Care Home: Lumley Court

What the care home does well The home provides a good range of information to people thinking of coming to the home, so they can make an informed decision. The home makes a full assessment of a person`s needs before deciding if it can meet all those needs. The home draws up plans to meet the care needs of its service users. Service users health care needs are also fully assessed and properly met. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends. Service users are also encouraged to take as much control over their own lives as they are able, and make their own decisions. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The home is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. The manager is very experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the home`s policies and accounting systems. The health and safety of the service users and of the staff are protected by the home`s policies and systems. What has improved since the last inspection? Some significant changes to the service have been made since the last inspection visit. Several areas have been decorated and some bedrooms have been refurbished to a high standard. All mandatory staff training has been brought up to date, and dementia care awareness training has been implemented. There has also been lots of training for staff relating to respect and dignity. The requirements from the last inspection have been addressed. What the care home could do better: Providing information about the home in a range of formats will enable all prospective service users to make an informed choice about where they want to live. when a risk has been identified, these should be fully discussed, agreed and signed by the service user if they are capable, or with their representative. The use of food moulds will enhance the presentation of soft food meals, and make these appear more attractive and appetising. To ensure that service users holistic needs are fully met at all times, it is essential that the numbers of staff on duty are kept under review. The service should consider replacing the carpets in the communal areas, and this will enhance the appearance of the environment, and minimise odours. Some of the lounge chairs should be renewed, and this will provide attractive and comfortable seating for the service users. In the lounge areas, service users do not have enough side tables available to place hot and cold drinks on, providing these will lesson the risk of accidental spillages. Information boards. and appropriate signage around the home will help people to become more orientated in their environment. Key inspection report Care homes for older people Name: Address: Lumley Court Portland House Hall Lane Estate Willington Durham DL15 0PW     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: Jim Lamb     Date: 2 6 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 29 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 29 Information about the care home Name of care home: Address: Lumley Court Portland House Hall Lane Estate Willington Durham DL15 0PW 01388747698 01388746219 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross OPCO Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia - Code DE, maximum number of places 40 Date of last inspection Brief description of the care home Lumley Court is a purpose built care home that shares a site with several other care facilities. It has been operating for around 16 years. In June 2008 it was registered to Southern Cross OPCO Limited which is a national provider of health and social care services. Lumley Court provides personal care for up to 40 older people with dementia care needs. It does not provide nursing care. The home is a single storey unit which shares the building, reception area, catering and laundry service with an adjoining nursing home. All the bedrooms have private ensuite facilities. Care Homes for Older People Page 4 of 29 Over 65 0 40 3 0 1 0 2 0 0 8 Brief description of the care home The home is easy for people to get around as it has one main corridor which is wide enough for wheelchairs. In the centre of the home there is an open plan arrangement of dining and lounge areas. All the baths and showers can be used by people with mobility needs. The home also has a garden area and several parking places. It is near the local village where there are shops, pubs and other amenities. The home has a no smoking policy. Fees for the home range from £471. 044 to £501. 050 per week. Care Homes for Older People Page 5 of 29 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people, and the views of Care Homes for Older People Page 6 of 29 people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, relatives, staff, the manager, area manager, site manager and visitors, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable,and checked what improvements had been made since the last visit. We told the manager/provider what we found. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 Providing information about the home in a range of formats will enable all prospective service users to make an informed choice about where they want to live. when a risk has been identified, these should be fully discussed, agreed and signed by the service user if they are capable, or with their representative. The use of food moulds will enhance the presentation of soft food meals, and make these appear more attractive and appetising. To ensure that service users holistic needs are fully met at all times, it is essential that the numbers of staff on duty are kept under review. The service should consider replacing the carpets in the communal areas, and this will enhance the appearance of the environment, and minimise odours. Some of the lounge chairs should be renewed, and this will provide attractive and comfortable seating for the service users. In the lounge areas, service users do not have enough side tables available to place hot and cold drinks on, providing these will lesson the risk of accidental spillages. Information boards. and appropriate signage around the home will help people to become more orientated in their environment. 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 9 of 29 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 29 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. Prospective service users are provided with enough information about the service to enable them to make an informed choice about whether this is where they want to live. Evidence: The care records for four service users were looked at. These showed that the manager makes sure that a full assessment of a new service users needs is carried out by the persons social worker before they come into the home. The manager also carries out her own assessment, to be doubly sure that the home can meet all of the new persons needs. More detailed assessments are carried out once the new service user has come into the home. These include assessments of risk, of nutritional needs, social needs, moving and handling needs and of behavioural needs. A dependency rating scale is Care Homes for Older People Page 11 of 29 Evidence: also completed. Skin care assessments are also carried for those at risk of developing pressure sores. As a result of all these levels of assessment, the manager can clearly demonstrate that all