Care Home: Silver Threads

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What the care home does well Silver Threads provides people with a homely, clean and reasonably well maintained environment. It only has 14 people living in the home and the registered owner is also the registered manager. Some people describe it as ``family like, friendly, home from home, gives the personal touch.`` The home can only provide care and support to people who are reasonably mobile as they do not have hoisting equipment and have stair lifts to access the bedrooms. This means that the home ensures that it has a good pre admission assessment process in place and spends time talking to the individual and their family about what the homes limitations are in terms of physical layout of the home and the sort of care they can provide. The home is staffed by a team of people who know the needs of the people who live at the home and work well together to provide care and support in a kind and respectful manner. Health care professionals who returned surveys said ``This home provides a caring and respectful environment and is pro-active in seeking the advice of other professionals if problems are encountered.`` Other comments included ``Treats the clients with respect and privacy. They are always patient with everyone. The meals are always good quality.`` ``Silver threads always seems like a calm positive place. The residents and families always seem content. I have visited the home on weekdays, evenings and at weekends. It appears to provide care consistently.`` What has improved since the last inspection? The staff have received training in areas such as moving and handling, basic food hygiene, first aid and infection control. These were areas that had lapsed and identified during the random inspection as training that needed to be organised to ensure staff could do their job safely and competently. The home have continued to offer people good training in the care of people with Dementia. The registered provider listened to the Commission and has now altered the access to the assisted bathroom to ensure that it does not compromise any individuals privacy. Previously this had been part of one of the bedrooms, in that the assisted bath was an en suite. They have also completed a wet room/shower rooms for people to use downstairs if they wish. What the care home could do better: Although the plans of care have improved so that they contain good basic information, we did find one person who was recently admitted who did not have a plan of care in place. This may mean care and support is not given in a consistent manner as there are no clear instructions for staff to follow. Any restrictions in choice or movement should be agreed and clearly included as part of the individuals plan of care. Plans need to be reviewed at least monthly and more frequently if needs change significantly. The registered provider should look to ensure that individuals are safeguarded against burns from hot surfaces. Ideally radiators should be covered or replaced with low surface ones. The home also needs to look at how it can continue to meet the needs of frail elderly people without specialist equipment such as hoists. Since this report has been written the registered provider has informed us that they are in the process of purchasing a lifting cushion that can be sued if people fall and are unable to get up. The registered manager needs to update his training in key areas such as moving and handling and infection control. Key inspection report Care homes for older people Name: Address: Silver Threads 1 Lyndale Terrace Instow Bideford Devon EX39 4HS     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: Joanne Walsh     Date: 1 6 0 7 2 0 0 9 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 29 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 29 Information about the care home Name of care home: Address: Silver Threads 1 Lyndale Terrace Instow Bideford Devon EX39 4HS 01271860329 01271860020 carehome@silverthreads.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Angela Flynn,Mr Robert John Flynn care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Silver Threads is situated in the village of Instow, between the towns of Bideford and Barnstaple. The homeowner aims to make every residents stay as comfortable as possible. Silver Threads caters for 14 service users over the age of 65 years, who may be physically or mentally frail. The property is an adapted three-storey terrace house and significant improvements have been made recent years. The accommodation is comfortable and homely. There is a stair lift to the first and second floors, with two communal lounges, a dining and reception area on the ground floor. There is also an attractive courtyard area with summerhouse for individuals use. The fees charged at this home range from £335 to £435 per person per week. Additional fees are levied Care Homes for Older People Page 4 of 29 Over 65 14 14 14 0 0 0 Brief description of the care home for toiletries, newspapers, hairdressing and chiropody. reports are available for staff, residents and visitors. Copies of previous inspection Care Homes for Older People Page 5 of 29 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: This inspection took place during a week day in July and lasted approximately 6.5 hours. During this time we spoke to 5 people about their experiences of living at Silver Threads. We also spoke to two care staff, the manager and the cook. We looked at some of the key documents including plans of care, pre admission assessment information, staff recruitment and training files, records relating to medication and individuals monies. This helps us to understand how well the home is run and managed. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. Care Homes for Older People Page 6 of 29 During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 9 people living at the home, and from 4 staff. We also received 6 surveys from social and health care professionals. Their comments and views have been included in this report and helped us to make a judgment about the service provided. A Random inspection was completed on the 8th June 2008, as a result of two complaints we had received. We found that most of the concerns raised were unfounded but did make some requirements as a result of this visit. The home have endeavored to meet these requirements, and for the most part they have been fully complied with. We have identified that staff have had updated training in all areas of health and safety, but this must also include he registered manager who is part of the care team. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Although the plans of care have improved so that they contain good basic information, we did find one person who was recently admitted who did not have a plan of care in place. This may mean care and support is not given in a consistent manner as there are no clear instructions for staff to follow. Any restrictions in choice or movement should be agreed and clearly included as part of the individuals plan of care. Plans need to be reviewed at least monthly and more frequently if needs change significantly. The registered provider should look to ensure that individuals are safeguarded against burns from hot surfaces. Ideally radiators should be covered or replaced with low surface ones. The home also needs to look at how it can continue to meet the needs of Care Homes for Older People Page 8 of 29 frail elderly people without specialist equipment such as hoists. Since this report has been written the registered provider has informed us that they are in the process of purchasing a lifting cushion that can be sued if people fall and are unable to get up. The registered manager needs to update his training in key areas such as moving and handling and infection control. 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 9 of 29 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 29 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. Individuals needs will be assessed prior to admission to the home to ensure that those needs can be planned for and met. Evidence: We looked at the pre admission assessment information for the three newest people to the home. Two of these people had come from out of the Devon area so assessment information was faxed to the home from their funding authorities. This enabled the home to make a decision about whether they could meet needs. The registered manager also confirmed that they spoke to the family to gain a further insight into the individuals routines and what support they may need with settling in and what their likes and dislikes with regard to food and drinks. One person had been assessed by the home prior to admission using their own form which gives basic information about what personal and health care needs are identified. This is then used to help the home devise a plan of care that will inform Care Homes for Older People Page 11 of 29 Evidence: carers how assessed needs should be met. We spoke with one of the people who has recently been admitted to the home. They said that their family had chosen the home and that they had come here from hospital and was settling in very well. Care Homes for Older People Page 12 of 29 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. Individuals personal and health care needs are reasonably well met, but better planning would ensure a consistent approach at all times. Evidence: Four plans of care were looked at in some detail. One person who had recently been admitted to he home did not have a plan of care in place. The registered manager said that they were using the pre admission information to plan their care. The pre admission information did not give clear instructions to staff as to how to support this person in ensuring their personal, health care and emotional needs should be met. This could mean care and support is not provide in a consistent way. All individuals in the home must have a plan of care in place as soon as they move in unless they are taken as an emergency, in which case a plan should be in place with 48 hours so that consistent care is given at all times. The plans overall are well organized and include the following sections, health and medication, eating and drinking, hearing and sight, mobility, washing and dressing, skin, nails and hair, oral hygiene, continence, social and emotional identity, sleeping, Care Homes for Older People Page 13 of 29 Evidence: advanced care planning for do people wish to be resuscitated. One persons plan also included a detailed section their personal history and included names of important people, events, important places, past occupation, war years, interests and hobbies, music tastes, TV, radio, important values. This is an area that the registered manager has identified in their AQAA as being something they wish to develop further for people as this gives a fuller picture of the individual and ensures carers understand them as a person. One person had been identified as being on a special diet due to being an insulin dependent diabetic in their pre admission information given by the hospital, but this was not included as part of the homes plan of care. The manager and cook both said that they did not provide a specific diabetic diet, but that they were offered smaller portions of the puddings, and that all recipes had reduced sugar content. The home have been asked to seek further advice about whether this person should in fact be on any special diet. One persons plan of care had been completed at the beginning of April and then not reviewed since. This plan did not have a fracture risk