Care Home: St Peters Grange

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What the care home does well Pre admission assessments are carried out on all prospective residents to ensure that the home is able to meet their needs, and where possible other external professional views and assessments are obtained. Care planning shows a person centred approach to the care to be provided to residents, and there is clear evidence that residents choices, likes and dislikes are part of their daily living routine in the home. Care plans are reviewed to reflect any changes in residents care needs, with any changes being recorded so that staff are able to adjust the level of care for the residents. Residents are able to make choices in regards to daily living routines and the activities they wish to participate in. The procedures for complaints and the protection of residents is good ensuring that residents are listened to and that any issues causing concern are investigated and acted upon without delay. The home is undergoing refurbishment work at the present time to ensure the standard of the environment is positive for the residents and that they live in a pleasant, comfortable and hygienic home. Staffing levels at the time of inspection were good and this was backed up by residents comments on the kindness and availability of staff at all times. Staff qualifications and training are ongoing, to ensure that residents receive care from an experienced, skilled and competent workforce. The registered manager, Jill Weeks and deputy manager work hard to ensure that residents are well cared for and that their needs, choices, likes and dislikes, personal, health, and social care are well met. Generally health and safety in the home is good, and all appropriate risk assessments, and checks are carried out and recorded on a regular basis. What has improved since the last inspection? All residents receive contracts and statements of terms and conditions when they take up residence in the home, where possible the registered manager ensures that residents sign their contract, and copies are then given to the residents and or their relatives or representatives. Emergency admissions to the home are avoided where possible, most residents come into the home in the first place for respite care. The registered manager ensures that all respite care residents have a pre admission assessment to ascertain that the home can meet their needs. Since the last key inspection in 2007 the home has changed pharmacy supplier. The present pharmacy has supplied the home with a medication trolley, this assists in the transporting of medication around the home and ensures that medication is kept securely. What the care home could do better: A requirement has been made with this report that the garden area of the home must be made safe where there is a drop between the building and lawn area down to basement level. Some work still needs to done to ensure that mid cycle and respite residents medication is reccorded onto the medication administration records appropriately and that liquid medication and eye drops are dated on the day of opening. The staff application form needs to be revised so that it requests a full employment history and written reasons for gaps in employment. Key inspection report Care homes for older people Name: Address: St Peters Grange 24 Upper Maze Hill St Leonards-on-sea East Sussex TN38 0LA     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: June Davies     Date: 1 7 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Peters Grange 24 Upper Maze Hill St Leonards-on-sea East Sussex TN38 0LA 01424423427 01424434678 stpetersgrange@beeb.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Anytime Ltd Name of registered manager (if applicable) Mrs Jill Weeks Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 44. The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP) Physical disability (PD). Date of last inspection Brief description of the care home St Peters Grange is a large Victorian building in a residential area of St Leonards-onSea approximately half a mile from the seafront and town centre. The home is close to local transport links. The home is located on three floors of the building with a passenger lift to all floors. The fabric of the home is bright and welcoming to visitors, substantial work has been carried out on the environment of the home over the last 5 Care Homes for Older People Page 4 of 27 Over 65 44 0 0 44 Brief description of the care home years and continues. This work has involved the installation of a more effective larger passenger lift. The home has secluded and well maintained gardens, which are used by residents. The garden represents a pleasant view for rear facing bedrooms. The home does not currently have its own vehicle although it loans a mini-bus for monthly summer outings. The home is registered to provide care for up to 44 people, up to 15 of which can have physical disability, and offers a limited number of respite places based on assessment. The home is currently not exceeding 34 people in number. The current fees charged can be obtained from the Registered Manager of St Peters Grange, fees do not include chiropody, toiletries, news paper and magazines, therapeutic therapy, and other luxury items. The latest Inspection report is sent out to any enquirer who expresses an interest in the home. A copy of the report is kept on display in the reception area of the home with copy obtainable via the manager. In March 2006 St Peters Grange moved in to the ownership of a company called Care Anytime after a successful registration process with the Commission. Care Anytime run by Mr Amin and V. Patel successfully owns and manages two other care homes, Nursing and learning disability services respectively, within the South East. