Care Home: Somerley

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What the care home does well This home has a very friendly warm atmosphere with both staff and residents praising the home for its welcoming, homely service. The 23 comments received at the Commission from residents prior to this visit all gave very clear messages that say the staff are `kind, caring and encouraging`. This is very apparent when walking around the building and observing interaction and listening to peoples conversations. The home has a good procedure for assessing residents to ensure the service can meet the person needs and the care plans are written with the resident that give a picture of the persons individual needs. The meals are praised by the residents who have choice and comment on the quality of the food and the how liquids are regularly available to encourage hydration. The home is managed by a competent and experienced person who works well with the staff team, ensuring the residents are listened to and that any complaint will be acted upon and treated with importance. The home does monitor and report the quality of the service to all interested parties from the annual check to monthly visits from senior management. What has improved since the last inspection? The home has updated some bathrooms to make them more accessible to residents and also to make the rooms more inviting. The home has improved the facilities by creating a different service in one unit that is now used for people who may need a short stay between hospital and going home but who no longer require clinical/hospital care. People spoken to in this unit tell us that they have improved greatly and are moving back home feeling much better and more able to cope. What the care home could do better: The home does need to improve the environment in some of the units. The toilets are in a poor condition and some need replacing. Some areas could be made more homely and inviting by the use of window blinds and improved lighting. The home needs to consider ways of managing the shortfall of staff overnight when only 2 waking staff are on duty to ensure all care needs can be met throughout the 24 hours. A system for ensuring all staff get the updated training as and when required should be in place so no staff member misses the statutory training. Key inspection report Care homes for older people Name: Address: Somerley Somerleyton Street Norwich NR2 2BT     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: Ruth Hannent     Date: 2 5 0 6 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 26 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 26 Information about the care home Name of care home: Address: Somerley Somerleyton Street Norwich NR2 2BT 01603623582 01603621802 somerley@norfolk.gov.uk www.norfolk.gov.uk Norfolk County CouncilCommunity Care care home 40 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: People who need wheelchairs to assist with independent mobility at point of admission can only be accommodated in rooms 5, 25, 105, 125. Date of last inspection Brief description of the care home Somerley is owned by Norfolk County Council and provides residential care for 40 older people. It is was purpose built in the 1970s, and is divided into small living units which house 6 to 8 residents with a shared sitting room and dining room. In addition to this there is a large lounge with a bar on the ground floor where larger social gatherings take place. This room has a pleasant view of the front garden. The Home is located on the main road and close to shops and facilities, and the busy community of Unthank Road area of Norwich. A hairdresser visits once every two weeks and chiropody services are also available. The current fee levels for the home are individually assessed with a maximum weekly charge of £368.72. 0 Over 65 40 Care Homes for Older People Page 4 of 26 Brief description of the care home Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited this home and spent time looking at records, talking to staff and residents and observing the day to day service provided in the home. As part of this inspection report we took in to account the information received prior to the site visit that included the Annual Quality Assurance Assessment (AQAA) completed by the Manager, any notifications received since the last inspection and any comments that had been sent by residents, families or professionals. Care Homes for Older People Page 6 of 26 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 26 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 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 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. Any potential residents do have a thorough assessment of need and will be offered appropriate information to help them make a decision about the service to ensure their needs can be met. Evidence: The home has a process to assess potential residents that is used by all the older peoples residential homes in Norfolk. It appears thorough and details obtained for potential residents for Somerley showed information that would enable the home to make a judgement on the suitability of the service to meet the persons needs. On talking to residents, 3 who had only been at the home for a number weeks, all felt the home was wonderful and that they are so much better for having moved to Somerley. The manager also told us that the home is now working closely with the hospital to Care Homes for Older People Page 10 of 26 Evidence: offer temporary placements for people who are clinically fit but need some temporary support while waiting for alternative housing or residential care. The assessments for these people are sometimes needed to be carried out quickly and the home now liaises with designated Social Workers to gather the details and complete the paperwork to ensure the home can meet the persons