Care Home: Ladywood Nursing Home

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What the care home does well People receive a good level of information about the home before moving in and a good assessment of their needs, this reduces the risk of people being admitted inappropriately. People who live at the home and staff working there told us that the leadership of the home had improved with the appointment of a new manager. They told us there was more support available to staff and more stability in terms of the general management. Overall quality assurance within the service had improved. This meant that people had more of a say in how the home was run, and that the management was more committed to improving the service. What has improved since the last inspection? This is the first Inspection whilst this home has been owned by the current Company. What the care home could do better: More consistency in care planning would ensure no care needs are overlooked. The management of staffing needs to be improved. Staffing levels need to be monitored in consultation with people living in the home to ensure there are sufficient numbers to meet people`s needs. The professionalism, recruitment and level of training received by staff needs to be improved so people can be confident they are not being exposed to potentially unsuitable workers. Key inspection report Care homes for older people Name: Address: Ladywood Nursing Home Eaton Avenue Ilkeston Derbyshire DE7 4HL     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: Helen Macukiewicz     Date: 0 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ladywood Nursing Home Eaton Avenue Ilkeston Derbyshire DE7 4HL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Modelfuture Limited Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The identified double room within the home is room 7 The maximum number of persons to be accomodated at the home is 38 The provider is registered to provide nursing and personal care for service users whose primary care needs fall within the following category: Old age not falling within any other catregory (OP) Date of last inspection Brief description of the care home The home was purchased by Southern Cross and re-registered in June 2009. The home is a two-storey purpose built building with passenger lift to the first floor. The bedrooms are for single occupancy and have en-suite facilities. There are gardens to all sides of the home. Situated in the village of Kirk Hallam, on the outskirts of Ilkeston, there are good Care Homes for Older People Page 4 of 28 Over 65 38 0 Brief description of the care home transport links to local shops, leisure facilities and pubs. The weekly fees payable at the time of this Inspection ranged between 344.82 GBP and 600.00 GBP per week. Copies of the Inspection report will be found in the foyer or from the managers office. 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 inspection was unannounced and involved a visit to the site on at 9.00am. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people using the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably District Nurses and Social Workers. We also use information gathered throughout the year, to support our judgments such as notifications from the provider, complaints or concerns. We also use information from an Annual Quality Assurance Assessment (AQAA), referred to throughout this report as the pre-inspection self-assessment, which the provider is required to complete prior to a visit to the service. This provides evidence for us to Care Homes for Older People Page 6 of 28 make informed judgments when assessing the National Minimum Standards (NMS). The primary method of inspection used during the visit to this service was case tracking. This involved selecting three people and tracking the care they receive through review of their records, discussion with them where possible, the care staff and observation of care practices. Time was spent in discussion with the Manager and staff. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place including some bedrooms. All of the key standards were inspected on this occasion. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 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 9 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. People have the right information to choose a home that can meet their needs. Evidence: Information about the home contained within the Statement of Purpose and Service Users Guides had been produced. This reflected the new ownership and management arrangements for the home. These documents provided people with all the information they needed about what they could expect from the service. The manager sent us a copy when we asked for it. We also saw copies in each persons bedroom and people told us that they knew about them. New paperwork had been introduced for staff to use when undertaking pre-admission assessments. This provided comprehensive documentation, covering areas of care needs as well as basic details about the person. Once admitted to the home, people had a full and more detailed assessment of their needs, including risk assessments in areas such as continence, moving and handling and skin care. Care Homes for Older People Page 10 of 28 Evidence: People told us they had been satisfied with their choice of home. One relative said Im quite satisfied with everything. Care Homes for Older People Page 11 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. People receive the care they need in a private and dignified way although gaps in care planning leave the potential for care needs to be overlooked. Evidence: Southern Cross standardised care documentation was being introduced at the time of this visit. Some care files we saw used the old style paperwork and others used both old and new. When we looked at peoples care records we found that these were generally well completed and comprehensive. However, we also found inconsistencies in terms of how well people had their care needs recorded. This was partly as a result of paperwork not being consistent, but also recording omissions on the part of staff. Some care plans were detailed and personalised, but others showed that not all care needs were included in the persons care plan. A review of one persons care had not prompted an assessment that had yet to be undertaken and a few basic details such as religion were missing from profile sheets, although in general, these were well completed. Care Homes for Older People Page 12 of 28 Evidence: In her completed pre-inspection self-assessment the manager had acknowledged that new documentation was needed. She wrote since the take over of Southern Cross in June new documentation is gradually being introduced, monthly internal audits are being undertaken which spot checks case tracking. We saw that scoring was high in the last audit of care plans that occurred in August. This did not reflect the inconsistencies that we found, suggesting that initially, more detailed audits may be required to maintain standards. In their completed pre-inspection surveys people told us they always get the care and support they need and one wrote the home does well at caring for the residents, seemingly working well as a team. One visiting professional also wrote my service user has responded well to the care she requires and has definitely improved in ability and health well being whilst at Ladywood. On