Care Home: Stanholm Residential Care Home for the Elderly

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What the care home does well The home is friendly and welcoming. Residents are well cared for and supported. Staff and management are skilled and competent in older people`s care. Food at the home is of high quality, and residents are given several choices of what to eat. Residents are consulted about how the home is run, and feel valued and respected by staff. What has improved since the last inspection? Many parts of the home have benefited from redecoration and refurbishment. Residents have benefited from an increase in activities, entertainment and outings. Extra staff have been recruited to the domestic team. Staff have received key training updates and courses in adult protection and manual handling. 75% of the staff team have obtained NVQ qualifications. What the care home could do better: Residents would benefit from a more robust approach to pre admission assessment and to subseqent care planning and risk assessment. This will ensure all needs are assessed and recorded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stanholm Residential Care Home for the Elderly Mill Hill Edenbridge Kent TN8 5DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Montgomery     Date: 2 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Stanholm Residential Care Home for the Elderly Mill Hill Edenbridge Kent TN8 5DB 01732863748 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) : stanholm@uwclub.net Anexas Care Limited care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose priimary care needs on admisison to the home arewithin the following category : old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Stanholm is a care home for 22 older people located in the town of Edenbridge. Accommodation is on three floors and consists of four double rooms, fourteen single rooms, a lounge, dining room and separate quiet lounge. There is a secluded attractive garden. Access to the first and second floors is via a stair lift. Each bedroom has a hand basin a telephone point and call bell. A payphone is available and telephones can be installed in bedrooms. Ramps provide access to the garden and into the home; car parking is at the rear of the building. Local shops are in the town centre within a short walking distance. The railway station and bus stops are situated within a short distance of the home. Care Homes for Older People Page 4 of 29 Brief description of the care home Information about the service and weekly fees are available in a brochure that is given to prospective residents and their families and can be given verbally. Additional costs are for hairdressing, chiropody, reflexology, occupational therapy, newspapers, toiletries and other personal items at cost. 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 key unannounced inspection was conducted by Sarah Montgomery, Regulatory Inspector, who was in Stanholm Residential Home for the Elderly on 22nd May 2009 from 10am until 2.20pm. During the inspection we spoke with the registered manager, staff and residents, and inspected documents and records. The Commission received a completed Annual Quality Assurance Assessment from the registered manager, and received surveys from residents. Information from these documents was used to inform the inspection process. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Care Homes for Older People Page 6 of 29 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: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 9 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. Residents would benefit from a more robust assessment of their needs. Residents can be confident they will have an opportunity to visit the home, and will be given information about the home prior to admission. Evidence: Standards 3, 5 and 6 were assessed. To assess these standards we looked at pre admission assessment documentation. This was cross referenced with the homes statement of purpose and service user guide. We also looked at information the home had sent us in their annual quality assurance assessment, discussed pre assessment processes with the registered manager, and spoke with residents about their experiences of moving into the home. Care Homes for Older People Page 10 of 29 Evidence: Standard 6 does not apply as the home does not offer intermediate care. It does offer respite care, and we looked at how the home does this through inspection of assessments and care planning. Three pre admission assessments were assessed. The home conducts their own assessment prior to the service user being offered a place at the home. This assessment is undertaken by the home manager, and gathers information from the prospective service user and their representatives on health and social needs. The home ensures that prospective service users have a care management assessment. When making a decision regarding the appropriateness of the placement, the home manager will consider information gathered by the homes assessment, the care manager assessment, and any other relevant information from other professionals, for example district nurses and specialist doctors. We note from information in the homes annual quality assurance assessment (AQAA) that the home has made improvements to their pre admission assessment form in the last twelve months. The home manager has also told us in the AQAA that I intend to improve my assessment process in the next 12 months by keeping up to date with any recommended changes, and by sharing ideas and consulting with other professionals to ensure I am providing a thorough and comprehensive assessment. Our inspection of the pre admission assessments evidenced some shortfalls in the way in which information is gathered. For example, under the question any history of falls, is just written yes. More information is required to inform the mobility risk assessment. The