Care Home: Pexton Grange

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What the care home does well People felt that the home provided good individualised care, with attention to detail, and input from all the relevant sources. Many positive comments were received such as, `Outstanding respect and consideration shown to each resident by all the staff`, and `Pexton Grange must be one of the best homes there are. The staff are first class. nothing is too much trouble`. In particular the Intermediate Care Unit was providing excellent rehabilitation in conjunction with occupational therapists, physiotherapists, nurses and the General Practitioner, and was successfully returning many people back to the community to live. All people in the home benefited from the good support and links this had created. People have opportunities to voice their opinions and to give feedback to the home, who then use that information to plan changes and improvements. One area being addressed at the time of the visit was the choice and quality of meals. What has improved since the last inspection? Since the previous visit the home has been purchased by Brancaster homes, who have a small number of homes mainly in the north of England. A new manager has also been appointed and is registered with CQC. People were very pleased with the improvements with the service since the new owners and manager were in place. A staff member stated,` This home has changed for the best ever since Brancaster took over. I`m happy to be part of it.` Activities are being increased and improved with feedback from people at the home. The home has undergone extensive redecoration and replacement of damaged carpets and furniture making it a pleasant environment. There has been an increase in staff training including training in caring for people with physical disabilities, and dementia. Registered Nurses were also expanding their knowledge and skills, and had plans for further development. Care plans were being reviewed regularly so that the information in them was up to date and accurate. What the care home could do better: There are no requirements from this visit or outstanding from the previous visit showing that the home has been very proactive in improving the service. There were quite a few people in their rooms with the door open whilst in nightwear and this should be confirmed with them so that their privacy and dignity is not compromised. Many of the daily recordings were detailed and described what had happened to people that day, however some were not and staff should be encouraged to always write detailed records. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pexton Grange Pexton Road Sheffield South Yorkshire S4 7DA     The quality rating for this care home is:   three star excellent 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: Stephanie Kenning     Date: 2 0 0 5 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 28 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 28 Information about the care home Name of care home: Address: Pexton Grange Pexton Road Sheffield South Yorkshire S4 7DA 01142441223 01142441224 maureenparr@sheffieldcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Gleneagles (Yorkshire) Limited care home 57 Number of places (if applicable): Under 65 Over 65 0 57 0 dementia old age, not falling within any other category physical disability Additional conditions: 57 0 57 The maximum number of service users who can be accommodated is: 57 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 and Dementia - Code DE Date of last inspection Brief description of the care home Pexton Grange is a purpose built home providing accommodation on three floors, serviced by a lift. The home is sited in a residential area in the North of Sheffield, close to local shops and a bus route to the city centre. The rooms are almost all en-suite with a toilet and washbasin, only three rooms do not have these facilities. Parking is located at the front of the building. The garden which has level access is attractive, well maintained and is situated to the rear of the building. Details of the services Care Homes for Older People Page 4 of 28 Brief description of the care home provided at the home were available in the foyer and copies of the last Commission For Social Care inspection report were also available for service users and their families to read. The weekly fees are: £485 to £560. This information was provided on the 20th May 2009. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: This was an unannounced key inspection carried out by Stephanie Kenning, Regulation Inspector. The site visit took place on 20th May 2009 between the hours of 9:30 and 17:00. The registered manager Trudi Ashmore was present during the visit. Previously, a key inspection was last undertaken in April 2007 and an Annual Service Review was held in April 2008. Prior to this visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Care Homes for Older People Page 6 of 28 Questionnaires had been sent out to people living or staying in the home, to the staff and to health professionals involved in the home. A total of 18 were returned and comments from these have been included in the report. On the day of the site visit opportunity was taken to make a tour of the premises, inspect a sample of care records, check records relating to the running of the home, and check some of the policies and procedures. Time was spent observing and interacting with people, and feedback from people present during the visit is also included in the report. The inspector checked all the key standards and some additional standards. We have reviewed our practice when making requirements, to ensure national consistency. some requirements from previous inspection reports may have been deleted or carried forward into this reports recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 28 Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have information about the home and opportunities to visit before making a decision. The personalised needs assessment means that their needs are identified and planned for before admission. Intermediate Care is rehabilitating many people and enabling them to return home. Evidence: We wanted to understand peoples experiences when they decide whether to choose this care home, and what it is like for people if they did decide to move there. We spoke to people living or staying at the home including some people who were at the home for intermediate care and rehabilitation. We also spoke to visitors, staff, therapists, social workers and the GP. We used information from questionnaires and from the AQAA, and we looked at the information the home give to people before admission and how they assess whether they can meet peoples needs. Care Homes for Older People Page 11 of 28 Evidence: People mainly said that they had received enough information about the home before being admitted, and that they found the information useful and helped to put them at ease. Copies of the Service User Guide were seen hanging on the back of each room and those people that had read it had found the information within it very helpful. Some people had visited the home before making a decision to move there permanently and found the opportunity useful. The AQAA stated that there had been 186 admissions for short term care in the past twelve months, but despite this large number people confirmed that their experience was good. We looked at the assessments of need of four people at the home, all of which contained all the required information, and the level of detail was good, enabling the home to make a clear decision about whether it could meet their needs or not. Good relationships with social workers had helped with obtaining the assessments of short term people before admission, and clear admission criteria had improved the selection of people that could be helped by the care at Pexton Grange. Intermediate Care was provided within a separate area of the home, with special facilities and a team of staff including qualified therapists based on that unit. People were observed to be receiving rehabilitation therapies and were very positive about their experiences. During the visit a multidisciplinary meeting was held that discussed the progress of individuals receiving intermediate care, and the plan for the next week. All of the team seemed to have great respect for each other and were striving to provide an excellent service. Most people were successfully rehabilitated and many went back to their homes. One person was concerned because she had been rehabilitated, but could not go home until a home care package was obtained. She had been ready for discharge for five weeks, and was therefore preventing another person from being rehabilitated by her place at the home. The whole staff team were frustrated at this slow process, and said that it was not unusual. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have their health and personal care needs met and receive medication safely. Evidence: We wanted to understand how people had their health and personal care needs met. We spoke to people in the home, observed practices in communal areas such as at meals times, and looked at records and medication systems. People made the following comments: People are treated with respect, Carers chat to the residents, and there is a welcoming atmosphere. People are well cared for. I have a great respect for the team at Pexton Grange, they are caring people with best interests of patients at heart. They support people to recover and achieve own goals. Excellent level of care for all patients. Provides an excellent intermediate care facility enabling people to regain their independence and return home when possible. I am extremely grateful for the high quality of care my mother receives. I am satisfied with the care. Care Homes for Older People Page 13 of 28 Evidence: People at the home were observed to be supported well with good attention to detail seen, for example one person asked for help to apply her make-up and was assisted immediately. Another person needed a lot of reassurance about their situation and was helped appropriately, by a staff member taking them to a private area to discuss the situation. This shows a good level of understanding of the needs of individuals. It was observed that quite a number of people were in their rooms with doors open, some in nightwear, and whilst some people had requested their doors to be open, it may not have been everyones choice and may have compromised their dignity. No one at the home had a pressure sore, and there was a range of equipment helping to prevent them. People on the intermediate care unit had good access to a range of therapists to aid their rehabilitation. People on the other units had to go through the usual channels to access therapists, but did seem to benefit from the ethos of rehabilitation within the home. The GP provides an excellent service by visiting everyone required each week, plus additional urgent visits, as well as attending the multi-disciplinary meetings and giving in-put to the people in intermediate care. Information in the AQAA and when talking to staff showed that there had been improvements in the care in the dementia unit. A new unit manager had been appointed who was looking at improving the environment to be more stimulating, providing a quiet area, and providing suitable activities seven days a week. In addition staff had attended further training in caring for people with dementia. Four care plan files were studied and found to contain relevant detailed care plans for all areas of need identified. There were clear assessments in areas such as nutrition and pressure sore risk with action in care plans that corresponded. Each care plan had a daily entry giving an outline of what had