Care Home: Orchard Cottage

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What the care home does well Residents live in a home run in their best interests. They benefit from a competent, qualified and experienced Registered Manager. Individuals enjoy living in a comfortable, homely and clean environment, which is attractive and well maintained. People benefit from a visit to the home before they decide to move in. This gives people a good opportunity to see whether the home is suitable to meet their needs. Residents are treated with dignity and respect. They are recognised as individuals and are able to exercise some choice over their lives. Individuals changing personal, health and social care needs are met. Residents benefit from appropriately recruited, supervised, qualified and trained staff who care for, understand and anticipate their needs and wishes. The views of residents and their representatives are listened to and receive appropriate consideration. People are protected from potential abuse and by the systems in place to protect their health and safety. Residents feel suitably occupied and can choose to take part in group activities or pursue their individual interests; they benefit from keeping in contact with their relatives and friends. Residents enjoy a good quality and varied diet. What has improved since the last inspection? Orchard Lodge continues to improve the quality of the service provided. What the care home could do better: Residents would be better protected if the assessment made by the home before they moved in was recorded. Residents changing personal, health and social care needs could be better reflected in care plans and risk assessments. Residents could be better protected by confirmation that there are sufficient staff on duty to meet their needs. Residents are protected by a safe environment, although a specific risk assessment of exposed radiators would confirm this. The systems in place for the administration of medication which aim to protect residents, may be enhanced by some improvements to record keeping. Residents are protected by the system in place for safeguarding their finances, although this could be improved by the retention of all receipts made on their behalf. Residents enjoy a good quality varied diet, although choices may be easier to make if planned meals were recorded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Orchard Cottage 78 Old Road East Gravesend Kent DA12 1PE     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: Helen Martin     Date: 1 5 0 4 2 0 0 9 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. 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. 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Orchard Cottage 78 Old Road East Gravesend Kent DA12 1PE 01474321127 Telephone number: Fax number: Email address: Provider web address: info@orchardcarehome.co.uk Name of registered provider(s): Type of registration: Number of places registered: Mrs Tersaim Kaur Khaira care home 10 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: 10 The registered person may provide the following category/ies of service only: Care home only - 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 - OP Date of last inspection Brief description of the care home Orchard Cottage is a detached property situated in a residential area of Gravesend. It is privately owned and is currently registered to provide residential care for ten older people. The accommodation consists of six single rooms, one of which has an en-suite facility, and two double rooms. There is a chair lift to the first floor. Each room has telephone and TV points and a call system. There is an emergency lighting system in place throughout the building. The entire building is decorated to a high standard; the Care Homes for Older People Page 4 of 27 Over 65 10 0 Brief description of the care home furniture and fittings are also of a high standard and are very homely. The home has attractive gardens. Full information about the fees and costs payable, the service provided and the homes Statement of Purpose are available from the Registered Manager. 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: 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: Orchard Cottage provides care and accommodation for up to ten older people. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key Unannounced Inspection included a visit to the home in Gravesend on 15th April 2009, where two Care Workers, the Deputy Manager and several Service Users were spoken with. In addition, the Registered Manager was present for some of the time. Some judgements about the quality of the service provided were taken from observation and conversation. Some records and documents were looked at together with the premises and facilities of the home. The last Key Inspection was undertaken on 16th April 2007 and an Annual Service Care Homes for Older People Page 6 of 27 Review was completed on 23rd April 2008. An Annual Quality Assurance Assessment, AQAA, has been received from the home. Any other information received since the previous Key Inspection has been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned in this report where appropriate. What the care home does well: What has improved since the last inspection? What they could do better: Residents would be better protected if the assessment made by the home before they moved in was recorded. Residents changing personal, health and social care needs could be better reflected in care plans and risk assessments. Residents could be better protected by confirmation that there are sufficient staff on duty to meet their needs. Residents are protected by a safe environment, although a specific risk assessment of exposed radiators would confirm this. The systems in place for the administration of medication which aim to protect residents, may be enhanced by some improvements to record keeping. Residents are protected by the system in place for safeguarding their finances, although this could be improved by the retention of all receipts made on their behalf. Residents enjoy a good quality varied diet, although choices may be easier to make if planned meals were recorded. Care Homes for Older People Page 8 of 27 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.