needs for the short period of time requested. The people receiving this short term support where spoken to and the progress and improvement for the individuals appears suitable and the service has helped them move on. Although this is not a full intermediate care service it is a supportive service to aid in the planning of moving people back into the community. In the home foyer is a stand with all relevant paperwork for any potential customers to read about the home and help them make a judgement about the suitability of the service. The manager also informs us in the AQAA that all information about the home is given to anyone who wishes and is taken to potential residents if an assessment at the hospital is required. Care Homes for Older People Page 11 of 26 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. Each resident has a detailed care plan that shows the care needs required. The home is supported well by the local medical centres. Medication is managed well but some areas of the procedures could be improved. Privacy and dignity is upheld for all residents. Evidence: The care plans for each resident are kept in the front office and sectioned into colours for each unit in the home. Three care plans were looked at in detail. The information is a little difficult to find and although relevant information is in place it appeared a little disjointed and although the care plans had been reviewed each month it was difficult to identify if any changes had been updated. The residents spoken to about their plans of care said they knew they had a special worker and that they knew what their care plan was. Some of the documents were noted to have been signed by the resident. All the residents spoken to said they were happy with their care and that all their needs Care Homes for Older People Page 12 of 26 Evidence: were met. The AQAA tells us that all the residents are supported by mainly two local GP practices. The medical support notes were noted in the individual care plans and details of any interaction with the doctor, district nurse or health professional was recorded clearly. The comment surveys completed by residents and received prior to this inspection visit told us that the medical support required was available and that staff will call in the doctor as and when required. The medication administration was observed in one dining area. The senior responsible was carrying out this task correctly with each person offered their medication appropriately. People were asked discretely if they required pain relief where the medication chart stated to be given when required. The medication is stored in a trolley designated for each unit. Trolleys were clean, tidy and all medication that was loose was dated on opening such as eye drops. One small area of confusion was the medication administration charts for PRN medication. The charts had occasionally been completed with a code as not required. There was no stock on record of the medication and therefore could not have been issued any if required. If there was stock it was difficult to know if the person had or had not been asked if they required the medication. A more robust system of managing PRN medication would improve the procedure and confusion would not occur. It was also noted that some of the applications of creams and lotions were not clear. In one bedroom three different charts were found. They were all out of date and should have been filed. A clearer system for the application of creams needs to be in place. Residents are encouraged to manage their own medication upon a risk assessment being produced. One risk assessment was seen of a person managing their own inhalers. Each bedroom was noted to have a lockable medication cabinet for safe storage of medicines. Throughout the day the staff were noted to be carrying out their duties in a dignified manner. All residents were spoken to politely and respectfully. Any personal care carried out was done so in the persons own bedroom or bathroom. Doors were knocked upon before entering and greetings were respectful and wishes of the resident were respected Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have available activities to suit most likes that will meet their recreational needs. Families, friends and visitors are welcomed and are involved in the life of the home. Autonomy and choice are in the control of the individuals. Meals are presented with choice are wholesome, well balanced and enjoyed. Evidence: The home has a varied and regular activities programme. On the day of this visit the residents were all gathering for a coffee morning and raffle. Around the entrance and community lounges displays of various arts and crafts can be seen. Comments received from residents stated that there is activities if you want to take part. On talking to three residents it was clear a choice in daily activities sis available but some prefer to sit quietly and read or enjoy the garden in the good weather. There is a monthly newsletter printed in large font telling of the events for the month, a small quiz and a few jokes. The local church have a service at the end of every month and Care Homes for Older People Page 14 of 26 Evidence: hold a social gathering after the service. The manager is trying to find drivers who may be willing to pick up residents and take them to a service to get them out into the community. The home has a resident who needs sensory support and all the staff have learnt how to communicate with this person. Time was spent with a staff member and this resident to get a picture of the life in this home. An outside agency also call 4 times a week to offer time for this person both inside and out of the home. Although outings are planned the home does find it difficult to obtain transport. The manager is hoping to get one to one time occasionally and take residents to the local facilities rather