Care Home: Nazareth House

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What the care home does well Residents care needs continue to be assessed and documented to ensure their safety and that of the staff assisting them. Residents continue to feel they are treated with respect and their privacy and dignity is recognised. Residents have a number of choices based around their individual needs, promoting people`s independence and decision making. Quality Assurance continues to be assessed regularly, and is used to obtain peoples opinions meals and menus, pastimes and outings. A number of staff from the home and head office assist in this process. Changes in practice are recorded in the monthly action plans produced by the manager. Complaints information is displayed throughout the home and staff are aware of how the complaints procedures works. Staff supervision continues on a regular basis, this is the process where the manager oversees the staff working practices on a one to one basis, and helps toward planning training events. The safety of residents and staff is seen as important and there are a number of the safety processes in place to ensure this. The registered manager continues to complete a monthly action plan. This is being used to record recent achievements and what remains outstanding. Comments by residents and staff made to the Expert by Experience and Inspector included, one resident stating "I had a problem with my eye, the GP was sent for and came and he arranged for me to go to the ophthalmic department at the hospital the same day. The service could not have been better." One resident said "sometimes (laundry) items go missing but they are usually found quickly" "the staff are always kind and gentle when they help dressing me", "if I am not ready the staff will come back to see to me later". "The activity lady does ask me if I want to go to the activities". Many residents stating that the meals had improved one stating"if I want something they will try to organise it for me". Other people added "the food is excellent", "I could not want better". Comments from the residents were supportive of the staff "very kind and caring", "nothing too much trouble for them", "they look after `A` very well and are very kind". What has improved since the last inspection? There were three requirements set at the last visit. These related to medication administration, and all three have been completed and improvements recognised in these areas. The requirement set for health and safety has also been undertaken and work completed. What the care home could do better: The management of staff where they are encouraged to question and challenge practices which appear incorrect. This would help in the overall l quality work already being undertaken by the registered manager. The activities organiser continues to offer pastimes and "group" activities. We commented in the last report about more one to one time with people. The Statement of Purpose and Service User Guide have still to be completed with information required to enable people to base any decision of a long term stay in the home. The administration of medicines in the home continues to be weak in certain areas. New requirements have been set, to ensure compliance in this area. Comments by residents and staff made to the Expert by Experience and Inspector included, "I do not stay in the lounge after tea because the staff begin to call out who they are going to take to bed next and I feel that is too regimented". Other people spoke about the activities, "she does not do any activities with me", "there is an exercise person but I never see them". "the staff are very busy and are usually called away and I do not like to trouble them". One person added about the meals, "we have to choose our menu two to three days in advance, I have forgotten what I ordered because I ordered it so long ago" . Comments from the residents about the staff also included "When a staff member does come to chat it does not work because the staff do not have the time and they are called away". Key inspection report Care homes for older people Name: Address: Nazareth House 118 Harlestone Road Northampton Northants NN5 6AD     The quality rating for this care home is:   one star adequate 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: Keith Williamson     Date: 0 5 0 5 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 27 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 27 Information about the care home Name of care home: Address: Nazareth House 118 Harlestone Road Northampton Northants NN5 6AD 01604751385 01604580435 sheila@naznptn.plus.com www.sistersofnazareth.com The Congregation of the Sisters of Nazareth Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julia Elaine Pullen Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 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 categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Nazareth House is a care home providing personal care for Older People, it is a large home located on the outskirts of Northampton. The home has been established for many years and is run by The Congregation of the Sisters of Nazareth who also offer a comprehensive range of spiritual support and guidance to meet the individual religious needs and preferences of people living within the home. Mass and The Rosary are Care Homes for Older People Page 4 of 27 Over 65 50 0 0 8 0 2 2 0 1 0 Brief description of the care home celebrated on a daily basis, in the Church which is attached to the home . Accommodation is provided over the ground and first floor, with access to the first floor being via a