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. People benefit from a visit to the home before they decide to move in. This gives people a good opportunity to see whether the home is suitable to meet their needs. Residents would be better protected if the assessment made by the home during this visit was recorded. This would show more clearly how the home can meet these needs. Evidence: The Deputy Manager said that people who are thinking about moving in to Orchard Cottage are invited to spend a day at the home, eat a meal and meet the other residents. This gives people a good opportunity to see whether they like it and if it is suitable, before they decide to move in. The Deputy Manager explained that during this visit people were also assessed by the home to ensure that their needs could be met. The aim would be that care plans for Care Homes for Older People Page 11 of 27 Evidence: the help that people need are developed from this. The care plan for one resident did not contain any record of this. The Deputy Manager explained that although the assessment was undertaken, it had not been written down and undertook to record all future assessments made prior to admission. A Statutory Requirement has been made. The Deputy Manager explained that the home does not provide any intermediate care. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated with dignity and respect. Residents changing personal, health and social care needs are met; although they could be better reflected in care plans and risk assessments. There are systems in place for the administration of medication which aim to protect residents, although this could be improved by a review of procedures. Evidence: Individual plans of care for each resident are developed. These aim to identify the action required from staff to meet residents personal, social and health care needs. Three care plans were looked at. These are clear and easy to follow. Information included is up to date, although not all is recorded in detail. The Deputy Manager explained that they were in the process of completing a care plan for one resident who had very recently moved into the home. Residents changing needs are reflected in notes written by staff on a daily basis. The Care Homes for Older People Page 13 of 27 Evidence: last key inspection report identified that entries in daily notes indicated AM, PM or night but did not always specify the actual time that events occurred. This continues to be the case in some entries. The provider is recommended to review all care plans to ensure that information is recorded in detail and to ensure that specific times of events and entries are recorded in all daily notes. The last key inspection report stated that no risk assessments, apart from mobility, were seen in files. Although further risks to residents are now identified in care plans, not all are recorded. Records do not show detailed information about the action needed to reduce the risk. The Provider is strongly recommended to review the risk management strategy for all residents to ensure that all risks and the action needed to reduce these are recorded. Residents health care needs are met. These are monitored and recorded in care plans. Records also show that health and social care professionals are accessed to support staff to meet residents needs including consultation and referral to medical professionals. Systems are in place within the home, which aim to protect residents regarding the administration of medication. Currently no residents manage their own medication and all benefit from support from staff to do so. All medication is stored securely in a locked cupboard, although not a metal cabinet designed for the purpose. A small quantity of insulin is currently stored in a bedroom and in a locked box in the kitchen fridge. Administration records are mostly completed appropriately, with the exception of some handwritten entries which are not signed by two members of staff as double checked. The Deputy Manager explained that as the home had recently changed pharmacy and although recorded previously, a new way of recording medication returned to the pharmacy is in the process of being developed. The Deputy Manager said that individual guidelines for medication taken on a when required basis will be recorded and made available for staff. It was also mentioned that new photos of residents are being taken. The Provider is recommended to ensure that hand written administration entries are signed by two members of staff as double checked; medication returns to the supplying pharmacy and individual guidelines for PRN medication are recorded. Residents are treated with dignity and respect. During the visit, staff were observed to be kind and helpful, attend to residents needs in privacy and respond quickly when needed. There is a good rapport between residents and staff. Staff spoken with Care Homes for Older People Page 14 of 27 Evidence: demonstrated a good understanding of individuals needs and described their roles well. Residents spoken with indicated that staff looked after them very well and thought them very good. