Care Home: Nuffield House

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What the care home does well People considering moving into Nuffield House can be confident that their needs will be assessed before they move in to ensure that the home and its staff can provide the appropriate care and support. People living at the home, or their representative are involved in the development of a care plan, ensuring that the care provided is as they expect and wish. People living at the home, along with health care professionals are satisfied with the care provided at the home. An enthusiastic and knowledge staff team that has the appropriate experience and training provides a good level of care and support. We sent surveys to health care professionals and asked them what they thought Nuffield House did well, they wrote:`Sincere, compassionate service provider, regular staff know their clients and collectively have an enormous amount of experience.` What has improved since the last inspection? Nuffield House has refurbished part of the first floor, to provide respite accommodation for up to ten people with a mental disorder. Staff have continued to attend training that enables them to provide a good level of care, and provides them with an insight into the conditions of people living at the home, and how they as carers need to provide appropriate guidance and support. The garden area has been improved to make it a more pleasant and accessible area for people living at the home to enjoy. What the care home could do better: People accessing services at Nuffield House, and those providing personal and professional support should have their views sought, as to the care and service provided by the home, to ensure that the service can continually plan for further improvements to enchance the experience and care of people living at the home. People could be further supported to manage their own lives, by having an assessment undertaken to establish their views and abilities to manage their own medication. Environmental improvements to the decor and fabric of rooms within the home, would provide a more homely atmosphere for people to live and visit. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nuffield House Barclay Street Leicester LE3 0JE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Linda Clarke     Date: 2 4 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Nuffield House Barclay Street Leicester LE3 0JE 01162541363 0116254163 socis214@leicester.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sandra Mary Hamilton Type of registration: Number of places registered: Leicester City Council care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: Named Person To admit a named person with physical disability under the age of 65 years of age, as identified in application number V19444 dated 11 April 2005. Service User Numbers DE(E) & MD(E) No one falling within category DE(E) or MD(E) may be admitted into Nuffield House when 20 persons who fall within categories/combined categories DE(E) or MD(E) are already accommodated within the home Service User Numbers PD(E) No one falling within category PD(E) may be admitted into Nuffield House where there are 6 persons of category PD(E) already accommodated within the home Service User Numbers SI(E) No one falling within category SI(E) may be admitted into Care Homes for Older People Page 4 of 28 Over 65 20 20 34 6 10 0 0 0 0 0 Nuffield House where there are 10 persons of category SI(E) already accommodated within the home Date of last inspection Brief description of the care home Nuffield House is a registered care home to accommodate up to thirty-four older people and is owned by Leicester City Council. The home is situated in a residential area and close to local shops and amenities. Public transport is nearby and a ten minute bus journey to the city centre. Nuffield House is a large purpose built property with level entry access. Accommodation is provided on the ground and first floor, which can be accessed via the passenger lift located near to the centre of the building. All the bedrooms are single rooms with a wash hand basin. Bathrooms and toilet facilities are located close to the bedrooms and the communal areas. There are a choice of lounges and dining area on the ground and first floor and a designated smoking area. All areas of the home are accessible to people using mobility support, aids and equipment. The home is well maintained with comfortable furniture and decor. Information about the service is provided to prospective and current residents within the `service user guide?. The `service user guide?, the terms and conditions of the stay are available in other languages and formats such as Braille. The monthly fees are #270 to #370. There are additional charges for hairdresser, chiropodist, newspapers, magazines, and toiletries. The CSCI published inspection report is available at the home. The residents are informed of the findings of the CSCI inspection at the `Residents Meetings? or individually. 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: On the day of the site visit we were advised by the Registered Manager that the weekly fee for people in receipt of a service is 386.00 pounds, the amount payable by an individual is based upon a financial assessment which is carried out by a representative of Social Services. We as it appears throughout the Inspection Report refers to The Commission for Social Care Inspection. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool completed by a representative of the service, reviewing previous Care Homes for Older People Page 6 of 28 Inspection Reports, and any information we have received. We sent surveys to people who use the service, and staff who work at Nuffield House, along with surveys to health and social care professionals who provide support to people living at the home. The unannounced site visit commenced on the 25th August 2008, and took place over eight hours. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Nuffield House. Four people accessing services were selected. Discussions were held with some of the people chosen, along with other people living at the home, visitors of people living at the home, members of staff and the Registered Manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home have access to information about the services provided, and can be confident there needs will be assessed to ensure that the home is best suited to them. Evidence: We were shown the information pack provided to people moving into the home, or on making initial inquiries. The information pack contains details about the services offered by the home along with information on how peoples care package will be kept under review to ensure individuals needs continue to be met, and to establish whether people are satisfied with the care and services they receive. We spoke with people living at Nuffield House and visiting relatives and friends, all said that they had been given information about the home, which included information about their rights, and contact details for health and social care services. We sent Care Homes for Older People Page 11 of 28 Evidence: surveys to some of the people living at Nuffield House, all those that were returned said that they had received sufficient information about the home to enable them to make a decision as to whether Nuffield House was the right home for them. We looked at the records of four people living at the home, everyone had had an assessment of their needs carried out by a Social Worker, to ensure that their needs could be met by the staff at the home. Nuffield House does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People accessing services at Nuffield House are consulted and involved in the development and review of their care package, and have their health and care needs met. Evidence: We saw committed members of staff meeting peoples needs, we spoke with a member of staff who was able to give an in-depth account of the health and personal care needs of people and new exactly how to look after them. Everyone at the home has a care plan which details the care and support they require, and the role of staff in ensuring peoples needs are met. We spoke with visitors who told us that they were aware of their relatives care plan, and agreed with its contents, and that they attended a meeting each year to review their needs. Everyone living at the home is allocated a keyworker who is responsible for reviewing and updating care plans, each month the keyworker will review and record significant events in the persons life including changes to care needs. Records showed that health Care Homes for Older People Page 13 of 28 Evidence: care professionals make regular visits to people living at the home, to provide health care support, the surveys we sent to people living at the home, told us that people are happy with the medical support they receive. We sent surveys to people living at Nuffield House which asked them whether their care needs were met, one person wrote mum and myself cannot fault Nuffield House, she is very content here and I am very happy with the staff, and the way she is cared for., whilst someone else wrote since mum has been in Nuffield House she has been made very welcome, I would like to thank the staff for the kindness shown to her. We spoke with relatives who were visiting and they told us we cant fault them, the staff are always polite and courteous, and everyone is very happy. Staff support people living at the home with the management of their medication, we observed a member of staff administering medication at lunchtime, policies and procedures for the administration of medication were followed, and the member of staff ensured that where people required support in taking their medication this was provided. Opportunities need to be developed within the home, that enables people to continue to retain responsibility with regards to their medication, if they so choose. We observed throughout the day staff supporting people with consideration to their privacy and dignity, and providing care and support in a sensitive manner, and this included the appropriate use of equipment for moving and handing people, to promote health, safety and welfare. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Nuffield House are able to make choices about their lifestyle, and are supported and provided with opportunities to engage in activities and recreational pursuits. Evidence: When we arrived at the home, people living at Nuffield House were up and about, and for a majority of people this meant they sat in one of the communal areas within the home, those in the large lounge and lounge set aside for people wishing to smoke, sat watching television, or reading their newspaper which had been delivered that morning. Staff served hot and cold drinks throughout the morning, along with snacks, and interacted with people living at the home, where possible. At lunchtime a majority of people were supported to take their seats in the dining room, this took in excess of twenty minutes, which meant that several people sat waiting for their lunchtime meal, during this period their was minimal care staff supervision, and several small altercations between people sitting at the dining tables took place, catering staff resolved these incidents. Care Homes for Older People Page 15 of 28 Evidence: The lunchtime meal was relaxed, and everyone appeared to enjoy their meal, we sat at one of the dining tables, and everyone told us that they enjoyed their meal. Choices were available for both the main course and dessert, and vegetables were placed within serving dishes on the dining tables, so that people could served themselves. After lunch a small group of people sat with the Activities Organiser and undertook craft work, they all spoke of the range of activities they participated in, which included, playing musical instruments, bingo, cards, gardening, cake baking and painting. The Activities Organiser said that the range of activities was intended so as