Care Home: Palace House Nursing Home

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What the care home does well People were given clear information about services available at Palace House; this would help them to decide whether their needs would be met. Detailed information had been collected about residents from a range of sources before they were admitted to the home; this would help to help determine whether they could be looked after properly. Each resident had a detailed care plan explaining what their individual needs and preferences were; residents and their relatives had been involved in decisions about care ensuring they would receive the care they wanted. One resident said `I get the care I want` and another said `the staff know what I want`. Residents said they were happy with the care and they received the care they needed. Staff were provided with clear policies and procedures that had been reviewed and updated; this helped them to meet residents needs and to keep people safe. Residents were offered varied and nutritious meals. Comments about the food varied, and included `the food is good`, `I like the food sometimes` and `I dont always like the food but there is a choice`. People knew whom to speak to if they were unhappy and were happy to raise any complaints with staff. Residents lived in a comfortable, clean and tidy home; there was evidence of ongoing improvements ensuring the home continued to be a pleasant place for residents to live in. Residents were happy with their rooms and had brought in personal items to enhance the homely feel. Residents comments included `there could be more staff`, `they could do with more staff` and `there doesnt always seem to be enough staff`. Two other residents said `there could be more staff but they always make sure I am looked after` and `there could be more staff but I am happy with the care`. Staff were provided with appropriate training to give them the skills and knowledge to look after people properly. Records showed that new staff were recruited safely to ensure the protection of residents. Staff said the standards of care were `good` and there was `a stable staff team`. Residents said the staff `are nice girls` and `work very hard`. Residents and their relatives were given the opportunity to express their views about Palace House; comments were used to improve standards. There were a number of systems in place to ensure staff were following policies and procedures; this would ensure residents were looked after properly. What has improved since the last inspection? The home had a new registered manager Claire Tighe. Mrs Tighe is a registered nurse with experience in management and care. Annual surveys had been introduced to allow residents and their relatives to express their views and opinions about the service; comments were used to improve standards. What the care home could do better: The care plans did not always clearly record action to be taken by staff when residents` health had changed such as short term illness and changes to skin condition; it was clear that the appropriate care and support had been given but the lack of recorded information could put residents at risk of not receiving the care they needed.Survey information indicated that suitable activities were provided `sometimes` and `never`. This aspect needs to be developed to ensure residents social and recreational needs were being met. Residents enjoyment of the meals was still being affected by the temperature of the food; this issue had been raised at the last inspection visit and had not been resolved. One resident said they usually liked the food but said `the biggest grumble is that the food is served cold`. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Palace House Nursing Home 460 Padiham Road Burnley Lancashire BB12 6TD     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: Marie Matthews     Date: 2 4 0 2 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Palace House Nursing Home 460 Padiham Road Burnley Lancashire BB12 6TD 01282428635 01282416165 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alliance Care (Dales Homes) Limited (wholly owned subsidiary of Four Seasons Healthcare Limited) Name of registered manager (if applicable) Mrs Claire Tighe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home Palace House provides nursing and personal care for up to thirty three people. It is situated on the main road between Burnley and Padiham near to shops, bus stops and pubs. The home is a converted Georgian building and still has some of the original features; Care Homes for Older People Page 4 of 27 care home 33 Over 65 33 0 0 33 Brief description of the care home there has been an extension built to provide extra accomodation. The first floor can be accessed by either a passenger or stair lift. The extensive gardens are attractive, safe and accesible and are visable from many of the rooms. There is a good sized care park. At the time of the inspection visit all bedrooms were being used as single occupancy. Seven rooms have en suite facilities and others were provided with washbasins. Communal areas are homely, well decorated and comfortable. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £392.00 to £498.00. Items not included in the fee include newspapers, toiletries, hairdressing and private chiropody. 