passenger lift, the ground floor provides all the communal amenities, along with bedroom and bathing facilities, whilst the first floor provides additional bathing facilities and bedrooms. Bedrooms in some instances include an en-suite facility. Nazareth House has a large and very well maintained garden, with mature trees, shrubs and plants and benefits from a large water fountain. Information about Nazareth House is provided in the form of a Service Users Guide and a Statement of Purpose. The Manager provided information on the day of the site visit with regards to fees. Fees range from £366.81 to £570.00 per week; the fee charged is dependent upon the specification and amenities of the personal accommodation. Care Homes for Older People Page 5 of 27 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: one star adequate 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 focus of the inspection is on outcomes for residents and their views of the service provided. The main method of Inspection used was case tracking which involves selecting a sample number of people and tracking the care they received through talking with them where possible, and looking at their records and accommodation, in this case three residents were chosen. This visit took place over one day, commencing at 9.30am and took eight hours to complete and also involved an Expert by Experience and specialist pharmacy Inspector. The Expert by Experience is a volunteer who has substantial links to people who have experienced residential care. The expert took the opportunity to talk at length with residents. The Inspector talked with the registered manager and staff, look around the home, view records, policies and care plans. Comments made to the Expert by Experience, and Inspector have been included in this report. Information was obtained from the Annual Quality Assurance Assessment, which gives information about the home, and is filled in by the registered manager. A copy of the last Care Quality Commission (CQC) Care Homes for Older People Page 6 of 27 report is displayed in the foyer of the home, and copies of this report are available from the registered manager. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? There were three requirements set at the last visit. These related to medication administration, and all three have been completed and improvements recognised in these areas. The requirement set for health and safety has also been undertaken and work completed. Care Homes for Older People Page 8 of 27 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 9 of 27 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 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents do not have full information on the home to enable an informed choice. Evidence: The Statement of Purpose and Service User Guide have still to be completed with information required to enable people to base any decision of a long term stay in the home. This information was required to be updated at the last visit, and those additions have been made, however there are further amendments needing done to complete and update the documents. Prospective residents continue to have their needs assessed before they move into the home this ensures that staff have the experience and numbers to meet peoples needs. All the residents files were found to include an assessment of their needs completed by a social worker or the senior staff member from the home. Care Homes for Older People Page 11 of 27 Evidence: Residents have a contract or terms and conditions of their stay issued to them. This ensures people are aware of the costs involved and limits placed on their stay. This home does not provide Intermediate Care, which is a specialised type of care following a hospital discharge and involves many staff you would find in a hospital setting. Care Homes for Older People Page 12 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff follow medication good practise and safe practise guidelines but there are inconsistencies in the level of detail applied which continues to place people at risk. Evidence: Residents care plans are up to date and continue to be reviewed regularly with the resident or a member of their family. Care plans are risk assessed, which gives staff vital information how to keep people safe in the home. Again these risk assessments continue to be reviewed periodically. From records kept by the home it was evident that health care services including General Practitioners and community nurses visit on the residents behalf. The residents stated that they did have a choice on getting up and going to bed and the clothes they wore. Privacy and dignity is recognised with staff being aware to knock and wait prior to entering peoples private accommodation. However one resident stated, I do not stay in the lounge after tea because the staff begin to call Care Homes for Older People Page 13 of 27 Evidence: out who they are going to take to bed next and I feel that is too regimented. Comments by residents and staff made to the Expert by Experience and Inspector included, one resident stating I had a problem with my eye, the GP was sent for and came and he arranged for me to go to the ophthalmic department at the hospital the same day. The service could not have been better. Medication handling practises have further improved at the home. There are now audits being carried out by the manager to ensure that people are given their medicines as prescribed. Controlled drugs were stored securely and all records were accurate. Changes in drug regimes are handled consistently and the home practises ensure these alterations are acted upon