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are recognised as individuals and are able to exercise some choice over their lives. Residents feel suitably occupied and can choose to take part in group activities or pursue their individual interests; they benefit from keeping in contact with their relatives and friends. Residents enjoy a good quality varied diet, although choices may be easier to make if planned meals were recorded. Evidence: People move into Orchard Cottage knowing the nature of the service. The pace of daily life is relaxed. People can choose whether to spend time in their rooms or in the communal areas of the home. Residents spoken with indicated they were happy in the home and with its routines and would not want to change anything. It was evident, however that some routines, such as the times that residents are assisted to get up in the mornings, were only flexible within staff availability. Residents can choose to pursue their own individual pastimes or to join in with group Care Homes for Older People Page 16 of 27 Evidence: activities. These are organised by staff in the afternoons, requested by residents and usually consist of games, such as Snakes and Ladders, I Spy and Bingo. Residents and staff were enjoying a game on the day of this visit. The garden is well kept and attractive. Residents enjoy walks and games of Bowles in the garden in warm weather. There are regular hairdressing and nail manicures available. Some residents attend church and the local church visits monthly. The home can support residents with different faiths to worship in a manner of their choice. The last key inspection report identified that no outings were arranged by the home as most residents make arrangements with their families. It continues to be the case that current residents go for trips out with either their family, friends or organisations to which they belong. Some residents go on holiday. Residents are encouraged to keep in contact with their relatives and friends if they wish. Visitors are welcome in the home at any reasonable hour. Residents spoken with indicated that they enjoyed the meals and that the food was good. People are able to choose what they want in advance and can request items to be bought. In addition the home has used questionnaires to find out what residents like to eat. Staff are aware of residents special dietary needs, such as likes, dislikes, any allergies and cultural or religious issues. There are hot and cold options for breakfast and tea, although it was less clear whether a hot alternative is available for the main meal. This is because, although meals are planned a week in advance, there is no recorded planned menu. However all meals eaten by residents are written down. The Provider is recommended to record the planned menu in advance. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of residents and their representatives are listened to and receive appropriate consideration. Procedures are in place, which aim to protect residents from potential abuse. Evidence: At the time of this visit, it was observed that residents were at ease talking with staff who listened to their views. Staff demonstrated a good understanding of residents. A positive relationship between both staff and residents with a good balance between professionalism and friendliness was observed. There is a written complaints procedure available for residents and their relatives. Residents and relatives spoken with did not voice any complaints and none have been received by the home recently. Residents spoken with indicated that they enjoyed living in the home; staff are very good; they have no complaints and they are very happy. Procedures are in place, which aim to protect residents from potential abuse. Care Homes for Older People Page 18 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. Residents enjoy living in a comfortable, homely and clean environment, which is attractive and well maintained. Residents are protected by a safe environment, although an up to date risk assessment of exposed radiators would confirm this. Evidence: Residents enjoy living in a comfortable environment. All areas of Orchard Cottage are clean, tidy and attractively furnished. The gardens are well maintained and attractive. The living areas are made up of a lounge, dining area and a conservatory that is also used as a lounge. The conservatory overlooks the garden and is a very pleasant room. There are pictures and ornaments that all add to the feeling of home and residents spoken with all indicated that it is a very comfortable place in which to live. Residents rooms are very homely and individually personalised. Residents spoken with indicated that they like the home and surroundings and their rooms; the garden is very nice; they can bring their own things and keep them in their rooms. Adaptations and specialist equipment is provided where necessary to assist people with their mobility and bathing if necessary. There is a stair lift to the first floor and a call system to alert staff in an emergency. Care Homes for Older People Page 19 of 27 Evidence: The home is warm and light. In order to protect residents, hot water temperatures are tested regularly. It was observed that no radiators within the home were covered or of a type to guarantee a low surface temperature. The Registered Manager explained that all radiators had thermostatically controlled valves, there had been no accidents and there was no risk to residents. Subsequent to this inspection the Provider stated a risk assessment by an independent company had been undertaken in January 2009, describing the home generally as low risk. However, in order to confirm reduced risk to residents specifically from scalding, the Provider is strongly recommended to undertake a specific risk assessment with regard to radiator surface temperatures, and to take any necessary action identified. The kitchen and laundry areas are maintained in a hygienic manner. All laundry is undertaken in house by care staff. Although there are no sluice facilities available, a member of staff described the procedures in place to maintain infection control. Care Homes for Older People Page 20 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. Residents benefit from appropriately recruited, qualified and trained staff who care for, understand and anticipate their needs and wishes. Residents could be better protected by confirmation that there are sufficient staff on duty to meet their needs. Evidence: A good rapport was observed between residents and staff. Residents spoken with indicated that staff are very good and