than all going out together. All residents seen throughout the day were smiling and full of praise for the time given. We have plenty to do if we want to. I really enjoy the coffee morning. The afternoons in the garden are lovely are just some of the comments said. Three visitors to the home were spoken to about the service they find on the days they visit. The comments were all complimentary. You would not find a better home. Staff are so good and make everyone feel welcome and My relative has improved since coming here. It was noted during the inspection that people were greeted well and offered a drink. A meal was taken with 6 residents in one of the units. The meal was a roast beef dinner with roast potatoes, yorkshire pudding, mixed vegetables and gravy with a vegetarian option if preferred. The pudding was rice, jelly or yoghurt. Each person was visited at the table in turn to ask them what they would like and how much. Some wanted a little of this and a lot of that, some no gravy, some no green etc. this was all done in a calm and dignified manner. The residents were full of praise for the meals provided. You would never go hungry and the meals are always good were some comments. Although the meal of the day is on the notice board the choice did not need to be made until the actual meal time giving people the opportunity to decide what they would prefer to eat at the time according to how they feel. At the end of the meal a fresh fruit bowl was offered for people to have a piece of fruit to take back to their own room if they wished. The kitchen is about to undergo a refurbishment and will have meals cooked at another home over a period of three weeks. Once the kitchen is finished the menus will be rewritten and each table will have a menu card for people to read and discuss. There is plenty of drinks available with hot drinks provided regularly and cold juice available in the lounges. Care Homes for Older People Page 15 of 26 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. Residents, relatives and friends can be assured that complaints will be listened to and acted upon. Systems are in place to protect residents from abuse. Evidence: The manager showed us the complaints, compliments and grumbles log. The majority of concerns were addressed straight away. The home did have one complaint (seen) and dealt with this appropriately and timely. The Commission has not received any complaints and the residents spoken to and comment surveys received prior to this inspection all said they could talk to the manager at any time about any concerns if any arose. The AQAA tells us that all staff are trained as part of their induction in the protection of vulnerable adults. Training records were seen to confirm this. The manager also told us that no staff member is employed until an enhanced CRB form has been returned. the personnel files looked at did show a CRB returned. Care Homes for Older People Page 16 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and maintained correctly but due to the age of some of the fixtures is beginning to look shabby and in need of refurbishment in certain areas. The home is clean and hygienic however, some carpets and toilets replaced would improve this further. Evidence: A tour of the building took place on arrival to the home. It is split into 6 units with each unit having a lounge/dining area. There is a larger lounge/dining/activities room at the front of the home offering plenty of areas to share with other residents. These rooms are bright and well furnished. The gardens have improved this year and a large open space for easy access and seating has been created. A central water feature creates a nice calm feeling and residents were noted to be enjoying this pleasant setting. The bedrooms are not very big and do not have en-suites and residents who have mobility problems rely on a commode in their rooms for night time use. Personal possessions made some of the rooms homely and comfortable but with limited space larger items would not be suitable. Care Homes for Older People Page 17 of 26 Evidence: Some of the toilets are badly stained and have old toilet seats. It was noted that 2 toilets were placed a distance from the wall so residents would not have back support when sitting. These toilets were shabby in appearance, studs to box in the cistern were rusted and old, a towel rail was rusted and items such as pads, plastic aprons and disposable gloves were lying around. The appearance of these rooms are institutional and not homely. The domestic staff had cleaned them but the stains could not be removed from either in the toilet or on the stained flooring. The home has recently had completed a new assisted bathroom with a second one nearly completed. The windows are bare and would look more homely with a blind or curtains allowing choice to the residents of having them drawn when bathing. The room is much more inviting. The home has the original metal framed windows and one comment from a resident was the main lounge can feel cold in the bad weather. On talking through this problem with the manager it is hoped that the authority will replace the windows with robust double glazing. The home throughout appeared very clean and tidy. There was some concern over faint odours in old and worn carpets but according to the manager a plan has been drawn up for carpets that are to be replaced. The laundry was clean and tidy with red bags in use for dirty laundry. The home has increased the number of hours for domestic use to ensure care staff can concentrate on the care duties required. Care Homes for Older People Page 18 of 26 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. The numbers of staff available at night could be improved but staff are generally competent and skilled in their job role. They are encouraged to gain a qualification and are recruited correctly to ensure residents