Care Home: Highview

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What the care home does well The home provides detailed information to people thinking about moving in. Assessments of people`s needs are carried out before people move in to make sure the home can meet their needs. Recruitment is robust and makes sure that staff are safe to work with vulnerable residents. They have good working relationships with colleagues in the Primary Care Trust such as community nurses and GP`s. They carry out quality audits both internally and externally. People thinking of moving to the home have an opportunity to visit to make sure it is the right place for them. What has improved since the last inspection? The manager is preparing her application to register with the commission. A number of bedrooms have been re decorated and some new furniture purchased. The manager`s office is being moved to the ground floor to make the managers more accessible to people living in the home and visitors. New care plans have been introduced. An activity organiser has been appointed. Policies and procedures have been updated. Staff have received updated safeguarding training. Liquid soap and paper towel dispensers have been fitted to bedrooms and bathrooms to reduce the risks of cross infection. What the care home could do better: The new care plans could be more detailed and person centred so that people receive support in the way they want. Armchairs in the main lounge area were stained or worn, these are to be replaced as part of the ongoing refurbishment of the home. Key inspection report Care homes for older people Name: Address: Highview 284-290 Great Clowes Street Higher Broughton Salford Gtr Manchester M7 2HD     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: Susan Jennings     Date: 1 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Highview 284-290 Great Clowes Street Higher Broughton Salford Gtr Manchester M7 2HD 01617922610 01617926763 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Highview Residential Limited Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The category DE is for two named individuals under 65 years of age. If either of these people leave, the service user category will revert to OP. The category PD is for the named individual under 65 years of age. If this person leaves, the service user category will revert to OP. The dependency levels of service users must be assessed on a continuous basis and staffing levels adjusted, where appropriate, to ensure continued compliance with the Residential Forum Guidance in Care Homes for Older People. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Care Homes for Older People Page 4 of 28 Over 65 10 22 0 2 0 1 Brief description of the care home Highview is a residential home providing care, support and accommodation for up to thirty-five older people. Of these twenty-five people require personal care only and ten people have dementia and require personal care. Highview Residential Ltd owns the home and at the time of the visit there was no manager registered with the Commission. The home occupies an elevated position off Great Clowes Street in Salford. Access is to the rear of the building via a level access route, which leads to the main entrancereception area. Parking is available to the rear of the building. The front of the building provides an enclosed patio seating area for residents. Accommodation is provided on three floors, which are all serviced by a passenger lift. There are 32 single bedrooms, 6 with en-suite facilities and 3 double bedrooms. The cost of the service is between £325.87 and £373.52 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Care Quality Commission) in relation to this home prior to the site visit. The site visit was unannounced and took place over the course of 8.5 hours on Tuesday 10th March 2010. During the course of the site visit we spent time talking to people who live at the home, the manager and care staff to find out their views. We spent time looking at records. We looked at the care files of people living at the home and staff files. We also walked round the home and looked at communal areas and a sample of bedrooms. Care Homes for Older People Page 6 of 28 This visit was just one part of the inspection process. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and to give us up to date information about the service provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with homeowners or managers. References to we or us throughout this report represent the Care Quality Commission. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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. Peoples needs were assessed by staff at the home prior to admission. Evidence: They produced a statement of purpose and a service user guide. These gave information about the home, the staff and the services they offered. We saw that these documents had been reviewed recently. We looked at a sample of five peoples care files. We saw that some contained a care managers assessment of the persons needs. They told us that they have introduced new care plans and pre-admission assessment documents. We did not see any completed pre-admission assessments on file but saw a blank document. They told us that the pre-admission assessments were held separately and stored in the managers office but as the office had been packed up ready to move to the ground floor none were available for us to look at. Completed documents had been Care Homes for Older People Page 11 of 28 Evidence: seen on previous inspections. The pre-admission assessment is carried out in addition to the care managers assessment to make sure that the home are able to meet an individuals care needs. This document also forms the basis of the care plan. They told us that two of the people whose files we looked at were emergency admissions to the home, initially on a short stay basis. These admissions would have been immediate and there would not have been time to carry out the pre-admission assessment, these care files contained a detailed care managers assessment. The other files were of people who had lived at the home for some time. The home did not provide intermediate care facilities. 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. The care plans and risk assessments did not fully address individual health, personal and social care needs. Evidence: We saw that the new care plan format had been fully introduced since the last inspection. We looked at a random sample of care plans including the most recent admissions to the home. The care plans varied in the amount of information they gave about peoples needs and some of the information was repetitive. The plans were not person centred and there was little evidence that people or their representatives had been involved in writing care plans so that support was provided in the way they would want. The care plan contains a social history section. In the sample of care plans we looked at none of these had been completed. This section should record peoples likes and dislikes, previous employment, family, interests and would be useful when planning social activities. None of the care plans we looked at had any information relating to peoples Care Homes for Older People Page 13 of 28 Evidence: medication needs. As a result there was no information about the management of peoples medication, pain, pain relief and communication needs. We spoke to staff who were able to tell us how