, very kind, always there if you need them". The home is well run by the experienced manager. People who live at the home can be confident that the home is run in their best interests. Health and safety is given a high priority. What has improved since the last inspection? The home makes sure that people`s wishes and expectations are explored when the pre-admission assessment is carried out. The home has an effective quality assurance system, which is used to improve life at the home. What the care home could do better: Weaknesses in some of the arrangements and practices for medication may place some people who use this service at unnecessary risk. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hazelhurst Nursing Home Bishopswood Ross-on-wye Herefordshire HR9 5QX     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: Sarah Blake     Date: 0 8 0 6 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 30 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 30 Information about the care home Name of care home: Address: Hazelhurst Nursing Home Bishopswood Ross-on-wye Herefordshire HR9 5QX 01600890600 01600890926 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) : Hazelhurst Nursing Home Limited care home 44 Number of places (if applicable): Under 65 Over 65 0 44 0 dementia old age, not falling within any other category physical disability Additional conditions: 44 0 44 The maximum number of service users who can be accommodated is: 44 The registered person may provide the following category of service only: Care Home with Nursing (N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 44 Dementia (DE) 44 Physical disability (PD) 44 Date of last inspection Brief description of the care home This service is provided at an Edwardian country house set in extensive grounds with gardens. Hazelhurst has been modernised and extended to create a care home with nursing. It is registered to offer services for people who may have care needs arising from ageing, physical disability, and dementia. On the outskirts of the village of Bishopswood, the property is approached by a long drive and is in a peaceful rural position. Care Homes for Older People Page 4 of 30 Brief description of the care home A schedule of fees is available from the home. There are additional charges made for some services, and details of these can be obtained from the home. A copy of this report can be viewed at the home. Care Homes for Older People Page 5 of 30 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 was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for three people. This included observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The service had previously completed an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 30 (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. 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. 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 Care Homes for Older People Page 8 of 30 7535. Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sufficient information to help people decide if they wish to move into Hazelhurst. The home carries out assessments of peoples needs before they move in, so that people can be confident that the home can meet their needs. Evidence: The home provides very detailed written information for people who are considering moving into Hazelhurst. This is in the form of a Service User Guide, which clearly sets out what people can expect from the home, and tells people what life is like at the home. There is no information to tell people if they can request the Service User Guide in other formats, such as large print or other languages. We spoke to one person who had recently moved into the home, and they told us that they had been made very welcome by the staff, and that matters relating to the care provided by the home had been discussed with them. Care Homes for Older People Page 11 of 30 Evidence: A relative of someone living at the home told us that they had looked at several homes before deciding on Hazlehurst, and said the staff seemed very nice, and theyve been lovely with Mum since shes been here. We looked at the records for someone who had recently moved into the home. These showed that an assessment of the persons needs had been carried out by a senior member of staff before the person moved in. By carrying out a full assessment, the home can be sure that it can meet peoples individual needs. We saw that the pre-admission assessment was brief, but covered all aspects of the persons care. It also included important information, such as the persons next of kin and their religious needs. Care Homes for Older People Page 12 of 30 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 living at the home are well looked after by staff and have their health care needs attended to. People can be confident that their privacy and dignity will be respected. Weaknesses in some of the arrangements and practices for medication may place some people who use this service at unnecessary risk. Evidence: The home uses a computerised system for planning care. This system stores peoples records securely and can only be viewed by staff who have the relevant authorisation. Copies of care plans are printed off and placed in peoples bedrooms, so that staff can easily see the care that needs to be provided and so that people can be involved in planning their own care. We saw that some care plans in peoples bedrooms were not as up to date or detailed as those stored on the computer. This could mean that staff may not know the most recent information about peoples