look after them well. Planned staff shifts are rostered and written down, although the record seen does not contain any dates or the full names of staff. The Deputy Manager explained that all staff had worked their shifts for some time, these did not change and they knew when to come in. It was said that the actual hours that all staff work is recorded in the day book. The Provider is strongly recommended to undertake a review to confirm that planned shifts and actual hours worked for all staff are recorded appropriately, including dates, times and full names. Records show that there are two care staff on duty during the day with one sleeping in at night. Staff spoken with described the on call system in place. Currently there are nine residents living in the home. There is a domestic member of staff who works over Care Homes for Older People Page 21 of 27 Evidence: six days per week. It was observed that there were enough staff on duty to meet residents needs at the time of this visit and this was confirmed by staff spoken with. It is evident however that the two care staff on duty during the day are responsible for meeting residents personal care needs, preparing and cooking meals, undertaking the laundry, making the beds, organising residents activities and also on Sundays, cleaning the home. The Provider is strongly recommended to undertake a review to confirm that staffing hours, both during the day and at night, are sufficient to meet all the needs of residents at all times; this should include personal care, residents activities, the flexibility of routines within the home, domestic tasks and cooking. The home has a procedure in place which aims to recruit suitable staff who can meet the needs of residents. Records seen showed that residents are protected by appropriate pre employment checks. Induction training is undertaken for all new staff, which the Registered Manager described as including the shadowing of more experienced staff. This is recorded, although it does not show detailed information. The home provides an ongoing programme of training for staff, which is designed to further develop and update their skills. Records show that appropriate courses and qualifications have been undertaken, which together with staff spoken with confirmed training as including moving and handling, the protection of vulnerable adults, health and safety, medication, first aid, food hygiene, infection control and National Vocational Qualifications. There is currently no risk assessment training provided. The Provider is recommended to review induction training records in line with Skills for Care, and the need for risk assessment training. Care Homes for Older People Page 22 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. Residents benefit from a competent, qualified and experienced Registered Manager. The home is aimed to run in the best interests of residents. Residents are protected by the system in place for safeguarding their finances, although this could be improved by the retention of all receipts made on their behalf. Residents benefit from well supported and supervised staff. The health and safety of residents is promoted by the testing and maintenance of systems and equipment in the home. Evidence: The Registered Manager is also the owner. They have a good knowledge of how the Service runs and have completed the Registered Managers Award. Although the Registered Manager is not hands on within the home, they tend to undertake the Care Homes for Older People Page 23 of 27 Evidence: administration, maintenance and the day to day management issues. There is also a Manager and Deputy Manager of care provision working in the home. The home has a system in place which aims to assure the quality of the service provided. Residents are relaxed and at ease when speaking to staff. The Registered Manager described a more formal system, which included using questionnaires; these are returned to the home, analysed with any action needed taken. The home only keeps small amounts of cash on behalf of a three residents; most deal with their own finances or relatives do this for them. Cash tallies with records, although these could be more clear. The last key inspection report identified that receipts were not kept for all purchases, including hairdressing. This continues to be the case. The Provider is recommended to ensure receipts are kept for all purchases made on behalf of residents. The Registered Manager indicated that staff are supported to undertake their roles through informal discussion, staff meetings, self assessment and formal recorded supervision sessions. Records of accidents and incidents are recorded appropriately. There are a range of detailed and comprehensive written policies and procedures designed to help carers complete their duties in an effective and consistent manner. Other records looked at as part of this visit have been mentioned elsewhere within this report where appropriate. Records generally indicate the testing and maintenance of systems and equipment within the home. The Registered Manager monitors the premises and the accommodation. This is done so that potential hazards to health and safety can be identified and addressed. The home has procedures in place for the maintenance of food hygiene; hot food temperatures are tested appropriately, although not recorded. The Registered manager stated that this would be done in future. Care Homes for Older People Page 24 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 25 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 3 17 The registered person shall 16/05/2009 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. Schedule 3 details records to be kept in a care home in respect of each service user, including the assessment referred to in regulation 14. All assessments of service users undertaken prior to their admission to the home must be recorded and kept. 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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