assessment or falls assessment completed. We were told by this individual that they were not allowed to go upstairs to their room during the day, as the staff were concerned they would fall. This was confirmed to be the case by staff. Any restrictions in movement or deprivation of liberty must be agreed and included as part of the individual plan of care. Where a risk is identified, then risk assessments need to be completed so that actions to minimise risks are known and followed by all staff providing care and support. During this inspection we checked the medication storage and recording system. The home have purchased a controlled drugs cabinet. The medication records appeared to be well recorded, except for two entries, where correctional fluid had been used. The home are reminded to ensure that staff are aware that this is not good practice and any mistakes need to have a single line drawn through it. Plans of care show clearly when medical intervention has been sought and one person told us that they are either assisted to appointments or health care professionals visit the home such as chiropodist and optician. People we spoke to said that their personal and health care needs were well met. One person said yes we are very well looked after, you couldnt wish for better. We also observed staff providing care and support in a kind and respectful manner. All of the health and social care professionals who returned surveys said that the home were very good at ensuring personal care needs were well met. Their comments included This home provides a caring and respectful environment and is pro-active in seeking the advice of other professionals if problems Care Homes for Older People Page 14 of 29 Evidence: are encountered. Other comments included Treats the clients with respect and privacy. They are always patient with everyone. The meals are always good quality. Silver threads always seems like a calm positive place. The residents and families always seem content. I have visited the home on weekdays, evenings and at weekends. It appears to provide care consistently. Care Homes for Older People Page 15 of 29 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. Individuals social and diverse needs are reasonably well met. Evidence: The routines of the home appear flexible to suit most peoples wishes and preferences. People were observed getting up at different times during the morning and two people we spoke to confirmed that they are able to choose when they get up and what they do with their day. One person said that staff did not allow her to go up to her room after lunch. This was discussed with the registered manager who said that this was because the person often complained of feeling dizzy and so was asked to stay in a communal area so staff could keep an eye on them. When such decisions are made about individuals choice, this needs to be clearly recorded as part of their plan of care. The registered manager stated that his wife came in most afternoons to organise entertainment such as games, quizzes, bingo and gentle exercises. They also have occasional paid entertainers. People we spoke to during the inspection said that they did enjoy taking part in the activities and those who were able said that they could not think of any thing else that they would wish to do in respect of social activities. One person told us that visitors were made welcome and that they were assisted to stay in touch with friends and family via phone calls and letters. The home has a Methodist Care Homes for Older People Page 16 of 29 Evidence: service every 6 to 8 weeks, a Catholic priest visits every 2 weeks and a volunteer also provides communion for some people. The home provides people with a good range and choice of meals. The main meal is served at lunch time and the cook explained that she tailors the menus to individuals likes and dislikes. She tries to ensure that people are given a choice and that fresh vegetables are used and meals are mostly cooked from scratch. People we spoke to said that they enjoyed the meals. Comments included The food is very good, you cant complain, I like most things, our cook is very good she knows what we like. Care Homes for Older People Page 17 of 29 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. Individuals views are listened to and acted upon Evidence: The home have a stated complaints process that is made available to people in the home and their relatives as it is given as part of their information pack. The registered manager is also the owner of the home and he says that because he works at the home on a daily basis, he is able to deal with any concerns as they arise. This was confirmed by two people who told us that they are able to discuss any problems or concerns and that any issues are dealt with by the manager or assistant manager. Since the last key inspection we have received two complaints one being from an ex member of staff. This prompted the Commission to do a random inspection on the 8th May 2008. We found that most of what the complainants had said to be unfounded, but some requirements were made as a result of this inspection. All of these have now been dealt with. The main one and one of the issues raised by one of the complainants was the fact that an en suite bathroom was being used for people other than the individual who lived in the bedroom. This has been addressed and the access to this bathroom has been moved. Staff said that they received training in the protection of vulnerable people and were aware of what they should do if they suspect abuse occurring. The home have robust recruitment processes in place to ensure that only people who are suitable to work Care Homes for Older People Page 18 of 29 Evidence: with vulnerable people are employed. The registered manager is aware of how to refer people who are not