care needs. We looked at the records for three people who live at the home. These showed that Care Homes for Older People Page 13 of 30 Evidence: the home carries out risk assessments for any identified risk, and then takes action to manage the risk. For example, we saw that one person was at risk of malnutrition. The home had carried out a full nutritional assessment, and the care plan included the instructions to staff to complete and monitor food and fluid chart and try to encourage with small meals or ask if there is any preference A (name of person) would like. We saw that the chart for monitoring food and fluid intake was kept up to date and the manager told us that any concerns would be passed on to the persons GP. Records showed that the home carries out risk assessments for people who are risk of developing pressure sores. We saw that one person with a pressure sore had a very detailed care plan drawn up by the homes tissue viability nurse, and that thorough records were kept of the management of the pressure sore. The home makes sure that people who are nearing the end of their lives are well cared for. The manager showed an excellent understanding and knowledge of current good practice in palliative care. We saw that the home makes sure that people are supported to make decisions about how they wish to be cared for at the end of their lives. Everyone who lives at the home has a named nurse and a key worker. People told us that they know who their named nurse is, and one persons relative told us that they felt that they could approach the named nurse with any queries or concerns. Most people who live at the home are registered with the local GP practice in Mitcheldean, but people can also choose from two other GP practices, who are willing to take on people living at Hazelhurst. The records showed that the home works with GPs and with other healthcare professionals to meet peoples health needs. We looked at medication records to make sure that the home manages medication safely. The manager told us that nobody living at the home currently manages their own medication. Records showed that one person was having a course of antibiotics. These had been dispensed in a box of 28 tablets, of which there were eight left in the box. The Medication Administration Record (MAR) sheet showed that there should have been nine tablets left in the box. On two occasions, there were gaps on the MAR sheet, so there was no way of knowing if the antibiotic had been given. There should never be any gaps on the MAR sheet; if medication is not given for any reason, this should be recorded. We looked at the stocks of several medications, and these showed discrepancies Care Homes for Older People Page 14 of 30 Evidence: between the amount of medication which was recorded as being in stock and the actual amounts. This means that the home cannot be sure that people have received their medication as prescribed. We saw that one person has an allergy to penicillin. Although this was recorded on the care plan on the computer, it was not mentioned either in the printed care plan or on the Medication Administered Record (MAR) sheet. This means that there is a risk that unsuitable antibiotics could be prescribed which might cause an adverse reaction. The home makes sure that people are treated with respect and that their dignity is maintained. Records showed that people are asked how they like to be addressed and if they have any preferences about how they like their care to be provided. We saw that the home recognises the possible embarrassment which incontinence can cause, as one care plan stated this will upset a lot of residents, so maintain dignity at all times. During the inspection, we saw staff treating people with respect, and providing care in a way which promoted privacy and dignity. Care Homes for Older People Page 15 of 30 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. People can join in a wide range of activities, and the home supports people to take part in local community events. The home provides meals which are varied and nutritious. Evidence: The home provides a range of social activities and leisure opportunities for people, and these are planned to take into account peoples individual wishes. The home employs a Welfare Worker, who talks with everyone who moves into the home, to find out what activities they might enjoy, and to help them to integrate into the life of the home. A large information board in the hallway showed details of some of the activities. These included music; mobile library; Stepout theatre visit; Tai Chi; craft; musical movement; PAT (Pets as Therapy) dog visits; a monthly Church of England service; an outing to Raglan Castle and an open afternoon for fundraising and community involvement. We spoke to people living at the home and they told us that the home provides a varied range of activities. Comments included theres always something to join in Care Homes for Older People Page 16 of 30 Evidence: with and I really like the exercises we do. Within the home there is a well equipped hairdressing salon, and the hairdresser visits regularly. The home has very extensive grounds, which include a garden area, with paths and a lawn area. The home makes sure that these facilities are used as much as possible, for exercise and for social gatherings. We saw that some very large patio pots had been planted up, and the manager told us that these had been planted to individual peoples choices. We saw that one person had a large pot of runner beans and parsley, one had strawberries, one had roses, and