the day one visitor said I think (x) is being well looked after, they (staff) are always very quick to call the Doctor if theres anything wrong. And another told us they look after (x) so well, Ive no complaints. Two people living in the home said they look after you. Care records and discussion with people showed that they received regular G.P and health professional visits, attended Hospital appointments and saw the Optician and Chiropodist. People told us that staff respected their privacy and upheld their dignity. We saw staff routinely knocking to request permission, prior to entering peoples bedrooms. One of the assisted baths on the ground floor was not in use. Staff said this had been out of order for some weeks. This meant that people living on the ground floor, who required a bath had to use the first floor one. This may impact on their privacy, dignity and choice. Medications were being managed well within the home. People had the medicines they needed at the right times and all records had been signed by staff. Care Homes for Older People Page 13 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 meals provided meet peoples expectations and needs. The range of daily activities on offer means peoples social needs are not fully met. Evidence: People told us that they would like more to do during the day. However, they acknowledged that activities had been affected by the temporary departure of the activities co-ordinator and were improving. At the time we visited a replacement member of staff had been found to cover this role. However, people said that they had been without an activity co-ordinator over the Summer. This had impacted on their social care. They had not been on any trips out and had missed that aspect of life. In her completed pre-inspection self-assessment the manager had acknowledged that this area needed further development and wrote they were planning to develop stronger links with the local community. Provide more opportunities to get involved in activities and support groups. People told us that their daily routine was flexible and that they could wander freely around the home, returning to their bedroom anytime. However, we saw that although care plans included what people liked to do, they were not well developed in terms of identifying a programme of social and religious care to meet their individual needs. Care Homes for Older People Page 14 of 28 Evidence: The cook knew the individual dietary needs of people and had recently attended some training on the Health and Safety recording requirements of Southern Cross. She had started using their forms to record health and hygiene risk assessments. She was also due to attend more comprehensive Nutmeg training, which is a system for improving and monitoring the nutritional value of meals. People had two choices of meal at lunch time, a hot snack or sandwiches each evening and cakes and biscuits at bedtime. Fresh fruit was given out with the morning drink. People living in the home described the food as very good, we get two choices and first class. Care Homes for Older People Page 15 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 have their rights to complain upheld and are kept safe through procedures and staff training. Evidence: People knew who to approach if they had any concerns about the home. The formal complaints procedure was on display in the foyer. This was also written into the information provided for people in their bedrooms. There had been two complaints received since Southern Cross took over the home. Both had been resolved and there were full records available at the home to support the action that the manager had taken. There had been no safeguarding issues at the home. Safeguarding procedures were available at the home and copies had been issued to all staff. Staff also told us they had received training on how to keep people safe. The Manager had attended training in the Mental Capacity Act and Deprivation of Liberty in the past year. Staff had yet to receive this and had limited knowledge about this area. An easy read guidance booklet was advised as a starting point and the deputy manager took a copy. Equipment was in use that carried an element of mechanical restraint (bed rails). In most cases, written consent from the person or their relative had been obtained. Care Homes for Older People Page 16 of 28 Evidence: Where this was not the case a note had been made in their care plan to pursue this. Anyone using bed rails had been subject to a written risk assessment. Care Homes for Older People Page 17 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 live in an environment that is generally suited to their needs. Evidence: A brief tour of the home took place. There was evidence of a redecoration programme for bedrooms. Those that were completed, were finished to a good standard. All bedroom doors had a lock on, but no-one had their own key and there were no records in care plans to suggest this option had been offered to people. Not all bedrooms had a personal lockable space inside for people choosing to keep items of value in. The manager stated that all bedroom doors were due to be upgraded as part of a wider refurbishment programme scheduled by Southern Cross. In her completed pre-inspection self-assessment the manager told us they had introduced hand gel in areas around the home. Infection control training has been undertaken by staff. At the time of our visit, staff confirmed they had received this training and we saw hand gel and items of protective clothing for staff to use, around the home. When asked, people told us their rooms were kept clean and tidy. At the time of our visit people told us the water system was not working properly, and they did not have a reliable source of hot water for their bedroom. Following our visit we received confirmation from the manager that this had been rectified. Care Homes for Older People Page 18 of 28 Evidence: People gave us mixed reports about the laundry service. Two people told us that they had occasionally lost clothing that had been internally laundered, or that clothing had been mixed up. However, one said the laundry was OK and another said I find the laundry good. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of staffing in the home is not sufficient to ensure peoples needs are fully met and that people are fully protected from unsuitable workers. Evidence: Staffing rotas showed there was a registered nurse on duty at all times. Four or five care staff worked each day shift and two at night. The manager was supernumerary and there was additional support from an activity person, cook and catering assistant plus domestics. People perceived that there were not enough staff on duty. One relative said there seems less staff now than there used to be, sometimes I think they could do with one or two more, they always seem so busy and another said there were times when they thought the home was short of staff, they had to look for someone to help them with their relative, but felt this has got better of late. People living in the home said when theres three staff on its that you have to wait longer and longer and they are short of staff and you have to wait, you have to wait to get out of bed. People told us there was a particular problem around the night handover period, as those wishing to retire to bed around 9pm had to wait for staff to have handover. They told us this meant they