Care Home: Orchard Residential Care Home

What the care home does well People are not admitted to the service without the staff taking the opportunity to make sure that they can meet their individual needs. This gives people an opportunity to discuss their needs and make sure that staff have the information they need. In return the manager provides information about the home and how they will support the person. Staff seen showed a caring attitude and a genuine need to provide a good level of care. They try to make sure that people receive a good choice of foods that is home cooked and enjoyed by the people living in the service. Health and welfare needs are met with people being supported to attend medical appointments as needed. Staff monitor people`s health and welfare and take any action that is needed. The staff team is stable and a number of them have worked at the home for some time. This means that people are more likely to receive care and support form people that they know. This includes the manager although she is not yet registered with us she has worked in the service for several years and is know to the people who live in the home. This experience helps her understand the needs of the people that she supports and the strengths of the staff working in the service. What has improved since the last inspection? The manager has tried to make the environment better suited to people with memory lose and cognitive impairment. There are "signpost" arrangements such as noticeboards with staff photographs and signs on bathrooms. All these help people who live in the service maintain their independence for longer. The prevention of the spread of infection arrangements have increased all of the bathrooms had hand washing and drying facilities. Staff are supplied with antiseptic hand gel that they use throughout the day. These practices help make sure that any potential risk of the spread of infection is reduced. What the care home could do better: The information to staff for some medications such as "as needed", creams and food supplements need to be clearer. The service needs to look at how it includes peoples needs, choices and preferences in their daily routine. Although a lot of group activities are available there is no clear indication that how people live each day is taken into account. This needs to include how the environment supports them to maintain their independence for as long as possible. Staff training, recruitment and supervision needs to be better recorded in order to make sure that staff are skilled enough to meet people`s needs. Guidance to staff such as policies and procedures need to be updated in order to make sure that any issues can be rapidly addressed. Key inspection report Care homes for older people Name: Address: Orchard Residential Care Home St Marys Road Huyton Liverpool L36 5UY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Garrity     Date: 0 5 0 2 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Orchard Residential Care Home St Marys Road Huyton Liverpool L36 5UY 01514806056 01514806056 admin@flightcare.co.uk www.flightcare.co.uk Flightcare Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following categories of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of people who can be accommodated is: 26 Date of last inspection Brief description of the care home The Orchards residential home provides personal care to 26 older people who have dementia. The home has two communal lounges and two separate dining rooms. A therapy room has also been provided to enable people to relax with staff support should they become upset or agitated. A separate enclosed garden is accessible at the front of the home. The home is closed to Huyton village so is in easy reach of local transport links. Care Homes for Older People Page 4 of 27 Over 65 0 26 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: Prior to the site visit taking place we (the commission) asked the manager to complete a document called an AQAA. This is a document, which gives information about the services strengths and weakness, and future plans for the service to develop. The inspector was accompanied on the visit by an expert by experience. Experts by experience are individuals who have personal experience of either living in or supporting a relative in a care environment. In some cases the expert by experience is an individual who has personal experience of either physical or mental ill health. The expert by experience was asked to talk to people and gather their opinions on what it feels like to live in service. There was a limited amount of time available for the expert by experience and as such they concentrated on the dignity and opportunity to make choices of the individuals living in the home. During the visit, we talked with people who live at the home, their visitors and staff. Care Homes for Older People Page 5 of 27 Their views have been included within the report. We looked at the environment and the care records in the service. This information was used to help us to make a decision about the quality of service that the Orchards provides. Feedback was given during the visit to the manager and the owner. The visit took place over three days and lasted a total of 12 hours. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The information to staff for some medications such as as needed, creams and food supplements need to be clearer. The service needs to look at how it includes peoples needs, choices and preferences in their daily routine. Although a lot of group activities are available there is no clear indication that how people live each day is taken into account. This needs to include how the environment supports them to maintain their independence for as long as possible. Staff training, recruitment and supervision needs to be better recorded in order to make sure that staff are skilled enough to meet peoples needs. Guidance to staff such as policies and procedures need to be updated in order to make sure that any issues can be rapidly addressed. Care Homes for Older People Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to move into the Orchards can have confidence that the staff will take the time to see they can can meet their individual needs. Evidence: We looked at how the service made sure that they were aware of peoples needs before they moved in. The AQAA for the service told us, A pre-assessment file that includes information and photographs are taken on assessments to show the new service user where they maybe moving too. This is to help them decide if they want to move in. Nobody moves into the home unless we have done a pre-assessment (looked at their needs) or have been given a care plan from social services. On the day of arrival to the Orchards, a member of staff will sit and spend time with the new service user and ask them questions about there preferred choice of day to day living, this is six pages long, and gives us a good guide of what they like or dislike. We saw that senior staff from the home meet with the person who is interested in moving in and/or with their families. This is done before they move into the home. The manager told us Care Homes for Older People Page 10 of 27 Evidence: that they try to see everyone even if they are being admitted as an emergency. Records in the service showed that staff gather as much information as possible during the assessment before people move in and after. They do this to make sure that they can identify peoples needs and plan how they will meet their needs. The manager told us that during this assessment people are provided with information known as a service user guide. This guide provides an overview of the support available within the home. The guide and another document called the statement of purpose were out of date and did not reflect what services the Orchards We looked at how the guide met peoples needs and noticed it is available in different colour paragraphs and in large print. This may help people who are visually impaired or who have memory problems to read the information. Care Homes for Older People Page 11 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. People living in the home have their health and welfare needs meet in a manner of their choosing. Evidence: We looked at how staff met peoples health and welfare needs. The AQAA for the service told us that Care plans are reviewed every month to make any changes to our residents day to day care. Medication is administered according to our residents MAR (medication administration Record) sheets, we also follow the policy and procedures. We looked at four care plans, these are records, which are used to give staff instructions about the care, and support that each person needs and how they would like to receive this support. We noticed that the plans had been based on the information that had been gathered during the assessment. Details such as the time the person usually went to bed and got up in the morning had been included. We saw that people or their representatives had signed the plan to say that they agreed with the care and support being offered. This shows that people are involved in deciding their own support. We noticed that some information was unclear in the plans in particular to information regarding medications, when to give as required Care Homes for Older People Page 12 of 27 Evidence: information, the use of creams and food supplements. Staff need to have full instructions available as to how to meet the persons individual needs. When we looked at how medications were managed we noticed that in general people were given their medications as they needed. Some of the records were not well kept as an example one person had painkillers but these had not always been signed for when they were given and did not show that the person had received these correctly. Care records showed that people were able to access external experts as needed. This included, GPs, chiropody and opticians. We noticed that people who needed regular in put from external professionals such as blood tests were supported to attend these appointments. We noticed that staff had been requested by external professionals to record and monitor blood pressure. Staff in the home are not nursing staff and are therefore not qualified in monitoring blood pressure. There was no evidence that staff had been trained, assessed as competent or given guidance as to what to do with the information. We discussed this with manager at length and discussed the support that they would need in order to continue this activity. The local Primary Care Trust has a service called options, a doctor visits the service twice a week. We spoke to the options Doctor who told us that staff access them as needed and do ask for advice for people that they may feel need to see a doctor. Care Homes for Older People Page 13 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. A variety of daily activities and meals are available that provide people with a choice. These are not always available with information or in a manner that meets peoples needs personal preferences and choices. Evidence: People spoken with said that there was a routine but they could get up and go to bed when they wanted. We looked at records, which showed us what activities had been offered to people who live at the home. We saw that a weekly planner had been completed and was on view in a prominent position so that people could see what activities were happening that day. This information was not in formats to meet the needs of the people living in the service. We discussed this with the manager on the first day of visit. By the second day she had made significant alterations including moving the notice board and arranging for staff to complete this on a daily basis. This prompt action will assist people to access information on activities available in a manner that sits their needs. The AQAA told us that, Activity programme in place to suit each resident of there choice each day, we have big playing cards for poor sight, old newspapers for our residents to reminisce about the past