are cared appropriately. The management of the training programme could be improved to ensure all residents are in safe hands. Evidence: On the day of this inspection there were 37 residents living in the home. On duty was 1 manager, 1 care coordinator, 1 senior, 5 carers, 2 domestics and kitchen staff. No one appeared rushed, residents praised the staff on the care given when talking to us and by comments stated in the surveys. We are given a high standard of care. The rota was shown to us by the manager and it was noted that the home has only two waking staff through the night. The home is a well spread home with sometimes 2 staff helping with a resident away from other units in the building. The concern is that some residents, especially in the early morning period may not have their needs met as and when required. One resident did tell us that they have to wait some mornings to be helped as too many people need help at the same time. The manager also shared her concern of emergencies that occur through the night with only 2 night staff on duty not always able to help other residents while managing an emergency. The home has the majority of the staff with an NVQ qualification. The most recently Care Homes for Older People Page 19 of 26 Evidence: recruited staff have already achieved the qualification (noted on their job application) and staff spoken to said they are encouraged and supported throughout the process of gaining their NVQ. At present 4 staff are in the process of completing their NVQ 3 advanced level. Copies of certificates are held on the personnel file and were seen. The home has a robust procedure for recruitment that is carried out by the homes manager. The files looked at showed application form, references, CRB clearances and forms of identification. The training carried out by the home is a continuous process. Certificates seen and dates available for training showed the support and development needs of the staff are managed. The home does need to develop some form of training matrix to show when staff are due to be updated in their training. All the statutory courses are available but some staff were noted not to have completed all the necessary training such as moving and handling. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a person who is competent, has good leadership skills with people involved within the service benefiting from her ethos. The home is run safely and within the best interests of the residents. Evidence: The Manager has been at Somerley since 2006 and has many years of experience. She has the Registered Manager Award and an NVQ Health and Social Care level 4. The conversations with staff, residents and with us show a competent and open manager who listens and responds to the needs of the service. A copy of the annual quality checks carried out by the home were seen and the most recent regulation 26 visit that was carried out by a senior manager in Social Services was read and details written were noted to be accurate as the days inspection progressed. Residents spoken to said they are consulted with and do have an active part in the home. Staff also complete a quality questionnaire that was seen by us that Care Homes for Older People Page 21 of 26 Evidence: show they are actively involved and consulted. A newsletter was also seen that consults and informs residents of the life of the home. Staff are regularly supervised on a one to one session. Three staff were spoken to about these sessions and all reflected positively about the meetings and the value of attending them. Notes on three files of recent sessions were read and noted were the follow through of requests such as further training required. The home appears safe and the welfare of residents, staff and visitors is managed well. The accident records are held in the office and any action required is followed through. (This was discussed in full with a staff member that showed the procedure in the home is understood). A tour of the home and practices observed showed a team of staff who were aware of infection control by the methods used for dirty laundry and the correct use of protective clothing. The taps in two different bedrooms and one bathroom was hand checked and ran at a suitable and safe temperature. The staff spoken to all stated that they had completed a thorough induction (2 completed induction packs seen) and that the support and extra training, to ensure they are competent, is always available. As mentioned previously the programme/matix for the training of staff could be improved to ensure all staff are fully up to date with all areas ao statutory training. Care Homes for Older People Page 22 of 26 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 23 of 26 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 30 18 The staff must be trained appropriately for the work they are to perform. To ensure the skills are developed and staff are working with residents safely. 01/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The home need to establish a system for PRN medication that shows, if the person is prescribed a medication, that they are asked if they require it and a code is placed on the chart. If no stock is in the building and the medication is not required it should be removed from the chart. Creams and lotions applied in the bedroom must have current charts in place and old charts filed for safe record keeping. Consideration in the development of the service should be given to upgrading the toilets. The night staff support for emergencies or busier parts of the night/early morning could be improved to meet the needs of residents in a preferred timescale. Page 24 of 26 2 9 3 4 21 27 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 Care Homes for Older People Page 25 of 26 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. 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