suitable to work with vulnerable adults. Care Homes for Older People Page 19 of 29 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. The home is clean and reasonably well maintained but some improvements to equipment and facilities would ensure a safer environment for people and staff. Evidence: The home is well maintained and kept clean and odour free. Since the last key and random inspection the registered provider has changed the access to the assisted bath so it is no longer part of an en suite bathroom. It has been altered so that access to this bathroom is via the main corridor. They have also installed a wet room with shower for people who would prefer showers. The provider details further improvements made in the AQAA. These include having the whole exterior of the building painted, installing flood protection and fitting smoke alarms in all cupboards. One area that the home should look to improve is ensuring individuals are not placed at any risk from hot surfaces, so covering radiators or replacing them with low surface ones. We have also discussed the fact that the home does not have hoisting equipment. The registered manager/owner states that this is due to lack of space within the home, and says they make it clear in their statement of purpose that they are only able to Care Homes for Older People Page 20 of 29 Evidence: take people who are mobile. If current people living at the home become palliative and wish to remain at the home, the lack of hoisting equipment could compromise staffs safety. Since the inspection the registered provider is in the process of purchasing a lifting cushion to assist people who have fallen to get up. Care Homes for Older People Page 21 of 29 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 are well trained and supported to do their job. Evidence: The staffing levels are sufficient for the number and needs of the current people living at Silver Threads. There is normally two carers on each shift, supported by the manager and assistant manager, and they also have a cook every day and cleaner three days per week. The is someone available after lunch until 3.30 to provide and organise activities five days per week. Staff recruitment files were sampled and they evidence that sound recruitment practices are in place. People are only employed to work in the home once all relevant checks and references have been obtained. The registered manager said they have worked hard to ensure that training is all up to date and more recently they have been using North Devon College and they now have an annual contract with them, to ensure that all core health and safety subjects are covered by all staff. This does not currently include the registered manager though. He has agreed that he will update his core skills training as he does work as part of the care team at times. Staff spoken to and those who returned surveys said that they have good Care Homes for Older People Page 22 of 29 Evidence: opportunities for training including completing the National Vocational Qualifications in Care. Care Homes for Older People Page 23 of 29 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 well managed and run in the best interests of the people who live there. Evidence: The registered manager is qualified and experienced to run the home. He is also the registered provider and plays a key role in the day to day running of the home. He had ensured that previous requirements to get core skills training for staff have been implemented, but he must also be able to demonstrate that his own training is up to date, particularly in respect of moving and handling, first aid, infection control and basic food hygiene. The home have various ways it enables people to have a say about the quality of the home and this includes using surveys. The manager ensures that the results of these are collated and used to help improve any areas or trends identified. They also use surveys to seek the views of visitors family and other health care professionals. The home have a robust system in place for accounting for individuals monies. Care Homes for Older People Page 24 of 29 Evidence: Detailed records are kept of any transactions including receipts to enable a good audit trail to be in place. The AQAA give us information to show how the home maintains a safe environment via regular checks and servicing of equipment, so this was not specifically looked at during this inspection. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 38 13 (5) You must ensure that 30/08/2008 suitable arrangements are in place for a safe system for moving and handling people. This includes staff training. This has been met, in that all staff have now had this training, but the registered manager needs to ensure he has the same training. Care Homes for Older People Page 26 of 29 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 Plans of care must be in 29/08/2009 place for all individuals in the home. Plans must be reviewed and include all risk assessments and any agreed restrictions To ensure consistent care and support is provided. 2 38 13 The registered manager 24/12/2009 must ensure that his training is up to date to ensure that he can provide care and support in a safe way. 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 19 The registered provider should ensure that all parts of the home are safe including minimising risks from burns from hot surfaces such as radiators. The registered provider should ensure that staff have Page 27 of 29 2 19 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 sufficient equipment in place to meet the ongoing needs of the people living in the home. This includes where needed hoisting equipment. Care Homes for Older People Page 28 of 29 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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