happened to people that day. Some entries were more detailed than others, with some comments too generalised such as safety maintained, which does not really describe what happened to that person. Care plans were regularly reviewed and updated so that people were getting appropriate care. Registered nurses and care assistants working at the home had been through a range of training to increase and update their skills, for example, Dementia, Parkinsons Disease, Moving and Handling, Diabetes, Physical disabilities Rehabilitation, Flu Vaccination and Phlebotomy (taking blood). The development of nurses skills in taking blood samples and giving vaccinations was felt to aid the multi-disciplinary approach and to be able to provide an efficient service. This training was hoped to be expanded to more nurses at the home in future and perhaps expand to other skills, such as ear syringing. Care Homes for Older People Page 14 of 28 Evidence: Medication systems at the home are well managed and staff have training in medication administration through the Lloyds pharmacy that services the home. The storage, administration and recording were good and demonstrate that the home follows safe procedures that protect people in their care. Some people self administer medication, and were supported to do this with appropriate facilities and assessments. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at this service have choices about their daily routines and felt that they were able to influence the menus and activities available. Evidence: We wanted to understand peoples daily experiences and opportunities for social activities and leisure. We observed the routines and the activities taking place and spoke to people in the home. We looked at the records of activities, routines and meals. People made the following comments: Meals although adequate and plentiful, often lack variety. I always like the meals. There are usually activities I can join in with. Sometimes there are activities. There are good celebrations and a range of activities for older people- on different occasions. I would like there to be more entertainment provided. The quality of meals could be improved. One relative stated that she always felt welcome at the home and that the staff were very friendly. Another relative stated that they were kept up to date with what was happening with their relative and with events at the home. Care Homes for Older People Page 16 of 28 Evidence: People were able to choose when they got up or went to bed, and had a choice of food at meal times. Information in the AQAA and when talking to people showed that people gave feedback about different aspects of the home such as meal choices and activities. Some of the feedback was influencing an improvement in the meal choices and also more outings from the home were being arranged. Recently there had been bingo, concerts and quizzes, and a quiz was being held on the day of the visit. The activities organiser was also spending time with individuals, particularly those who were alone in their rooms, giving them company and individual attention. Training had been given in activities and occupations and it was hoped that more activities would be developed with the particular needs of the three different units. People generally liked the meals and they appeared to be of good quality on the day of the visit. People had a choice of pork chops with vegetables and potatoes or spaghetti bolognese. There were other options available for special diets, including for desserts, and a healthy option was available. The menus showed a good range of nutritious options available over the whole week. People stated that if they did not like what was on the menu they could ask for something else. Drinks and snacks were offered between meals and people were assisted sensitively if they needed help. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are protected by the policies and procedures in place. Evidence: We wanted to understand how people were protected from abuse or neglect and how the service responds to complaints. We looked at records, policies and procedures and talked to people living and working in the home. People made the following comments: I always feel that the staff listen to me. I dont know how to complain, but I can talk to the staff. Outstanding respect and consideration shown to each resident by all the staff. People were observed to communicate well, and staff were seen listening to people and acting on what they heard. Written procedures for making complaints and dealing with vulnerable people were available within the home. There had been four complaints and one referral through safeguarding procedures, all of which had followed procedures and been dealt with well, including information sent to CQC. Staff had received training in safeguarding adults and knew what to do if they suspected abuse. They demonstrated that they had safe procedures for dealing with individuals monies, and that they had safe procedures for recruiting staff, all of which help to protect people. Care Homes for Older People Page 18 of 28 Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, comfortable and meet their needs. Evidence: We wanted to understand what it was like to live in the premises and whether they were appropriate for the lifestyles of the individuals living there, and staying on the intermediate care unit. We were shown around the premises including some of the rooms of people who invited us in. We observed for good repair and maintenance and for cleanliness. We looked at the facilities available in each unit and spoke to people living and working there. We looked at records of maintenance and safety checks to ensure that equipment was kept in good working order. People liked their rooms and the communal areas and gardens. All comments were positive and people felt that the home was generally kept clean and fresh. People commented