they identified if people were in pain, but this information needs to be recorded in the care plans. We saw a short term care plan for one person admitted for respite care. This had good information about how to provide support including that they prefered a female carer and what the person likes to talk about. We saw that risk assessments had been carried out in relation to moving and handling the assessments contained the same information for a number of people. Risk assessments should be completed based on each persons individual needs and they should not be the same for everyone. The home provided support to people with dementia but there were no detailed dementia care plans in place. This means that people may not be receiving the support they need. The manager told us that they were looking at ways to improve the care plans further. We saw that regular reviews were being carried out but that there was no information recorded to show if the person has made any progress during the previous month. This would enable staff to assess what if any changes to the care plan need to be made. Throughout our visit we observed staff interacting well with people living in the home. Staff addressed people by their preferred names and provided personal care support in private. We saw that where people needed support with eating their meals, this was done in a sensitive manner. Staff were seen sitting at the dining table chatting whilst assisting people with their meals. We sent out surveys to people living in the home. To the question what does the home do well, one person wrote everything another told us they look after me, I am comfortable and have regular meals. One person told us I am happy with what the home provides. We saw that medication was dispensed from the pharmacy in blister packs and stored in a lockable trolley inside a locked room. We saw that staff responsible for administering medication received training in the safe administration of medicines. The Medication Administration Records (MAR) sheets were accurate and up to date with no gaps in recording. They should have a list of signatures and initials of those staff responsible for administering medication with the MAR sheets. This is to identify Care Homes for Older People Page 14 of 28 Evidence: who has administered medication. They told us that this information is usually kept with the MAR sheets and the manager stated that she would replace the information. We saw that some MAR sheets were handwritten the amount of medication and the date it was received had been recorded. This had been signed by two people to make sure that the correct dose and frequency had been copied from the medication container to the MAR sheet. People living at the home were registered with local GPs and had access to other health care professionals such as district nurses, continence nurses and chiropodists. One person told us If I need the doctor they will call him out. The continence nurse was visiting the home on the day of our visit. They told us that referrals usually come from the GP or district nurses. They also told us that staff in the home help in the assessment process by monitoring and recording peoples continence needs. We saw that people looked well dressed and their clothes were clean and tidy. We saw the hairdresser was visiting the home and ladies were having their hair washed and set. One person told us they are lovely to us and I like having my hair set it makes me feel better. Care Homes for Older People Page 15 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. People were given a choice of meals and a range of activities were provided. Evidence: They told us that ministers from various faiths visited the home on a regular basis. The manager told us that one person has expressed an interest in a specific religion and they are obtaining information for the person to make an informed decision. An arts and crafts session was taking place during our visit. The activity organiser had asked people to paint a picture that represented a happy time in their lives. This produced some interesting paintings and opened up conversations. The arts and crafts sessions are planned once a week. The sessions are advertised in the lounge and open to everyone. In addition a physiotherapist visits the home each Friday for armchair aerobics and a pet therapy dog visits the home on a regular basis. The manager told us that some people are supported to have an annual holiday and they are currently looking at hotels in Blackpool. For those people who are not able to go on Holiday other outings are planned. For example a trip to Harry Ramsdens is Care Homes for Older People Page 16 of 28 Evidence: planned for the 30th March and an entertainer is visiting the home on the 31st March. We saw that they had a varied menu and that people were offered a choice. The menu was written each day on a board in one of the small dining rooms. The meal on the day of our visit was a choice of liver and onions or sausages with mashed potato sweetcorn and green beans. The sweet was fruit cocktail with fresh cream and the evening meal was a choice of bacon butties, pizza, soup or sandwiches. There were three dining rooms two were in use on the day of our visit. We saw staff supporting people who needed help to eat their meals. We saw that this was done in a sensitive manner with staff sitting with people at the dining table chatting. We saw that people were supported to eat at their own pace and the meal was not rushed. We received completed surveys from people living at the home. People commented that the home arranges activities they can be involved in and each survey said people liked the meals. The manager told us that they welcomed visitors at any time. They told us that people could see their visitors in the privacy of their own rooms or in one of the communal areas. There were no visitors to speak to during our visit but people told us that their family and other visitors were always welcome. Care Homes for Older People Page 17 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. People knew how to make a complaint and were confident that their concerns would be listened to and acted upon. Evidence: We saw that a copy of the complaint procedure was included in the service user guide and a copy displayed in the home. The procedure includes timescales for responses. The complaint procedure informs people who to contact if they had any concerns. We spoke to people living at the home. They told us I would tell one of the girls if I was not happy and I would tell the manager. One person told us they listen to me and they would tell the manager. The manager told us that they would prefer to deal with issues before the became a major concern for people. They had produced safeguarding and whistle blowing policies and procedures. A copy of the Salford joint agency safeguarding procedure was available in the home. We asked staff what they would do if they witnessed poor care practices or abusive situations. All of the staff we spoke to told us they would immediately report any concerns to the manager or to the owner. Staff told us that they also had a contact number for the safeguarding coordinator at Salford council. We saw that all but two staff had attended safeguarding training. The homes two Care Homes for Older People Page 18 of 28 Evidence: chefs had not yet attended training but will be nominated to attend. There has been one safeguarding referral made since the last inspection. The manager dealt with the incident appropriately and made a safeguarding referral. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home continue to benefit from the refurbishment works. Evidence: The home is set in large grounds with access via electronic gates. The grounds are well maintained and provide a pleasant area for people to sit out in the nice weather. We walked around the home including communal areas, bathrooms and with permission a sample of bedrooms. The main lounge on the ground floor had been decorated and a new patio door has been fitted to allow easy access the the patio area. This has enabled people using wheelchairs to access the patio more easily. We saw that although the area had been redecorated some of the armchairs in the main lounge were worn and some were badly stained. The manager told us that they were going to replace the armchairs as part of the refurbishment. In order to provide a more pleasant environment they should consider replacing or cleaning the armchairs as soon as possible. There is a conservatory that is the full width of the main lounge and is used as a dining area. There are two further smaller dining rooms. This means that people are given a choice of where to eat their meals. Care Homes for Older People Page 20 of 28 Evidence: There were ongoing refurbishment works in the home. This included re-siting the managers office to the ground floor so that they are more accessible. One of the smaller lounge areas had been redecorated and a new kitchen area was to be fitted. This is to provide a quiet area where people can make a drink and relax. They told us that they plan to redecorate one bedroom each month. This is to minimise any disruption to people living at the home. We saw a sample of bedrooms. We saw that people had brought their own belongings such as photographs and paintings. We saw that one person preferred to sleep in their double bed and that this had been arranged. We saw that bedrooms were clean and free from odours. They told us that they have access to a maintenance person. This person is available as and when required. Care Homes for Older People Page 21 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. People were protected by the recruitment procedures and staff were encouraged to participate in training. Evidence: The manager told us that they were interviewing for a senior carer on the morning of our visit. They told us that staff retention in the home was good and many of the staff had been employed at the home for a number of years. On the day of our visit there were three care staff one senior care and the manager on duty at the home. We saw that there was a mix of male and female staff. This gives people a choice about whether they want a male or female carer to help them. They told us that thirteen of the sixteen staff employed in the home have achieved NVQ level 2 or above. They told us two staff were working toward NVQ level 2 and the two senior staff were nearing completion of their NVQ 3. They told us that they have a trained first aider on duty at each shift. They told us that staff had received training in relation to the Mental Capacity Act 2005 Deprivation of Liberty Safeguards and Safeguarding Vulnerable Adults. They told us that they have a thorough recruitment process. All potential staff have two interviews and two written references are requested one being from a previous Care Homes for Older People Page 22 of 28 Evidence: employer. We looked at a sample of staff files. We saw that the older files only contained one written reference but the files of the most recently recruited staff did have two written references and some had three. Where overseas staff had been employed work status checks had been made with the Home Office. Where documents had been copied as proof of identity they had been signed and dated to show that the originals had been seen. We saw that staff had received training in safe working practices such as Medication Administration, Health and Safety, Moving and Handling and Infection Control. The manager told us that all new staff undergo an induction programme and are given a copy of the General Social Care Council codes of conduct. We received completed surveys from people living at the home. People told us that staff were always available when they needed them and that staff listen to them and act on what they say. We spoke to staff who told us that they received regular supervision with the manager. This covered updates to policies and procedures and training needs. One member of staff told us that the whistle blowing policy had been discussed at their last inspection. Staff told us that the manager was approachable and that they would not hesitate to raise any concerns or queries with her. Care Homes for Older People Page 23 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 home is managed in the best interests of the people who live there. Evidence: At the time of our visit the manager had been in post for six months on a probationary period. The owner told us that they had asked the manager to take up the post on a permanent basis and they assured us that the manager was in the process of making application to register with the Care Quality Commission (CQC). The manager has 30 years experience in the care sector 8 years in a management role. They had the necessary skills qualifications and experience needed to manage a care home. The manager is supported by a full time deputy. Before our visit the manager had completed their Annual Quality Assurance Assessment (AQAA). It gave us the information we asked for and showed that they know what further improvements they need to make. Care Homes for Older People Page 24 of 28 Evidence: Information given in the Annual Quality Assurance Assessment (AQAA) showed that fixed Gas and Electricity appliances had been regularly maintained. They also carried out a periodic test of portable appliances and lifting equipment. These checks mean that the safety of people living at the home, staff and visitors was given priority. They carried out quality audits. This is to monitor the performance of the home in areas such as medication storage and administration, staff training and health and safety. We saw that policies and procedures were in place with regard to managing peoples finances. They told us that social services finance department or relatives helped people to manage their finances. They told us that they received personal allowances on a monthly basis from social services. We saw a sample of financial records, receipts were kept for all transaction made on behalf of people living at the home documents are signed by two members of staff. This showed us that the peoples financial interests are safeguarded. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 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 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 7 7 Risk assessments in care plans should be based on the persons individual needs and ability. Care plans should contain sufficient detail on all aspects of a persons care needs to enable staff to offer appropriate support. In order to fully audit the medication systems they should have a list of signatures and initials of all staff responsible for administering medication. Worn and damaged armchairs should be replaced or cleaned as soon as possible. 3 9 4 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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