one had an alpine garden, which had been planted up with plants from their own garden. The pots had been placed so that people could easily reach the plants, and the manager explained that one person liked to tend their plants, so the pot had been placed by a seat to make this easier. We also saw pots which had been planted with sunflowers and onions for a growing contest. The Welfare Worker has been very active in encouraging links with the local community. These have included lunches in the village hall, and involvement in the church flower festival. Volunteers from the local community work with the home, and the Welfare Worker makes sure that people who do not have relatives or friends living locally are linked with a volunteer, so that they receive regular visits. We spoke to visitors, and they told us that they are always made welcome, and can visit at any time. In the AQAA, the manager told us that the home has introduced more seasonally appropriate foods. Lunch on the day of the inspection was a starter of fruit juice, or orange and grapefruit cocktail; beef and onion pie or cold meat (pork or chicken), creamed potatoes, vegetables and gravy; apricot sponge with vanilla sauce or ice cream. Because many people who live at the home have difficulty chewing food or are at risk of choking, the home provides a soft diet option, which on the day of the inspection was mince beef and onion pie, with pureed vegetables and gravy. There was no vegetarian option on the menu, but the manager assured us that this would be provided if anyone requested it. People told us that they enjoy the food provided by the home. Comments included excellent, you can choose what you like, theres plenty to choose from and lovely, plenty to eat. The home has introduced a catering comments book, and we saw that people had made some, mainly positive, comments about the food. Care Homes for Older People Page 17 of 30 Care Homes for Older People Page 18 of 30 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. People can be confident that any concerns will be taken seriously and will be resolved. Staff receive training to help them to know how to protect people from any risk of abuse or neglect. Evidence: The home has a clear and comprehensive complaints policy and procedure. This is given to everyone who moves into the home, and is displayed in the home. The complaints procedure does not make it clear that complaints can be referred to the commission at any stage of the procedure. People told us that they knew how to complain. One person said Id talk to Jane (the manager), shes excellent and another said if you have a problem, the nurses are very good. We looked at the records of complaints kept by the home. These showed that the complaints which the home had received had been dealt with according to the policy. One person told us about an issue which they had raised with their relatives named nurse, which was resolved quickly and in such a way that they felt confident about raising any future issues. Care Homes for Older People Page 19 of 30 Evidence: The home has shown that they are aware of the local procedures for protecting vulnerable people from abuse or neglect. The manager has good relationships with the local Social Services Department and knows how to pass on any concerns about peoples safety and welfare. Staff receive training in the protection of vulnerable adults, and the homes recruitment procedures help to protect people by making sure that only suitable staff are employed. Care Homes for Older People Page 20 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and comfortable environment for people to live. The staff have a good understanding of infection control. Evidence: The home is a nineteenth century house with a purpose built extension. It is situated in the countryside a few miles from Ross-on-Wye. The grounds are extensive and are exceptionally well maintained. There are two lounges, one of which has been designated as the quiet lounge. We saw that comfortable armchairs were arranged mainly around the edge of the room, but with some closer together for conversation. The second lounge has a television, with armchairs around the edge of the room. A budgerigar in a cage, a flame effect electric fire in the grate and a piano give the lounge a homely feel. The dining room is a large room, with tables well spaced so that there is plenty of room. The home has recently purchased new dining chairs. Throughout the home, there are ornaments and pictures, and flowers from the garden, which add to the homely and welcoming atmosphere. People can bring items of their own furniture and ornaments to make their bedrooms Care Homes for Older People Page 21 of 30 Evidence: more personal. The bedrooms are kept very clean and people told us that the home is always clean and fresh. Many bedrooms have profiling beds. Profiling beds can be electrically adjusted to enable the users position to be changed without strain for anyone involved. The Service User Guide states that people are able to hold keys to their bedrooms and also to have lockable storage within their bedrooms. Some bedrooms have ensuite facilities, and there are also bathrooms with specialist bathing equipment if needed. The home has recently purchased a specialist shower chair, which means that people with mobility problems are able to shower in comfort. The grounds include a lawn and a paved area with planted pots and bird feeders. There is a large pergola, which provides a shaded area where people can sit and chat or take part in activities such as Tai Chi. Part of the lawn has a mesh base so that people in wheelchairs can access it. Infection control is well managed by the home, and we saw that all bathrooms contained liquid soap and paper towels. On the day of the inspection, we saw staff using personal protective equipment such as gloves and aprons, whenever they provided personal care to people. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are kind and caring, and have the skills and knowledge they need to support the people who live at the home. The homes recruitment procedures help to protect people by making sure that only suitable staff are employed. Evidence: People who live at the home were very positive about the staff. People described the staff as very kind, very good girls and lovely, very kind, always there if you need them. The staffing rotas showed that there are enough staff on duty at all times to meet peoples needs. People told us they come round in the night to see if youre all right and whenever Ive asked for help, somebody always comes and helps. We looked at the records for three members of staff. These showed that the home had carried out all the required checks to make sure that staff are suitable to work with vulnerable people. These include a Criminal Records Bureau (CRB) check and two written references, one of which must be from a previous employer. In the AQAA, the manager told us we offer good training opportunities and good staff support. Records showed that there is a wide range of training opportunities, as well Care Homes for Older People Page 23 of 30 Evidence: as the mandatory training which all staff must do on a regular basis. The home makes sure that each person is allocated a named nurse and a key worker from among the care staff. The Welfare Worker has responsibility for overseeing the key workers. We saw that the key workers have a job description which tells them clearly what is expected of them, and includes the instructions to try and plan one small treat or something different from the normal routine and get feedback from them about the way they feel about their care. This shows that the home is taking steps to make sure that people who live at the home have a good quality of life. Care Homes for Older People Page 24 of 30 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 well run by the experienced manager. People who live at the home can be confident that the home is run in their best interests. Health and safety is given a high priority. Evidence: The manager has worked at the home for seven years and has been the manager for the past two years. She is registered with the commission, which means that she has been judged to have the skills and experience necessary to manage the home. The manager is supported by a deputy manager and a team of nurses, care staff and support staff. The home is privately owned, and the registered provider, Mr Corbett, visits the home regularly. Mr Corbett holds fortnightly meetings with the management team and we saw that the notes of these meetings include information about any actions to be taken by him or the manager. Care Homes for Older People Page 25 of 30 Evidence: Mr Corbett was present for some of the inspection, and it is clear that he is very involved with the running of the home. We saw that the home carries out customer satisfaction surveys and the latest survey carried out in March 2009 showed a high level of satisfaction, with people commenting favourably on the staff; the standard of care; the housekeeping, and other areas such as food and social activities. The home keeps a record of any accidents or incidents, and the manager told us that she analyses these to try to identify any trends, so that systems can be put in place to manage any risks to people living at the home. The home does not take responsibility for peoples personal money. The manager sent us the AQAA when we asked for it. It contained detailed information about the service, and showed that the manager is clear about how the home can make improvements. The manager has notified us, the commission, of incidents which affect people living at the home, and has shown that she works well with us to ensure that peoples needs are met. The home has robust procedures for managing health and safety, and staff receive the appropriate training. Care Homes for Older People Page 26 of 30 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 27 of 30 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 8 13 (2) You must ensure that 20/07/2009 records for the administration of medication state what medication was administered, when it was administered, who administered it, or a specific reason is documented if it is not administered. This is to ensure that medication is administered according to the directions of the prescriber, so that the people who use the service are not at risk of not having their medication needs met. 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 1 You should ensure that the Service User Guide can be made available in formats to suit peoples communication needs. Care Homes for Older People Page 28 of 30 2 7 You should ensure that the care plans in peoples bedrooms are up to date and match the care plans held on the computer system. You should ensure that any medication allergy is clearly documented on the care plan and in the medication records. This is so that people are not at risk of receiving medication which could cause them harm. 3 9 Care Homes for Older People Page 29 of 30 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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