the service users are in a home that can give them the care that they need. All prospective service users and their representatives are always invited to visit the home prior to moving in. Phased admissions can be arranged, and these may involve a period of respite care. The homes service users guide is available, and information will soon be available in a range of formats. All are provided with a contract explaining the homes terms and conditions, and fees. Intermediate care is not provided. Care Homes for Older People Page 12 of 29 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 planning system is clear enough to ensure that staff have the information they need to meet the assessed needs of the service users. Evidence: Each service user has his or her assessed needs met by an individual care plan. A basic care plan, based on the initial assessment is drawn up so as to be in place when the person is admitted. This is good practice, as is the fact that the staff then draw up more detailed care plans on the day of admission. There was a good match between identified needs (including risk assessments) and corresponding care plans. Care plans are comprehensive, detailed and holistic, in that they cover social, spiritual and emotional needs, as well as their physical needs. In one example seen, staff had accurately identified that an individuals interests included painting, gardening and reading, and the care plan included helping the service user to access all three. Care Homes for Older People Page 13 of 29 Evidence: Each service user has a monthly re-evaluation of the care plans, to make sure they are still up to date and relevant. A thorough assessment of the physical health needs of each person takes place before/on admission, and monthly, thereafter. One service user who is prone to falls did have a detailed moving and handling assessment completed. Another service user who needs lots of encouragement to eat had a very detailed nutritional assessment completed. risk assessments were detailed and comprehensive about service users health and social care needs, providing clear guidance to staff. They were subject to regular review and evaluation, involving service users, relatives and social workers where appropriate. To be sure that all concerned are fully aware of the identified risks, it would be better if they were agreed and signed by all concerned. All service users nutritional needs are routinely assessed. Care plans cover all assessed needs, including health care needs. Mental health needs are assessed as part of the overall dependency assessments, more detailed assessments would be carried out by mental health workers, where necessary. All visits to and/or from health professionals are clearly recorded in the care record. There was evidence of the full range of community health professionals, as well as specialist referrals, as needed. Each service users weight is recorded monthly, and action taken where there is significant weight loss/gain. The home uses the monitored dosage system for its medications. The Medication Administration Records (MAR) was being well completed, with no blank entries. All senior staff have had training on how to use the medication system. They have also had external Safe Handling of Medicines training. Each persons section in the MAR has a photograph of the person, to make sure that the right medicines are being given out. All personal care and medical examination/treatment is carried out in private. Care Homes for Older People Page 14 of 29 Evidence: Service users confirmed that they are treated with respect at all times and have their privacy respected by the staff. Staff were seen to treat service users with respect and kindness. One service user said,The staff are very good and caring, nothing is to much for them. This is a nice place and i am very settled here. Another said,I have been here for eleven months, and i have settled in very well, the staff are very helpful and kind to me. Care Homes for Older People Page 15 of 29 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 service users are offered a good quality lifestyle, which includes varied social contact and activities. Evidence: Each service user has a social skills assessment carried out. All service users and their representatives participate in this process. The completion of the skills assessment assists staff to implement more detailed social care plans. There are daily activities available, and entertainers frequently visit the home. The home has a full time activities co-ordinator. The activities programme is based on service users interests and choice. Individual social activities records are kept for each person. All service users are supported to maintain very close links with their families. They can choose who they want to see and when. The homes menus are based on the known likes and dislikes of the service users. At least two hot meals are provided each day. The menus are varied and well balanced. Care Homes for Older People Page 16 of 29 Evidence: The cooks had good knowledge of the service users dietary needs. Special diets are provided when necessary. The use of food moulds will improve the presentation of soft food meals. The manager said that she will purchase these. All those spoken to said that the meals were very good and that they were always offered a choice. The management team have agreed to review the meal time serving arrangements, this will free up two staff to assist those who require support with their meals. A religious service which is open to all denominations, is held in the home every two weeks. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints management is effective, and this results in the service users being protected from harm and abuse. Evidence: There is a complaints procedure. The procedure is written in a way that ensures service users fully understand its contents. One service user said that she had been given a copy of the procedure and that staff always listened to any concerns and always dealt with them fairly. The home keeps a record of complaints. The home has a Whistle Blowing policy, the Local Authorities Vulnerable Adults procedures, and a copy of the Department of Healths document, NO SECRETS. Staff are aware of these procedures and have easy access to them. Since the last inspection visit, there have been no complaints received. Safeguarding adults training is ongoing for all staff. Service users can deposit cash for safe keeping and records are kept of accounts. A sample of personal finances records was examined. Transactions were appropriately recorded. There was plenty of evidence of personal spending. Receipts are obtained Care Homes for Older People Page 18 of 29 Evidence: for purchases and numbered to cross-reference to the transaction. Weekly checks of balances and cash are carried out. Care Homes for Older People Page 19 of 29 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. The home provides a comfortable and safe environment for those living there. Evidence: The premises maintain a pleasant and homely atmosphere. The home is set out into three interlinked lounge areas and two dining areas. There is potential to create a variety of additional communal areas, all of which are accessible by service users. For example, one area in the corridor has successfully been