space for writing information throughout the form is limiting. In the medical history section, only four lines are given for medical history, current health problems, oral health and foot care. The space allows for brief notes. All health concerns or needs must be written in detail to enable accurate decision making regarding the appropriateness of the placement, and accurate care planning and risk assessment. We spoke with several residents about their experiences of moving into the home. All residents spoken with described a process which they found helpful and informative, with the home manager visiting them in hospital or at home, and providing them with information about Stanholm. One resident told us I came straight from hospital and settled in straight away. Some residents told us it was not possible to visit the home prior to admission due to being in hospital, but that arrangements had been made for their relatives to visit, and the home manager made sure they and their relatives had as much information about the home as possible. Care Homes for Older People Page 11 of 29 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. Service users would benefit if their assessed support needs and identified risks included more detailed compreshesive information. Evidence: Standards 7, 8, 9 and 10 were assessed. To assess these standards we looked at care plans, risk assessments, inspected documents and records which told us how the home meets individual health care needs, including medication, and spoke with staff and service users about how the home ensures people are treated with respect and dignity. We also looked at the homes annual quality assurance assessment, and at questionnaires the service users had returned to the Commission. Four care plans were assessed. Information from these care plans were cross referenced with information gathered during pre assessment, and with daily notes. Information read on care plans demonstrated that information gathered at the pre assessment stage regarding support needs had been tranferred onto care plans. Care Homes for Older People Page 13 of 29 Evidence: However, the care plans do not contain sufficient information for staff about how they support individual service users. An example of this is a care plan which stated staff need to encourage fluids. The care plan is not supported by guidance for staff regarding how to encourage fluids, nor is it supported by a fluid chart. The assessment information on this individual suggested a high risk of dehydration due to the service user not being keen on drinking. At present, the home has no formal system to know whether the care plan is being met. Daily notes for this service user do not record any information regarding fluid intake. We spoke with the home manager about care planning, in particular, discussing the need for the care plans to contain more detail about how staff support service users. The manager spoke to us about how service users are cared for, and described how staff support service users with their assessed needs. It was clear from conversation with the manager that the staff team have in depth knowledge of service users individual needs. This knowledge needs to be transferred onto care plans to ensure consistency of care, and to ensure the home has records which can demonstrate they are meeting the needs of residents. Inspection of risk assessments evidenced the home has considered risk factors in all areas of assessed need. Risk assessments describe the risk, and give information about prevention or reduction of risk. We spoke with the home manager about providing additional guidance for staff in some areas of risk assessment. For example; written guidance on recognising pressure areas, and guidance on ensuring nutritional needs are met (including fluid charts). The manager accepted that some staff would benefit from this further knowledge, and stated on the AQAA that More training could be provided on pressure sores and nutrition. Policies and protocols for medication were assessed. Inspection of Medication administration Records evidence that the home is appropriatley recording adminstration of medicines. The medication routine was described to us. This demonstrated medication was being appropriately administered to residents. The medication is kept in a secure cabinet which is secured to the wall. Controlled drugs are stored in a metal safe which is secured to the wall. Inspection of the controlled drugs register evidened some shortfalls in recording balances. We were assured this would be rectified, and that staff would be made aware of the need to fill in all columns in the controlled drugs register. At present, the medication folder did not contain photographs of the service user in individual sections. The home manager told us she was not aware of the need for photographs, and would ensure that photographs of residents are inserted into their Care Homes for Older People Page 14 of 29 Evidence: sections of the medication file. Health care plans inspected did not contain person centred plans about service users wishes and preferences. The home needs to consult with individual service users about how they like their support to be given. Some drugs (eye drops) are kept in a fridge in the residents dining room. The fridge is used to store cold drinks. The drugs are stored in a locked metal cabinet in the fridge. The home do not record temperatures for this fridge. We have sought advice from our pharmacy inspector who tells us that temperatures must be recorded. These temperatures must be between 2 and 8 degrees celcius. The pharmacist further recommends that this fridge is not kept in a communal area, and that the home put a risk assessment in place regarding safety of medicines in an unlocked fridge. We spoke with service users and asked about how their privacy and dignity was upheld. Without exception, all service users told us they were happy at the home, and felt they were treated with respect. Comments from service user questionnaires included; I am very happy at Stanholm. The staff are very helpful, happy and pleasant. In fact, one big happy family. Another said; I am very happy with my care. 