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: The key unannounced inspection, including a visit to the home, took place on 24th February 2009. The last key inspection was completed on 6th March 2007 with an annual service review done on the 6th March 2008. The inspection process included looking at records, a tour of the home, discussions with the registered manager, two care staff and four residents who lived at the home. Information was also included from surveys filled in by two residents. An expert by experience accompanied the inspector on this visit. An expert by experience is a person, who because of their experience and ability to communicate with people visits the service with the inspector to help them to get a picture of what it Care Homes for Older People Page 6 of 27 is like to live in and use the service. The expert by experience was involved to help to determine whether peoples social needs and expectations were being met and whether the meals were enjoyed. Aspects of her findings were included in this report. The registered manager sent us their annual quality assurance (AQAA) before the inspection visit; this gave us a reasonable picture of what had improved over the last twelve months and where further improvements were needed. The inspection also looked at things that should have been done since the last visit and a number of areas that affect peoples lives. There were twenty residents living in the home on the day of the inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: The care plans did not always clearly record action to be taken by staff when residents health had changed such as short term illness and changes to skin condition; it was clear that the appropriate care and support had been given but the lack of recorded information could put residents at risk of not receiving the care they needed. Care Homes for Older People Page 8 of 27 Survey information indicated that suitable activities were provided sometimes and never. This aspect needs to be developed to ensure residents social and recreational needs were being met. Residents enjoyment of the meals was still being affected by the temperature of the food; this issue had been raised at the last inspection visit and had not been resolved. One resident said they usually liked the food but said the biggest grumble is that the food is served cold. 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were given clear information about services available at Palace House which would help them to decide whether their needs would be met. Evidence: Information about the services available at Palace House was clear and accurate and made available to prospective and existing residents and their relatives; this would help people to decide whether the home was suitable for them. The information could be provided in other formats to ensure everyone was aware of the services and facilities available to them. A regular newsletter provided people with additional information about the home and other homes in the group. Three residents care records were looked at in detail. Detailed information had been collected about residents from a range of sources before they were admitted to the home to help determine whether they could be looked after properly. Care Homes for Older People Page 11 of 27 Evidence: People were given the opportunity to spend time in the home prior to admission; this allowed them to view the facilities, ask questions about life in the home and to meet with other residents and staff. From observation of care practices, discussion with staff and residents and looking at records it was clear that staff had the skills and experience to meet residents needs. 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 health and care needs were met although the detail in the care plan did not always reflect the care that was being given. Evidence: Three residents care records were looked at in detail. The care plans had been generated from the assessment information and generally included the information about how residents needs would be met. However the care plans did not always clearly record action to be taken by staff when residents health had changed such as short term illness and changes to skin condition; it was clear that the appropriate care and support had been given but the lack of recorded information could put residents at risk of not receiving the care they needed. The plans had been reviewed regularly and there was evidence that residents and their relatives had been involved in decisions about care; this would ensure they received the care they wanted. The care plans included some good information about residents routines and preferences; this ensured they received the care they both needed and wanted. One Care Homes for Older People Page 13 of 27 Evidence: resident said I get the care I want and another said the staff know what I want. Residents said they were happy with the care and they received the care they needed. Survey information indicated that staff listened to residents and acted on what they said. Any risks to residents had been assessed and there were details informing how residents would be kept safe from harm. It was clear that residents health and well being was monitored and advice and support from appropriate health care professionals had been sought where necessary. Residents were provided with a range of specialised aids and equipment to maintain their comfort and safety and to help them to maintain their independence wherever possible. There were clear policies and procedures to support staff with the safe management of residents medicines. The current residents were unable to or preferred not to look after their own medicines; permission should be obtained for staff to manage residents medicines. It was clear from the records that medicines were managed safely; however as directed medicines should be supported by clear directions and external creams should be signed for by the carer responsible for this task to ensure residents received the treatment as prescribed. Medicines were stored correctly and safely. Regular checks had taken place to ensure medicines were managed safely and according to procedure. Residents said they were happy with the care they received. One said you would have to pay me to move out. Staff were observed responding to residents and visitors to the home in a friendly but respectful manner. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and entertainments did not always meet residents social needs and expectations. Residents were offered a healthy nutritious diet although some residents enjoyment was affected by the temperature of meals. Evidence: Residents said they were able to exercise choice in various aspects including meals and routines. From discussion and observation it was clear that staff had a good awareness of residents preferences and routines; this would ensure they received the care they wanted. There was an activity programme but in the absence of records it was unclear what activity had taken place, who had participated and whether the activity had been enjoyed. Survey information indicated that suitable activities were provided sometimes and never. Three residents said they preferred to stay in their rooms and that this choice was respected. The social histories that would provide useful information about residents likes, dislikes, routines and preferences had not always been completed; it was unclear Care Homes for Older People Page 15 of 27 Evidence: whether residents social needs had been met. Residents spiritual needs were met by visitors from the local church and convent; one resident was visited by members of his church. Residents said their friends and family were able to visit at any reasonable time and that staff were friendly and welcoming. The menus had been reviewed and offered varied and nutritious meals; records were incomplete and did not always confirm that residents had been given choices or alternatives to the menu. The expert by experience dined with two residents in the dining room whilst other residents had chosen to dine in their rooms. It was noted there was not a choice of vegetables and some of the food was cold; one resident, who always ate in the dining room, said this happened practically all the time. It was noted that the food was uncovered when being transported from the kitchen to the dining room which would cause the food temperature to drop. This had been a concern raised at the last key inspection and heated trolleys had been provided for residents dining in their rooms. Other comments about the food varied, and included the food is good, I like the food sometimes and I dont always like the food but there is a choice one resident said they usually liked the food but said the biggest grumble is that the food is served cold. One resident said he enjoyed the meals as he preferred to purchase his own food and said the chef cooked it for him. The dining areas were clean and bright and tables set attractively; the days menu was close at hand. The chef was aware of residents preferences, likes and dislikes; this would ensure their dietary preferences were respected. Checks were in place to monitor whether residents dietary needs and expectations were being met and to ensure staff were following company procedures. Work was still outstanding from the environmental health officers report; the registered manager advised she had received authorisation from head office to commence work to improve the kitchen. (see standard 19). Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were protected by clear policies and procedures and staff awareness. Evidence: People had access to clear information regarding complaints; residents were aware of whom to speak to if they were unhappy. The home had received two complaints in the last twelve months and records showed they had been responded to appropriately. The adult protection procedures were clear and staff had received training to ensure they were aware of how to respond if abuse or neglect was suspected. It was recommended that the contact information of local organisations who would be involved in any report of abuse were included with the procedure; this would ensure any incidents would be dealt with promptly. There were clear procedures to support staff with dealing with residents finances; records showed that residents money was managed safely. Procedures were in place to support staff with safely managing any physical or verbal aggression and to report any bad practice within the organisation; this would help to keep people safe. 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. People lived in a clean, well maintained and comfortable home that met their needs. Evidence: A tour of the home was conducted. All areas were comfortable, clean and tidy with evidence of ongoing redecoration and refurbishment to improve the home for residents who lived there. Bedrooms and communal areas were comfortable, bright and pleasantly decorated. Furniture and fittings were of a high standard and aids and equipment were provided to promote comfort and maintain independence where possible. Residents were happy with their rooms and had brought in personal items to enhance the homely feel. Not all rooms had en suite facilities but were provided with commodes and wash basins; fully equipped toilets and bathrooms were nearby. All rooms were fitted with a nurse call system to enable residents to summon help from staff. Bedrooms were lockable and secure storage spaces were provided; this would help residents maintain their privacy. Grounds were attractive, safe and accessible to residents and their visitors. Care Homes for Older People Page 18 of 27 Evidence: Residents said the home was always clean and fresh. The fire safety department had recently inspected the home; work to improve the fire system and to make the home safe had been requested. The registered manager advised that work was due to start. Work was still outstanding from the environmental health officers report; the registered manager advised she had received authorisation from head office to commence work to improve the kitchen. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were suitable, competent and provided in sufficient numbers to meet residents needs. Evidence: The staffing rotas were clear and showed the numbers and roles of staff on duty each day. Residents comments included there could be more staff, they could do with more staff and there doesnt always seem to be enough staff. Two other residents said there could be more staff but they always make sure I am looked after and there could be more staff but I am happy with the care. Residents surveyed said there were usually staff available. Information from discussion with staff indicated there were sufficient staff although the lack of staff in the laundry at week ends and in the kitchen over tea time made it hard work. The manager said she was reviewing the situation in the kitchen and had rostered an extra carer to cover the laundry. From looking at records and discussion with staff it was clear that staff were provided with appropriate training to give them the skills and knowledge to look after people properly. However the training matrix and individual training records provided for inspection were not up to date as they did not reflect recent and additional training that had taken place. It was noted there had been gaps in the provision of training although the registered manager was aware of this and had taken action. Care Homes for Older People Page 20 of 27 Evidence: Staff and records confirmed that new employees were provided with structured training and support. A number of care staff had achieved a recognised qualification in care; this would help them to meet residents needs. The recruitment procedures were clear and provided staff with safe guidance. Three staff files were looked at and showed that a safe and fair recruitment process had been followed. Residents had not yet been involved in the recruitment and selection of new staff. Staff said the standards of care were good and there was a stable staff team. Residents said they are nice girls and they work very hard. 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. People benifited from a safe and well managed home. Their views and opinions were sought about the day to day running of the home. Evidence: The registered manager is Claire Tighe. Mrs Tighe is a registered nurse with experience in management and care. She has achieved a recognised management award that would help her with her role. Ms Tighe is supported by regular visits from a senior manager and meets regularly with managers from other homes within the organisation. Residents and their relatives were given the opportunity to express their views about Palace House in the form of meetings and service user surveys; the results had been analysed and were due to be discussed at a meeting with residents and their relatives. Any areas of concern had been identified and action taken to improve the service. Care Homes for Older People Page 22 of 27 Evidence: The home had achieved the Investors In People award; this was an external quality monitoring system that would help the home to improve standards. Staff were provided with clear policies and procedures that had been reviewed and updated; this would provide staff with current and safe guidance and helped them to meet residents needs safely. Issues raised at the last key inspection had been resolved to ensure residents comfort and safety. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. There were a number of systems in place to ensure staff were following policies and procedures; this would ensure residents were looked after properly. It was clear from the records that there had been gaps in the provision of one to one support for staff; staff need this to help to identify if they needed any additional support or training. Staff confirmed that one to one support had recently recommenced and they were happy with the level of support they received from senior staff. Records showed that residents finances were safeguarded. Records showed that systems were serviced and maintained and staff had received training to keep them and others from harm. 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 7 15 Residents care plans must clearly detail the action needed to be taken by staff to ensure their needs are met. This will ensure residents needs will be met. 23/03/2009 2 19 13 Work identified at the last environmental health visit must be completed. This will ensure people are safe. 31/03/2009 3 19 13 Work identified at the recent 31/03/2009 fire safety inspection must be completed within the set timescales. This will ensure that people are safe. 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 25 of 27 1 2 3 9 9 9 There should be clear directions on all medicines to ensure they are administered correctly. Care staff should sign for creams/treatments at the time of administration. Permission for staff to manage the medicines of residents who prefer not to or are unable to manage their own medicines should be obtained. Information about residents routines, preferences, hobbies and interests should be included in the care plan; this would help to provide residents with suitable activities and support. Records of activities and entertainments should be maintained; this would help to determine whether residents social needs were being met. The records of food served should always be completed in full; this would help to determine whether residents were receiving a healthy and nutritious choice of diet. Action should be taken to ensure food is always served hot. The contact information of local agencies that would be involved in any report of abuse or neglect should be included with the safeguarding procedures. A minimum of 50 care staff should have achieved the NVQ 2 or equivalent. Records to evidence training should accurately reflect the current level of staff skills and knowledge. Staff should receive regular one to one support; this would help to identify whether additional training and support was needed. 4 12 5 12 6 15 7 8 15 18 9 10 11 28 30 36 Care Homes for Older People Page 26 of 27 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. 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. 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