to encourage as many people as possible to participate. We looked at the care plans and records of four people living at the home, which recorded their hobbies and interests and involvement in activities and trips. We read that trips this year have included pub lunches, barge trips on the river and visits to Museums. Care Homes for Older People Page 16 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. Peoples welfare is supported by staff that are aware of their responsibilities in reporting any suspicions, which puts the welfare of an individual at risk, and by the complaints procedure, which provides a route for people to express their concerns. Evidence: People and their family when moving into the home are provided with an information pack, which includes information on how to make a complaint, in addition the information pack provides names and addresses of external agencies which may be of benefit to the individual, including advocacy services and the contact details for the Commission for Social Care Inspection. We asked people living at the home if they knew how to make a complaint, one person told us, theyd know if im not happy, im not afraid to say., someone else told us, the girls always listen to what you have to say, so things are quickly sorted out. We asked visitors if they knew how to raise a concern, they told us we know how to make a complaint, but weve never had the need to do so. Surveys which we sent to people living at the home told us that people living at Nuffield House know how to make a complaint, and surveys we sent to staff working at the home told us that they are aware of their responsibilities should anyone wish to complain. We received one complaint about Nuffield House, which we asked the home to Care Homes for Older People Page 17 of 28 Evidence: investigate, we received information about how the complaint was investigated and the outcome, and are satisfied that the home handled the complaint well. We looked at the complaints records kept by the Registered Manager of Nuffield House, and noted that the home has not received any complaints or concerns in the last twelve months. We spoke with staff who spoke passionately about the rights of people living at the home, and how they as staff would respond if they felt that people living at the home were being subjected to abuse or mistreated in any way. We looked at the training records of staff, which evidenced that staff have received training on safeguarding adults from abuse. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people to live in a safe, and comfortable environment. Evidence: Nuffield House on the ground floor has a large lounge, which is well lit looking out over the front of the property, the room is decorated to a good standard, and provides comfortable seating, and has a large television secured to the wall. In addition their is a smaller lounge/dining room, for people who prefer a quieter area in which to sit or eat their meal. For people wishing to smoke their is a dedicated lounge, which is in need of decoration and refurbishment, the wall paper is torn in places, and the paintwork in a poor state of repair. The dining room is large, and looks out onto the rear of the property, with access into a well maintained garden, which provides plants and flowers, seating and a gazebo. The Registered Manager told us that the dining room was to be redecorated soon, but no date as yet has been provided, the dining room has torn wallpaper, and damage to the walls and paintwork. A visitors rooms is also available on the ground floor for those wishing to meet their friends and relatives in private. The corridor linking all communal areas is in a poor state of repair with torn wallpaper, damaged paint work and a carpet which is stained in places, these areas do not provide a welcoming and homely view of the home. Care Homes for Older People Page 19 of 28 Evidence: Bedrooms, bathing and toilet facilities are provided on the ground and first floor, bedrooms are decorated to a reasonable standard, and other corridors within the home are in a good state of repair. We asked people living at the home if they were happy with the environment in which they lived, all expressed satisfaction, and surveys we received from people living at the home told us that the home is always clean. Nuffield House has made changes to some of the services it provides and has recently refurbished a part of the home to create a respite facility for people with a mental disorder on the first floor. The respite facility has been refurbished, and has yet to receive its first customer. The facility provides two lounges, one for people who wish to smoke, there is large dining and kitchen area, which will be used to encourage people staying at the home to continue to be self sufficient. Bathing and shower facilities are provided, bedrooms are single, one bedroom can be used as a shared facility if a couple wish to come into the home together. A secure garden area is provided for people staying within the respite facility. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Nuffield House receive care, which is delivered by enthusiastic, experienced and trained care staff that are able to meet their individual needs. Evidence: We observed the support offered to people living at Nuffield House by the care staff during morning of our visit, peoples needs were met, and staff provided hot and cold drinks along with snacks, during this time staff conversed with people and ensured they were comfortable. Staff resources were stretched during lunchtime, as a result of this some people sat up to twenty minutes at the dining table, whilst care staff continued to support other people to come to the dining room, during this time their was minimal care staff observation, and small altercations with people sitting at dining tables took place, with kitchen staff taking responsibility. We spoke with a member of care staff, who told us that the two carers she was working with were agency workers, one having worked at