and form a discussion, bingo is played for our Care Homes for Older People Page 14 of 27 Evidence: residents to interact together and have fun. Social assessment as well as religious needs are catered for, visiting times are flexible. The service provides a variety of group activities for people to be involved in. The manager informed us that she is considering how to expand this approach to make sure that individual activities and daily routines become part of the support that they provide. This is known as a person centred approach, the manager intends to take this approach in all areas of the service including assessments and care planning. This is good practice as it will make sure that peoples daily routines are of their choosing and provide daily activities that suit their personal choices. We viewed the menus and saw that ranges of home cooked meals are offered. The expert by experience told us that people were eating snacks such as biscuits and cakes outside of the main mealtimes. During the visit we saw that people were eating a three-course lunch. When we spoke to the manager about how the menu was developed they told us that it was developed between the cook and the management team. As such it was not taken from the expressed choices or needs of the people living in the service. There was no indication on the menus as to what meals were suitable for special diets such as diabetes. We looked at records in the home and found that there was little or no determination of what food people preferred. People living in the service have dementia care needs and are not always able to clearly express their individual choices. The manager informed us that she is making arrangements to have all meal choices in picture form and this will help people make an informed choice. Staff told us that people were free to go out with relatives or friends whenever they chose. The service has a secure small garden area, which people can access with staff support. The manager told us that plans were being developed to organise groups outings in the near future. The manager also explained that people would often accompany staff for a car journey when they have to run errands. The manager explained that there are no restrictions on visiting however visitors are reminded of when mealtimes are as some people become distracted and will not eat if they receive visitors. Peoples weight was monitored in order to make sure that they maintained a healthy weight as much as possible. Records showed that the majority of people maintained the weigh that they were admitted with showing that general eat an appropriate diet. Care Homes for Older People Page 15 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. Potential complaints and concerns are recognised by the staff and management. Appropriate action is taken to make sure that all concerns are dealt with rapidly and people are protected. Evidence: We saw that the home has a copy of the local guidelines on how to protect people form abuse. Staff spoken with told us that they had received training. When we discussed how they would deal with safeguarding i.e. how to protect people, all were correct in their approach and able to deal with these serious concerns correctly. Training records did not show that staff had received up to date training and the policy in the home did not reflect what actions the staff and manager did take. Staff need good up to date guidance at all times in order to make sure that they deal with serious concerns correctly. The AQAA for the service told us that, Policy in place for complaints which is clear and easily accessible, one also in place for staff, no secrets policy for protection, which is then investigated by the manager, and await the outcome of the complaint. We looked at records of complaints including safeguarding. The service has had 2 complaints both of which were investigated and resolved within 28 days. There were also five safeguarding referrals made by the service. Two were not to do with the service of the home but correctly reported by them. We noted that the manager had investigated these and kept records of what actions had been taken. Complaints were Care Homes for Older People Page 16 of 27 Evidence: monitored in order for the service to make sure that management recognised and dealt with any concerns. 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. Orchards Residential home is safe, clean environment for people to live in. Evidence: We walked around the home and looked at the decor and quality of furniture and furnishings. We saw that the home was clean and decorated in a homely way. The manager spoke to us about the possibility of using peoples photographs to help them identify their bedrooms. She has included other signposts, such as large signs for toilet to help people move around the home with the minimum of support. Peoples bedrooms had been personalised with their own items helping to keep the environment familiar to them. There are separate seating and dining areas available and this helps people decide where they would like to spend their time. There have been adaptations to the environment such as notice boards with pictures to help people living their understanding the home. The manager discussed further changes that she would like to make including redecorating some areas and using appropriate sign posts to help people move freely around the environment. The manager has plans to expand the hairdressing facilities so that people at the home can have their hair done whilst listening to relaxing music. The service has a therapy room which is set out to be a comfortable and quiet space for people to relax in. Care Homes for Older People Page 18 of 27 Evidence: A small garden is available for people to use. The manager would like to make better use of the area at the front of the building to give people more garden space to use in good weather. When walked around the building we saw how staff reduce the risk of infection spreading. We saw that the home is equipped with plastic disposable aprons and disposable gloves and we saw staff using these during our visit. We also saw that the home has sluice rooms which were well equipped to manage soiled products and that variety of bags are used and available to transport dirty linen. We spoke with the laundry assistant who explained that staff do use these products and we saw that the machines in the laundry are equipped to wash clothes so that the risk of infection is reduced. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are not sufficiently managed to make sure that there are staff who are skilled to meet the needs of people living in the service. Evidence: We looked at off the duty rotas that showed how many staff were on duty in the home during the day time and the night time. This showed that staffing levels have been monitored and changes made as more people moved into the service. Staff spoken with told us that in their opinion there was sufficient staff available. The expert by experience spoke to some of the people living in the service who confirmed that in their opinion there was sufficient staff available. Staffing files were reviewed to determine how staff were recruited. Records in all files were incomplete, not all the files had an application form, two references or evidence of a full induction. The head office for Orchards Residential keeps all records that show police checks and another check known as POVA. The head office had not completed this information for the home to be sure that all checks had been done. We spoke with the owner of the home who told us that the manager would have this information available to them in the future. The manager needs to be assured that all staff working in the service are fit to do so. We spoke to staff about training and all confirmed that they had received a variety of Care Homes for Older People Page 20 of 27 Evidence: different training over the last year. Staff surveys also confirmed that staff were offered training as needed. The manager stated the company the owners the Orchards employs their own trainer and that they had delivered lots of training to staff recently. When we looked at the records held by the head office we noticed that there were no records of training since late 2008. Of particular importance was medication training for staff as we noted some areas that needed to be improved. There was no evidence that the staff had up to date medication training. The owner told us that head office would update this information and send a copy to the manager in order that she can monitor that staff training remains up to date. Care Homes for Older People Page 21 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. The home is managed safely and is a safe place for people to live. Evidence: At the time of our visit the manager was not yet registered with the commission to manage the service. Na interview date has been arranged to take place shortly in order to determine the managers fitness. The owner of the service has already checked that the manager is suitable to work in the Orchards. The manager has worked at the home for several years as a carer, senior carer and deputy. When the manager moved to another service she took over as the manager and states she is enjoying the job. People living in the home, relatives and staff are all known to the manager and she to them. As someone who has worked in the home for a long time she is well known to all stakeholders. All people spoken with thought that she was approachable, helpful and able to maintain a good quality of service. Care Homes for Older People Page 22 of 27 Evidence: The service sends out surveys once a year to the people who live at the home as another way of monitoring standards and gaining their opinion. The provider visits the home twice a month to make sure quality is maintained. The service has not audited (checked on) several aspects of the service including medications audits on other areas such as care plans, staff training, staff recruitment, accidents and environment as examples. We looked at policies and procedures that give staff guidance on how to do their job. The AQAA for the service told us that these had not been updated since 2006 it also told us that hoists are in need of checking to make sure that they are safe to use. Senior staff at the home support some people to manage their money. We saw records, which were clear and easy to track who spent what money on which day and for what purpose. Care Homes for Older People Page 23 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 24 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 29 18 Review all staffing files to 05/03/2010 make they include evidence of application (with gaps in history explained), 2 verified working references, CRB, POVA and induction To make sure that staff are suitable to work in the care home. 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 The recording of external medicines and nutritional supplements should be improved to help make sure accurate records are always made. Arrangments need to be in place to make sure that staff are aware of how to give as needed medications. 2 12 Consideration needs to be made about activities that are person centred and involved peoples daily routine as apposed to group activities. Menus need to reflect special diets and be in formats that are accessible to people living in the service and assist Page 25 of 27 3 13 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations them to make informed choices. 4 5 19 30 Consideration needs to be made in further adapting the environment to meet the needs of people with dementia. Update all training and make arrangements that support the manager to check that staff are receiving the correct training including induction and mandatory training. Consider updating policies and procedures as several are four years out of date. The hoists in the home need to be checked to make sure that they remain safe to use. 6 7 33 38 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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