had to wait too long before being assisted to bed. The manager told us that perceived shortages in staff were more to do with mix of Care Homes for Older People Page 20 of 28 Evidence: staff and skills rather than numbers, and that she hoped the recent training would address some of those shortfalls. People said that in general, staff were kind and helpful. In their completed preinspection survey one person living in the home wrote everyone seems friendly and helpful. On the day of the visit one relative told us that staff were always nice and they always had a chat with them. Another said they (staff) all seem so friendly. However, people also told us there was a small number of staff who did not always act in a professional manner and who were less friendly towards them. These concerns were relayed directly to the manager at the time, for her action. In her completed pre-inspection self-assessment the manager acknowledged the need to train more staff through National Vocational Qualifications to level 2 and above. However, in terms of other training, staff had recently had a lot of input. This meant that almost all staff had completed the required mandatory training updates. In their completed pre-inspection surveys staff told us they were happy working at the home. They felt supported and had the right training. We saw that staff were subject to most of the required pre-employment checks meaning that people were largely being protected from unsuitable workers at that point. However, gaps in employment history were not fully explored in two staff files. Induction checklists supported that staff had some initial instruction. However, the more detailed foundation training programmes were not in place for new staff. This was particularly important as not all staff had commenced National Vocational Qualifications. Care Homes for Older People Page 21 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 effectively managed in peoples best interests. Evidence: A new manager had been appointed to the home. She had been in post since June 2009. She qualified as a registered nurse, although she is not currently registered to practice as a nurse. She had several years experience of managing social care services. She was in the process of applying to register with us. She had a registered managers award and had undertaken further training updates relevant to her role. A new deputy manager had also been employed. She is a registered nurse with several years experience in the care of older people. In their completed pre-inspection surveys people told us they were happy with the new management arrangements. One member of staff wrote it is nice to have a new manager who is committed to the home for the long term, and one visiting professional said new management improved standards of hygiene and patient reviews. Care Homes for Older People Page 22 of 28 Evidence: In her completed pre-inspection self-assessment the manager told us that she had started several quality assurance initiatives. She wrote that she held regular minuted resident, family and friends meetings and take action to address issues and ideas raised. Carry out residents satisfaction surveys, publish the results and address issues raised. The manager held a managers surgery between 6pm and 7pm each Monday, where relatives could come and see her. Regulation 26 monitoring visits were also taking place on behalf of Southern Cross. The report for august was seen and showed that people who lived in the home were being consulted about their views. The manager had notified us of incidents that had happened in the home, as required. She completed an annual self-assessment and sent it to us when we asked for it. People were generally happy with the system for handling money on their behalf, although one person said they would like receipts for hairdressing services. The manager agreed to do this on the day. Financial records showed that financial transactions made on behalf of people were being monitored by Southern Cross and that it protected people from financial abuse. Staff told us they felt supported by management and there were records to show staff were being regularly supervised. There were service records in place to support that equipment in use by people living in the home was safely maintained. Southern Cross had conducted a health and safety audit in September 2009, this was carried out by the facilities manager for the region. A fire risk assessment was also carried out in September 2009. We saw both documents. An action plan had been devised with works to be completed within a one to three month timescale, one item had already been completed and signed off. Care Homes for Older People Page 23 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 24 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 7 15 2b) Care plans must be 30/11/2009 updated as care needs change and include specific medication regimes such as Warfain therapy. Reviews of care plans must be effective in identifying and addressing any outstanding assessments or actions required. This is to ensure care needs are not overlooked. 2 12 16 2n) People must be consulted about the programme of activities and this must be recorded in their plan of care and met through the provision of activities. This is to ensure people lead a fulfilling lifestyle of their choosing. 31/12/2009 3 27 18 1a) The number of staff on duty and organisation of shifts must ensure that 30/11/2009 Care Homes for Older People Page 25 of 28 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 people have their care needs met and that they are adequately supervised. This is to ensure people have their care needs met. 4 28 18 1a) There must be systems in place to monitor the professionalism of staff and to address poor practice. People living at the home must be further consulted about this issue. This is to ensure people are protected from potentially unsuitable workers. 5 29 19 and schedule 2) A full previous employment history must be obtained and any gaps explored, with a written declaration. This is to ensure people are protected from potentially unsuitable workers. 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 30/11/2009 30/11/2009 1 7 Internal audits of care plans should be effective in identifying any corrective actions required. This is to ensure that internal quality measures are effective in raising standards of care. The assisted bath on the ground floor should be repaired. Page 26 of 28 2 10 Care Homes for Older People 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 This is to promote the dignity, privacy and choice of people living in the home. 3 13 People should be consulted about their social interests and a programme put in place to maximise engagement in the wider community.This is to ensure people are not socially isolated from their community. People should be offered the option of a key for their bedroom and/or personal lockable space, following risk assessment. This is to promote independence. Care staff should be trained through National Vocational Qualifications to level 2 or above, to improve the professionalism and skills of the workforce. Care staff should progress through a foundation training programme when they commence employment, to improve the skills of the workforce and improve quality of care. 4 19 5 28 6 30 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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