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. Service users can be confident they will be supported and encouraged to enjoy a lifestyle of their choosing, and will be offered a range of activities to participate in. Evidence: Standards 12, 13, and 15 were assessed. To assess these standards we looked at records which told us about the daily routines in the home, and about how service users are supported to make decisions regarding their daily lives. These included planned activity records, daily individual notes, and care plans. We also looked at how the home meets service users nutritional needs by looking at menus and speaking to service users. In addition, we looked at the homes annual quality assurance assessment, and looked at information supplied by residents to the Commission in service user surveys. Fifteen service user surveys were returned to the Commission. In these surveys residents told us they were very happy with the support they receive with regard to their daily lives. They particularly praised the support received from staff, and also told us the food is very good at all times. During the inspection we spoke with a number of residents. They told us there were a range of activities, and they were given choices Care Homes for Older People Page 16 of 29 Evidence: about what to do in the day. They added that if they did not want to join in, that was fine. Records viewed during the inspection demonstrated the homes commitment to providing meaningful day time activities. These included board and card games, gentle movement and music, and visiting musical performers. The home have also organised tea parties and day trips out. Family and friends are made welcome at the home. There is an open door policy, and visits can take place at anytime. Residents and their families can choose to sit in the lounges, or in residents private rooms. We observed lunch. Residents had two options for the main course, and three options for desert. Desert always includes cheese and biscuits and fresh fruit salad. Residents are given the option of a glass of sherry following lunch. All meals are freshly prepared, and are nutritionally balanced. Special diets are catered for. Meal presentation is attractive and appealing. All residents spoken with told us that the food was wonderful. 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. Service users can be confident they will be listened to, and any concerns will be appropriately dealt with. Evidence: Standards 16 and 18 were assessed. To assess these standards we looked at the homes complaints policy and adult protection protocols. We spoke with residents about how they make a complaint, and spoke with staff about their understanding of their responsibilities regarding protecting residents from harm and abuse. We also looked at information the home had sent us in their annual quality assurance assessment, and looked at information residents sent us in service user surveys. On the day of inspection the staff team were undergoing adult protection training. We spoke with the manager regarding her role and responsibilities in ensuring residents are protected from abuse. The manager demonstrated knowledge and competence in this area, and has a good understanding of the protocols to follow should it be necessary. Responses in resident questionnaires told us they are confident about how to complain and who to complaint to. They told us never had to make a complaint, but know who to see, and the manager comes in to see me every day to make sure I am alright. Care Homes for Older People Page 18 of 29 Evidence: Residents spoken with during the inspection echoed those comments. They told us they were aware of their right to complain, but added it had never been necessary. They described the manager and staff as approachable, and as good listeners, and would feel comfortable discussing any concerns or complaints should the need arise. 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. Service users benefit from living in a homely, clean and comfortable environment. Evidence: Standards 19, 24 and 26 were inspected. To assess these standards we looked at communal areas of the home and some bedrooms. We looked at protocols and systems the home adopts to ensure the home is kept clean and hygenic. We also looked at information contained in the homes annual quality assurance assessment. Stanholm is a spacious home, and residents benefit from having a range of communal areas. These include a conservatory, a large lounge, a smaller quiet lounge and a dining room. Inspection of these areas demonstrated that care had been taken to ensure residents had a homely, safe and comfortable environment. Two bedrooms were inspected. They had clearly been personalised by the residents, and were comfortable and pleasant rooms. We could see that equipment needed to ensure the comfort and safety of residents had been provided. Inspection of the garden area evidenced some hazzards. Paving is uneven and presents a possible trip hazzard. A gate leading down to steep concrete steps for the basement was left open. Information in the homes annual quality assurance Care Homes for Older People Page 20 of 29 Evidence: assessment tells us that they recognise improvements are needed in the garden. The manager told us that building work for an extension to the lounge and dining area was due to begin. This will involve a redesign of the garden, which will ensure a safe garden area for all residents. All parts of the home are clean and hygenic. The home employs two domestic staff members, and all staff members have benefitted from infection control training. 