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on Wednesday 17th June 2009. During the inspection the inspector spoke with the Registered Manager, Jill Weeks, the deputy manager, seven members of staff and nine residents. Documentation relating to the key standards inspected was looked at, the views of residents were sought, medication was checked on, and observations made in respect of the premises and garden. All residents were positive in regard to the standard of care they received and the choices they were able to make. Staff showed a positive attitude towards team work, their training and the general standard of care in the home. The quality of care for people using this service is Good. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? All residents receive contracts and statements of terms and conditions when they take up residence in the home, where possible the registered manager ensures that residents sign their contract, and copies are then given to the residents and or their relatives or representatives. Emergency admissions to the home are avoided where possible, most residents come into the home in the first place for respite care. The registered manager ensures that all respite care residents have a pre admission assessment to ascertain that the home can meet their needs. Since the last key inspection in 2007 the home has changed pharmacy supplier. The present pharmacy has supplied the home with a medication trolley, this assists in the transporting of medication around the home and ensures that medication is kept Care Homes for Older People Page 7 of 27 securely. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident is aware of their role and responsibilites in the home. Residents move into the home knowing that their needs can be met and that their independence will be maximised and promoted. Evidence: All residents have a pre-admission assessment carried out by the registered manager or her deputy manager. Plans of care or hospital assessments are obtained were appropriate. The registered manager ensures that a full assessments is carried out to ensure the home can meet residents needs, and that staff have the training and knowledge and skills to meet these needs. All residents, their relatives or representatives are invited to visit the home so they are able to make an informed decision in regard to long term care, this also gives them the opportunity to meet with other residents and staff. Care Homes for Older People Page 10 of 27 Evidence: All residents are given a contract and statement of terms and conditions once they have moved into the home, these documents are retained in the back of residents care plan folders. The home does not offer intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is clear and consistent and provide staff with the information they need to meet individual needs. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for medication administration are generally good but small improvements needs to be made to ensure residents are not placed at risk. Personal support in the home is offered in such as way as to prom9te and protect residents privacy, dignity and indpendence. Evidence: Care plans are initially based on residents pre admission assessment, but are expanded upon once the resident has come to live in the home. There was evidence that residents, relatives or representatives are involved in the care planning process. Care plans gave detailed information regarding the residents daily living preferences, Care Homes for Older People Page 12 of 27 Evidence: their likes and dislikes as well as social interests. Risk assessments are in place according to each individual residents physical, mental capacity and social interests. Each care plan and risk assessments are reviewed monthly. Good evidence was available to show that residents health care needs are met, and that visits to and from health care professionals are recorded in the care plan. Personal hygiene care is recorded, but there was little evidence to show that dental and oral care is carried out. The inspector had conversation with six residents, all said how happy they were with the care that they receive in the home. Residents spoke highly of the staff team and how their needs are being met. Medication policies and procedures are in place and were reviewed in January 2009. Generally the administration of medication in the home is well managed, with all medication administration sheet initialled for each administration. Due to a mediation error last year, two staff at all times carry out administration of medication, and sign a daily sheet to state which shift they have been responsible for administering medication. It was noted however that when medication is brought into the home mid cycle, or a respite resident moves into the home, while medication is hand written onto a mediation administration record, it does not always state the quanity of medication received, the date it was received or who has checked the medication in. Eye drops and liquid medication is not dated on bottle on the day of opening. Staff said that they had received medication training and due to a change in pharmacy a training day is being organised within the next week. The training matrix showed that on each shift there are staff who have been medication trained. Throughout the inspection staff were observed talking to residents in a kindly and professional manner and observing the resident rights to have the privacy and dignity upheld. One residents said, Staff always treat me with respect, they are so kind. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make choices in regard to their daily living routines, and the variety of activities available to them. Staff support residents in maintaining choice and control over their lives. Dietary needs of residents are well catered for with a balanvced and varied selection of food available that meet residents tastes and choices. Evidence: Care plans and residents themselves indicated that they are able to make choices in regard to daily living routines. The home has a dedicated day centre that residents are able to visit as and when they wish to. The residents said that they enjoy going to the day centre, but wished that people from the community would use it. The day centre offers residents a variety of acctivities on a daily basis. The local Church of England Church is opposite the home, and residents who wish to attend for services are supported by staff to do so. One resident in the home is visited by a lay preacher on a regular basis. Residents spoke to the inspector about a recent trip to Sea Life in Hastings and said how much they enjoyed it. Care Homes for Older People Page 14 of 27 Evidence: Visitors are made welcome in the home at any time and this was supported by the residents during conversation. Two residents have chosen to manage their own financial affairs and receive minimal support from the registered manager and her deputy manager to do so. Residents said that they are able to bring small personal items into the home from their own homes so that they can personalise their bedrooms. Meals in the home offer residents a choice and variety of nutritious and appealing meals. This includes a cooked breakfast if required, lunch and supper, with drinks and snacks being offered throughout the day. The cook is able to cater for specialised diets as and when required, but at the present time only caters for diabetic diets. The inspector joined residents for a lunch time meal, and observed the member of staff on duty offering assistance in a discreet and sensitive manner. Residents told the inspector that meals in the home are very good, that they are able to make choices as to what they would like to eat and their likes and dislikes are also observed. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know their complaints will be listened to and acted on. Staff have a good knowledge and understanding of Safeguarding Vulnerable Adults protection issues this helps to protect residents from abuse. Evidence: The complaints policy and procedure is up to date and reflects the name change of the Commission. This policy is displayed in the main entrance to the home. Residents said that should they need to make a complaint they would speak with the registered manager or her deputy. There is evidence in the complaints file of one complaint being made in the last twelve months, this was appropriately recorded, investigated and timely response was made to the complainant. Staff are also aware that if a resident or visitor wishes to make a complaint this will be referred directly to the registered manager or her deputy. The home has up to date policies and procedures in place for Safeguarding Vulnerable Adults, this includes the Sussex Multi Agency Policy and Procedure for Safeguarding Vulnerable Adults. At the present time thirteen staff have received Safeguarding Vulnerable Adult training, and further courses have been booked for 3rd July 2009 and 3rd August 2009, this will ensure that all staff have then received training. There is evidence on staff personnel files that appropriate checks are carried out prior to staff being deployed to work in the home, and this will be reported on further under the Care Homes for Older People Page 16 of 27 Evidence: staffing section of this report. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On going investment in the home provides residents with an attractive and homely place to live. The standard of cleanliness within the home helps to keep the risk of cross infection to a minimum. Evidence: St Peters Grange offers its residents a comfortable clean homely place to live. All communal rooms are of a good size and are decorated and furnished in a domestic style. The residents spoken to said how much they liked the home, and the standard of hygiene and cleanliness in the home. All bedrooms have en suite facilities. There is a dedicated part of the home that is used for respite care throughout the year and the bedrooms are well furnished and bright and airy. There has been extensive refurbishment work taking place on the second and third floor of the home, this is now coming to a end, with just some minor works to complete. The gardens of the home are accessed via two ramps, one from the dedicated day centre and another from an external door at the rear of the home. The gardens were seen to be well tended, with lawns, flower beds, trees and shrubs. However it was noted that from the lawn there is a drop of approximately 12 feet down to a concreted area in the basement of the home, and a requirement is being made that some type Care Homes for Older People Page 18 of 27 Evidence: of safety fencing is placed along this area to ensure the safety of residents using the garden. The home has cleaning routines to ensure that at all times there is a good standard of hygiene and cleanliness. Visitors are requested to use alcohol rub when entering the home, all communal toilets are provided with liquid soap and paper hand towels. This all helps to prevent risk of cross infection to the residents. The laundry room is clean and tidy and provided with the appropriate equipment to ensure that foul linen is put through a disinfection process. There are no offensive odours in the home. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Recruitment policies are consistently followed but further improvements will help to protect residents from abuse. Staff are multi skilled ensuring good quality care and support. The arrangements for induction of staff are good with the staff demonstrating a clear understanding of their roles. Evidence: At the time of this inspection the home is adequately staffed. Residents praised staff for the work they do, and say that all their needs are met. Residents were able to confirm that there is always a member of staff available if they need them. Several staff do have a NVQ level 2 or above qualification and there are four staff who are in the process of completing their NVQ qualification. Recruitment procedures are followed, but there is concern that the application form does not at present request a full employment history, or written explanation for any Care Homes for Older People Page 20 of 27 Evidence: gaps in employment. The manager assured the inspector that this would be mentioned to higher management and that she is confident that this will be put right. All staff are appropriately vetted prior to taking up employment in the home, this helps to reduce the risk of abuse to residents. There was evidence on the staff training matrix and from staff themselves that staff have access to many other work related training courses, to ensure that they is a good skill mix of staff in the home. Residents praised the professionalism and skills of the care staff in meeting their needs. From discussion with staff and viewing the training matrix there is evidence that many of the staff have completed their mandatory training with evidence of further mandatory training courses being booked to ensure that all staff have received this training. New staff complete their initial induction and are then expected to undertake the Skills for Care common induction standards within the first twelve weeks of their employment. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well managed and the registered manager is aware of the improvements that need to be made. The quality assurance system is still being developed to ensure that residents receive the best quality of care. Health and safety is given high priority in the home to ensure that residents and staff live and work in a safe environment. Evidence: The registered manager Jill Weeks has obtained her NVQ level 4 and Registered Managers Award, she continuously updates her skills and knowledge by attending relevant training courses. Evidence was avaialbe that both the registered manager and deputy manager are attending Mental Capacity Act and Deprivation of Liberty training in the near future. Both residents and staff were full of praise for the registered manager and her deputy, saying that one of them was always available if needed. Care Homes for Older People Page 22 of 27 Evidence: The quality assurance system in the home is still being developed. Evidence was available that the views of residents and relatives are sought on a regular basis. Comments on questionnaires were all positive about the standard of care and support, the quality of meals, and cleanliness of the home. The Area Manager, Richard Vendavles carries out Regulation 26 visits to the home each month, and all systems used in the home are monitored during this visit, and a report is written on each monitoring visit. Fire, Health and Safety risk assessments cover the whole home and have been carried out recently. The manager still needs to develop a stakeholder questionnaire, and to publish a copy of the quality assurance findings each year, as part of the homes development plan. This will ensure that residents continue to receive a high quality standard of care throughout. Where residents request the manager to look after personal allowances this is carried out appropriately with seperate records being kept for each resident for monies coming in and going out. Residents money and personal allowance records are kept securely in the home. Stringet checks are carried out on all issues of health and safety in the home and recorded, these include fire point checks, emergency lighting checks, hot water delivery checks. Up to date maintenance certificates are available for all appliances used in the home. The home is secure and night staff have to carry out a night security check. Health and safety policies and procedures are reviewed regularly and easily accessible to staff working in the home. A record is kept of all accidents that occur, and these are reported to the relevant authorities. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered person shall 19/08/2009 having regard to the number and needs of the service users ensure that: external grounds which are suitable for, and safe for use by service users are provided and appropriately maintained. Residents must be able to access garden areas that are safe and do no put them at risk. 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 All medication must be recorded onto the medication administration record properly and eye drops and liquid medications should be dated on the bottle on the day of opening to save possibly placing residents at risk The staff application form should require a full employment history and written explanation of any gaps in employment 2 29 Care Homes for Older People Page 25 of 27 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 3 33 The manager to continue to develop the quality assurance system in the home. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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