on how hard the staff worked to keep the home nice, and that the staff did a good job. Since the previous visit damaged decor and carpets had been replaced and the home was well maintained. Some minor areas of damage were seen to handrails and doorways caused by equipment used in the home. People were able to spend time in their rooms and those seen were well decorated, coordinated and were clean and fresh. Some people had many personal items helping Care Homes for Older People Page 20 of 28 Evidence: them to feel at home. The patio areas had seating and planted areas and were a pleasant place to sit on a fine day. The dementia unit had some brightly coloured items and the unit manager was using recent research to help to refresh the unit so that it helped people with dementia. The intermediate care unit had areas for therapists and for meetings as well as the bedrooms and communal areas. Records showed that routine checks and maintenance were carried out to ensure that equipment was working well and safely. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who are recruited to thorough procedures and trained well, to protect and develop individuals. Evidence: We wanted to understand how staff were recruited and trained to ensure that they could carry out their jobs well. We talked to people living and staying at the home, visitors and staff, including the manager. We checked the recruitment files and the training records to see if procedures had been followed. We looked at the questionnaires returned from people, and noted the comments they had made. People made the following comments regarding staff: People are treated with respect and dignity. Staffing levels are excellent, no staffing shortages. The staff are multicultural and work well together. Staff are given relevant training and refresher courses. The staff provide a high standard of practice and care at all times. I usually get the care and support I need. Outstanding respect and consideration shown to each resident by all the staff. The staff are all first class. Nothing is too much trouble. Staff are usually available when I need them. We looked at a sample of staff recruitment files and found that staff had been recruited well with all the relevant checks made to help to safeguard people. People Care Homes for Older People Page 22 of 28 Evidence: had induction training and then a range of relevant training according to their job roles. Following the previous inspection visit staff had also had training in caring for people with a range of physical disabilities, rehabilitation with occupational and physiotherapists, dementia, and safeguarding people. More than 50 of care staff have at least NVQ level 2 as required by the standards, and showing that the service is committed to developing staff. Registered Nurses were also given opportunities to attend relevant training and were developing skills such as taking blood samples, that would benefit people at the home. On the day of the visit there were 4 nurses, 10 care staff, 8 ancillary staff, 1 administrator and 4 therapy staff, plus the manager. This was to care for 55 people and shows the range and number of staff available was good. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and people are protected by the systems put in place by management. Evidence: We wanted to understand how the home was managed and ensuring the quality of service for people living and staying there. We talked to people in the home, visitors and staff, including the manager. We looked at some records and used information from the AQAA and surveys. People made the following comments: Pexton Grange must be one of the best run homes there are. This home has changed for the better ever since Brancaster took over. Im happy to be part of it. I feel that I am listened to, and can put my ideas into practice. The registered Manager Trudi Ashmore has many years experience and qualifications Care Homes for Older People Page 24 of 28 Evidence: in nursing and management. She understands the requirements of running a home and has created some good systems for people to follow. The atmosphere within the home was friendly and welcoming, and people said that they felt able to approach her regarding any concern they may have. She is supported by a deputy manager and individual unit managers, and has good support from the owners and their regional manager Val Kendall. They have kept us informed of complaints and concerns, and have acted appropriately to protect people in their care. The Intermediate Care Unit has been developed well to provide an excellent service in conjunction with the therapists and other health care professionals. There are excellent working relationships and a great deal of professional respect, and weekly meetings that discuss individual progress. The Dementia Rehabilitation unit is now being developed and there are some good ideas and plans for this service. The long term care unit also provides a good standard of care that benefits from having so much expertise in the building. The health and safety of people living in the home and the staff supporting them is promoted by having systems in place that check that things are working, and by training staff in safe working practices. Records are kept that show these are being done. There was a clear system of managing monies for people at the home with accurate balances and well kept accounts. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Improve the daily recordings in the care records so that they all describe what has happened to that person that day. Ensure that peoples privacy and dignity is maintained by always checking if they want their door to be left open, especially when in nightwear. 2 10 Care Homes for Older People Page 27 of 28 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). 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. 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