immediately. Anomalies did arise in the continual administration of eye drops for a newly admitted person. This person did develop discomfort in her eye which was brought to the attention of a GP. This decline in her condition could have been possibly avoided if medication was given as prescribed. Another shortfall was seen in maintaining accurate records for a person. A handwritten medication sheet did not clearly show what month this administration was related to. Although improvements have been noted regarding cold storage of medicines, a room temperature check on a medication room showed that this was not at a range that was suitable for medicines. Hence there could be a decline in the medicines effectiveness. The expert by experience was involved in establishing what the medication administration and handling process was like for people living at the home. When confirming how the home deal with people who self - administer their own medicines , one resident stated she kept her medicines in a locked drawer , the key was kept on top of the drawer. For another person who kept her steroid ointment in her room, although the staff administered it, said it is just dumped wherever there is space in my room. Further comments received regarding when they are offered their medicines and whether this is at a time that suits them and in a place they want to take them. Responses stated except for the pain relief medication, they accepted that most of the medication had to be given at a certain time. The administration was mainly carried out in their rooms and they felt their medicines are given to them without them being rushed. Care Homes for Older People Page 14 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of one to one contact for people is leading to social isolation. Evidence: Residents continue to be offered choice on a daily basis. The residents agreed these include when to get up or go to bed, what to wear, a choice of meals and whether to join in the activities provided. These are important as they ensure residents can retain a good level of control over their lives. The activities organiser continues to offer pastimes and group activities. We commented in the last report about more one to one time with people. This does not appear to have increased with the emphasis still being on group work with the majority. Comments passed by residents have been included below. Spiritual comfort continues to be offered to people with the resident group of nuns from the attached convent. The menu system ensures people are still offered an extensive list of meals. The manager and catering staff are working on the system to improve the timing of meal choices to the same day. This will greatly improve and be less confusing than the current system. Comments by residents and staff made to the Expert by Experience and Inspector Care Homes for Older People Page 15 of 27 Evidence: included many residents stating that the meals had improved one statingif I want something they will try to organise it for me. Other people added the food is excellent, I could not want better, we have to choose our menu two to three days in advance, I have forgotten what I ordered because I ordered it so long ago . The activity lady does ask me if I want to go to the activities, she does not do any activities with me, there is an exercise person but I never see them. I was told if I wished to have a chat to ring my buzzer but the staff are very busy and are usually called away and I do not like to trouble them. One resident said sometimes (laundry) items go missing but they are usually found quickly the staff are always kind and gentle when they help dressing me, if I am not ready the staff will come back to see to me later. Care Homes for Older People Page 16 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of a complaints procedure in some documentation has the potential to leave people with no adequate means of seeking redress for outstanding issues. Evidence: We looked at the four complaints recorded since our last visit. These were dealt with promptly and acted on appropriately. We looked at the complaints policy and procedure and there have been no recent changes. We noted these have yet to be added the Statement of Purpose and Service User Guide. Care staff spoken with during the inspection were aware of what to do should they suspect any act of abuse. There has been additional training on this subject. There have been no safeguarding issues forwarded directly to the Care Quality Commission (CQC). Care Homes for Older People Page 17 of 27 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 ineffective action of staff has the potential to place residents at risk of cross infection within the home. Evidence: The home is clean and comfortable, and is set in extensive grounds, these are well kept and spacious, and many of the bedrooms have a pleasant outlook onto the garden area. Staff have received training in infection control and observations during the inspection again confirmed that staff used the appropriate protective clothing when carrying out their duties. However the Expert by Experience pointed out a bathing area which caused some concern. The bath mat which is to ensure peoples safety, was very perished, and could not be cleaned effectively to ensure peoples hygiene was not put at risk. The laundry is well appointed and the floors and walls are easily cleaned. This is important as it helps guard against cross contamination within the home. The laundry has had a new sorting system introduced, this should ensure are placed into the correct rooms. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure continues to ensure people are protected. Evidence: We looked at the employment and recruitment records of staff employed since our last visit. Most of the files were up to date and documents in place. Criminal Record Bureau checks (CRB checks) and other information to increase the security of people were in place. One of the references could not be found, but indications were this had been received in the home and a telephone call made to ensure it was valid. Training is ongoing, staff continue to undertake courses run by a variety of trainers from in the home and and external agencies such as Boots the chemist. Training needs are looked at on an individual basis following a training appraisal. This is part of the supervision and development of staff and take place on a regular basis. Comments from the residents were supportive of the staff very kind and caring, nothing too much trouble for them, they look after A very well and are very kind. When a staff member does come to chat it does not work because the staff do not have the time and they are called away. Care Homes for Older People Page 19 of 27 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. Poor monitoring of staff practice, continues to place people at risk. Evidence: The manager has now completed the process to become registered with the CQC. Quality Assurance (QA) continues to be developed in the home. Quality Assurance which is where the staff seek the views of people who live and others with an interest in the home. This has been extended since our last visit and includes feedback from areas such as activities. The questionnaires we saw the last time are still being circulated and are still placed in the reception alongside the complaints procedure and copy of the latest CQC inspection report. The Responsible Person, who is appointed to see the home is safe and staff are meeting peoples needs, continues to visit and copies of the reports from these visits were seen. This again indicates the home is being overseen on a regular basis and any areas of improvement are being recorded. Residents monies is handled safely, and accurate records kept of transactions. As mentioned in the staffing section staf supervision is regularly undertaken and adds to Care Homes for Older People Page 20 of 27 Evidence: the overall safety within the home. We again looked at the health and safety tests performed by staff. These continue to be regularly performed and the outcomes recorded. The overall safety within the home remains good, but there continues to be a failure by staff to challenge or question areas that they find wanting in the home. Examples have been given throughout the report, but areas such as the medication fridge and the bath mat highlight the need for staff to be aware of each others practice, and take steps to rectify any shortfalls. We have taken into consideration the improvements that the manager continues to improve on. We have written to the Responsible Person and Manager outlining what action we will take if improvements are not made and maintained in the home. Care Homes for Older People Page 21 of 27 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 22 of 27 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 1 6 (a) keep under review and, where appropriate, revise the statement of purpose and the service users guide. This is to ensure people have the appropriate information on which to base a stay. 21/06/2010 2 9 13 Medicines should be stored in an environment that ensure that there is not any unnessary decline in the effectiveness This is to ensure that there is no decline in a persons condition due to the administration of a sub therapeutic medicine. 21/06/2010 3 9 13 Medication must be administered as prescribed and accurately recorded. 21/06/2110 Care Homes for Older People Page 23 of 27 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 this is to safeguard the health and welfare of people living at the home 4 10 12 The registered person shall 21/06/2010 ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users. Staff need to be aware to preserve peoples privacy and dignity. 5 12 16 (m) consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communicate with, their families and friends; This is to lessen peoples isolation in the home. 6 15 12 (3) The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain 21/06/2010 21/06/2010 Care Homes for Older People Page 24 of 27 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 and take into account their wishes and feelings. Staff must ensure people are encouraged to choose meals at the specific meal time. This will lessen confusion in what people have chosen. 7 26 12 (1) The registered person 21/06/2010 shall ensure that the care home is conducted so as, (a) to promote and make proper provision for the health and welfare of service users; This to ensure the safety of people in the home. 8 38 12 (1) The registered person 14/06/2010 shall ensure that the care home is conducted so as, (a) to promote and make proper provision for the health and welfare of service users. This is to ensure staff are prompted and enabled to challenge shortfalls that may detract from the safety of people in the home. Care Homes for Older People Page 25 of 27 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 9 All medication administration sheets that are handwritten are double checked and countersigned by a second person who is trained to deal with medicines Care Homes for Older People Page 26 of 27 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. © 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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