adapted to resemble a garden area, and service users were seen to be making good use of this facility. All parts of the building seen were clean, suitably equipped. Some parts of the communal areas have been decorated with wallpaper, and this makes these areas appear more homely and attractive. Consideration should be given to renewing some of the lounge chairs and floor coverings in the lounge areas and corridors, and this will enhance these areas greatly. There is an ongoing programme of decoration and refurbishment and several bedrooms have been refurbished to a high standard. There is lots of visual and touchy-feel art work displayed around the home, and an Care Homes for Older People Page 20 of 29 Evidence: artist has recently completed several murals depicting various scenes of the past, for example, a very realistic old fashioned range fireplace, a bookcase and dresser. More of these are planned. There are plans to create a reminiscence lounge, and service users and their relatives will be involved in its design. The management team intend to implement orientation boards and improved signage throughout the home, the latter will help service users to find there way around the home more easily. The home is also considering memory lane boxs, these will be located outside each persons bedroom door and will be unique to each individual, and again, these will help service users to identify their own bedrooms more easily. The grounds are well maintained and are used regularly by service users. The sensory garden recently won a design award. A number of service users spoke positively about their bedrooms and the accommodation in general. The home has policies and procedures on hygiene and control of infection. However, the odour control in several areas throughout the home was lacking and very apparent. Despite regular deep cleaning, It is several years since the communal carpets were laid, renewing these will no doubt improve odour control. Staff receive infection control training. There is suitable hand washing facilities throughout the building. Disposable gloves and aprons are provided for staff use. Arrangements are in place to dispose of clinical waste. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and supervised. Evidence: Currently there are 36 service users, several with very complex needs. There are six care staff across the day, and 3 night staff. Should the number of service users increase above 36, it will be necessary to review the staffing levels again. The Area manager said she will ensure this happens. The personnel records of two staff were examined. Both had completed application forms, the dates of employment were clear, making it easy to follow a clear employment audit trail. The manager also completes an audit check list and this ensures that all the necessary checks have been completed prior to commencing employment. All had the required two work references, (crb) criminal record bureau check, documentary evidence of identity, induction and training and development information. The manager confirmed that, if there are any concerns about the content of a CRB Care Homes for Older People Page 22 of 29 Evidence: disclosure, these are discussed with the proprietor. The organisation employs a training and development officer, and all staff have an annual training matrix drawn up, this covers all mandatory training needs, and other core training needs, such as Dementia Awareness and Adult Protection. Individual staff members have his or her individual training needs analysis on their personal file. Currently over 86 of staff have achieved NVQ level 2/3 training in care. The manager said that, mental capacity and deprivation of liberty training will be cascaded to all staff during the next 12 months. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by the organisation in providing good leadership throughout the home, with staff demonstrating an awareness of their roles and responsibilities. Evidence: The is well qualified and experienced in senior roles within social care settings. Service users, relatives and staff described her as being approachable and caring. She has the Registered Managers Award at National Vocational Qualification (NVQ) level 4. She confirmed that all staff will be regularly supervised (bimonthly) and have an annual appraisal. Good accounting procedures are followed, with receipts and signatures being obtained for all financial transactions involving service users personal monies, such as pocket monies, clear individual accounts and records are maintained. Service users have ready access to their money, even at short notice. Care Homes for Older People Page 24 of 29 Evidence: Comments received from staff and management confirmed that there are good health and safety policies and practices that promote the health, safety and welfare of service users and staff. All relevant staff members do refresher training in Health and Safety, such as moving and handling, fire safety and food hygiene. This helps reinforce the registered providers written policies on Health and Safety. Health and Safety issues are also discussed at staff meetings. Service users and staff expressed satisfaction with the way the home was run and the good standards that were evident in many instances. For example, all service users and relatives commented that the home was always nice and clean. Service users and staff said they enjoyed living and working at the home and believed the home was safe and run in the best interests of the service users. The manager said she routinely invites comments and suggestions for improvements from both service users and visitors to the home, via regular meetings, surveys and consultations. She will also implement an annual development plan. The maintenance records for the home were all up to date. Care Homes for Older People Page 25 of 29 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 29 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 1 The current service users guide provides prospective service users with the information they need to enable them to make a choice about where they want to live. The information should also be available in a range of formats suitable for the people for whom the home is intended, this could be: pictorial, video, audio, or braille. All identified risk assessment documents should be agreed and signed by the service user or their representaive. By doing so, this ensures that the risks identified are accepted and fully understood by the service user (whenever capable) or their representatives. 2 7 3 15 the purchase of food moulds will make soft food meals more attractive and appealing for service users. By diong so this will improve the appearance and texture, in order to maintain appetite and nutrition. 4 19 The renewal of the communal carpets, some lounge chairs, soft furnishing and further decoration throughout the home will provide a more attractive and homely environment for the service users. Page 27 of 29 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 5 27 The staffing levels for the home must be kept under review, this will ensure that the service users receive the support they require to fully meet their holistic, personal. health and social needs. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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