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. Residents would benefit from the home adopting a more robust recruitment process. Residents benefit from being supported by staff who are well trained and supervised. Evidence: Standards 27, 28, 29 and 30 were assessed. To assess these standards we looked at records which told us about staff skills and staff numbers. This included information about training and staff rotas. We also looked at staff recruitment records. This told us whether staff were being recruited appropriately, and whether information regarding the staff members suitability for the post was obtained. This information included references and police checks (criminal records bureau). Staff were observed working with residents in a professional, caring and friendly manner. Conversations with residents during inspection, and information taken from resident questionnaires evidenced that residents have trust and confidence in the staff that care for them. Examples of comments made to us are the staff at Stanholm are all first class and always ready to help, and, staff are all very kind and helpful. Training records viewed evidenced staff are receiving the necessary training in order to carry out their jobs. On the day of inspection the staff team were undergoing Care Homes for Older People Page 22 of 29 Evidence: safeguarding training. 75 of the staff team have an NVQ qualification. The rota evidenced that 4 members of staff are on duty for each shift. They are supported by the manager, deputy manager, one cook and two domestic staff. Staff told us they have regular supervision and appraisal, and feel supported and valued by the manager. We looked at five staff files. The annual quality assurance assessment tells us that all employment checks prior to commencement of work are undertaken. The files we inspected did not have evidence that POVA first checks had been made. Proof of identification was also absent. Although references are in place, the homes recruitment process would be more robust if at least one reference was obtained from a professional source, for example a college or school tutor or a previous employer. 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. Residents benefit from living in a home in which the manager is knowledgable, competent and skilled in the care of older people. Residents would benefit if the pre assessment process and health care planning were more robust. Evidence: Standards 31, 32, 33, and 38 were assessed. To assess these standards we looked at information which tells us how the home is run. This includes the qualifications and experience of the registered manager, the ethos and management approach of the home, records which demonstrate the home monitors how it is run, and documents which evidence the health, safety and welfare of service users are promoted and protected. In addition, we spoke with the registered manager, and with residents and staff, and looked at information the home gave us in their annual quality assurance assessment. Care Homes for Older People Page 24 of 29 Evidence: The registered manager has several years management experience in residential settings for older people, and has the necessary management qualifications. Throughout the inspection, and in the annual quality assurance assessment, she demonstrated knowledge, skills and competence in the care of older people. Residents and relatives spoke highly of the manager and owner, both in questionnaires and when speaking with them during the inspection. They told us; this place is a credit to those who own and run it in a first class way. Staff were equally happy with the manager and management style of the home, telling us the manager is approachable and the home is a good place to work. Staff turnover is very low. Records seen demonstrated the manager is committed to ensuring staff are trained in key areas of moving and handling, first aid, infection control and adult protection. Staff spoken with displayed competence in these areas. Quality assurance systems at the home are in place, and there are formal practices in place to gain the views of service users, their families, and stakeholders in the community. The manager has ensured there are systems, policies and protocols in the home which ensure the health, safety and welfare of service users. These include appropriate staff training, safety of equipment, and appropriate reporting and recording of accidents. It was clear from the annual quality assurance assessment that the manager has insight into some of the shortfalls identified in our inspection. As noted in outcome area one, the registered manager stated in the aqaa I intend to improve my assessment process in the next 12 months by keeping up to date with any recommended changes, and by sharing ideas and consulting with other professionals to ensure I am providing a thorough and comprehensive assessment. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 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 13 Regulation 13(4)(c) The registered person shall ensure that (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person must ensure that risk assessments contain more detail regarding the management of identified risk. 31/08/2009 2 7 15 Regulation 15(1) 31/08/2009 Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. The registered person must Care Homes for Older People Page 27 of 29 ensure that care plans include more detail of support needs and subsequent guidance and recording tools for staff (ie; nutrition charts). 3 9 13 Regulation 13(2). The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must ensure that all columns on the controlled drugs register are filled in when drugs are administered. 31/08/2009 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 3 It is recommended that pre admission assessments record more detailed information about individuals assessed needs. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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