the home on a frequent basis, and therefore knew the people living at the home, the other agency worker however had not. We observed that the agency staff were supported by the regular member of care staff, to ensure that the care provided was appropriate to the individual. The member of care staff employed by Nuffield House had a very good understanding of the needs of people in her care, and through observation and Care Homes for Older People Page 21 of 28 Evidence: listening to people was able to offer timely and appropriate support. We received surveys from three staff members working at the home, they told us that they are not entirely happy with staffing levels, and felt that the use of agency staff hampered the care they deliver, one staff member wrote working with agency staff makes it harder as they dont know the individuals, their likes/dislikes and abilities. The Registered Manager told us that the length of time it took to obtain the necessary pre-employment checks prior to people commencing work at Nuffield House, meant that in some instances people took other positions due to the time delay. The Human Resource Team of Leicester City Council oversees the recruitment of staff at Nuffield House. All records with regards to staff recruitment including application forms, references and Criminal Record Bureau (CRB) disclosures are stored centrally; therefore we could not view these. People living at Nuffield House are supported by staff with training and experience, many of which have a National Vocational Qualification (NVQ) in Care, we asked visitors their views about the care their relatives receive, one person told us the attitude of staff is excellent, the same level of support is offered throughout the day and night, by all staff. We asked relatives whether staff appeared knowledgeable when they asked them about the care of their relative, they told us that they were always kept informed, and were aware of their needs. Surveys we received from staff working at the home told us that were satisfied with the training they received, one person wrote raining is a key element of working at Nuffield House, courses such as moving and handling are revisited at regular intervals. whilst someone else wrote Nuffield House is a happy - friendly home, on the whole staff work well together. Support is there if needed, training is on going and encouraged. Care Homes for Older People Page 22 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. People living at Nuffield House reside in a home, which is managed well and are provided with opportunities to influence and contribute to wards the care they receive. Evidence: The Registered Manager, Sandra Hamilton has held her current position for many years, and has attained a National Vocational Qualification at level 4 and the Registered Managers Award, and continues to attend training which enables her to update her knowledge and skills. We asked staff their views with regards to the support they receive from the Senior and Management Team, all said that they attended regular staff meetings, and receive regular supervisions from their line manager. One staff member said the office door is always open, if you have a query you just ask. Staff wrote in their surveys that supervision takes place at regular intervals.........our manager has an open door policy and can be approached at any time.......my manager is very supportive and everything Care Homes for Older People Page 23 of 28 Evidence: is treated confidentially and hand overs take place at the beginning of a shift, care staff meetings are always at regular intervals. People living at the home and their visitors receive a monthly newsletter which informs everyone about planned events within the home, and events special to individuals such as birthdays, and includes information about staff. Meetings are held regularly for people living at the home, providing an opportunity to discuss issues, such as meals and activities. A formal quality assurance process needs to be established which seeks the views of people living at the home, and those providing support such a health and social care professionals, family and friends, this will enable the Registered Manager to make changes and plan for the future to ensure Nuffield House continues to meet the needs of people it provides a service for. Information provided by the Registered Manager states that systems within the home including central heating, fire systems and electrical systems are regularly maintained. Care Homes for Older People Page 24 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 25 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 19 23 The Registered Person to provide an action plan with realistic timescales for environmental improvements to the lounge used for people who smoke, the dining room and connecting corridor to communal areas. People living at the home, to be provided with an environment which is well maintained 30/10/2008 2 33 24 A quality assurance system 02/12/2008 to be developed which seeks the views of people living at the home, as to the care and the service they receive and from those providing support such as professionals, relatives and friends. The views of people using the service and those providing support, will provide information that Care Homes for Older People Page 26 of 28 once analyzed will enable the Registered Manager to review the service is provides, and make plans to ensure the service continues to improve and meet the needs of 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 1 7 Care plans should be updated, where monthly reviews undertaken by keyworkers identify that individual needs have changed. People who receive a service from Nuffield House, need to be assessed to determine their wishes and abilities with regards to managing all or some aspects of their own medication, and care plans and risk assessments put into place where appropirate. 2 9 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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