Care Home: Terravis Park

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What the care home does well Good systems are in place to make sure that peoples` needs are fully assessed before they move into the home. This ensures that people can be confident their needs will be met and the staff can be sure that they are prepared for the admission. People using the service receive good care that is organised to suit their individual needs. Staff have appropriate training to meet the needs of the people at Terravis Park. Good information is kept about peoples` care needs, assessments are carried out and these are detailed and person centred and this ensures that they get consistent care. Care plans are updated to reflect any changes to peoples` care needs. Social activities are organised and planned to suit the needs of the people using the service. The people using the service enjoy the varied programme of events. The food is well cooked and the menu provides a varied, wholesome and healthy diet. Residents were complimentary about the food being served. Terravis Park provides welcoming and homely accommodation that suits the needs of the people living there. It is located in a pleasant area with attractive gardens. Sufficient numbers of staff are employed and they have good training opportunities to make sure that they can meet the needs of the people staying at the home. Recruitment practices and procedures are clear and protect people using the service What has improved since the last inspection? Care plans have improved significantly since the last inspection and the requirement has been met. Accident recording is now clear, detailed and records are completed for each incident. Regulation 37 notifications of any event affecting the welfare of a resident are now completed and sent to CQC as necessary. What the care home could do better: Hand written entries in medicines records should be signed by two staff to check the correct entry has been made. Copies of all prescriptions should be kept by the home so that staff are able to check all medicines against these. Although it is acknowledged that the food is good the home should review practice at breakfast to ensure that people are afforded appropriate choices. Infection control training must be provided for all staff. The quality assurance system should be developed further to make sure that there is clear information about the quality of the service being provided. This process should include regular audits to minimise the spread of infection and a system for auditing medicines. Key inspection report Care homes for older people Name: Address: Terravis Park Choppington Road Morpeth Northumberland NE61 6NX     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: Anne UrwinBrown     Date: 2 2 0 4 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Terravis Park Choppington Road Morpeth Northumberland NE61 6NX 01670519773 F/P01670519773 noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kay Care Services Limited Name of registered manager (if applicable) Ms Edna Eagleton Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Two service users may be between 60-65 years of age. Date of last inspection Brief description of the care home Terravis Park was purpose built in the grounds of a family home in 1989. The home has been extended and now includes the existing house and can provide personal care and accommodation for up to 42 older people, 6 of whom have a dementia. Situated in a rural setting approximately two miles from Morpeth town centre, the home has a large car park at the front and well-tended landscaped gardens. A bus service to commercial and retail centres is available from outside of the home. The home is built over 2 floors serviced by 2 passenger lifts. There are 40 bedrooms. All but 1 of the bedrooms contain en-suite toilet and washing facilities. Fees range from £449 to £454 per week. Information about the home and inspection reports are available in the Care Homes for Older People Page 4 of 26 Over 65 6 36 0 0 1 3 1 1 2 0 0 9 Brief description of the care home 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: The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out Before the visit: We looked at: Information we have received since the last visit. How the service dealt with any complaints & concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service & their relatives, staff & other professionals. Care Homes for Older People Page 6 of 26 The Visit: An unannounced visit was made on 22 April, 2010 by two inspectors. The visit lasted a total of eight hours. During the visit we: Talked with people who use the service, staff, the manager and provider. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the provider and the manager what we found. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Hand written entries in medicines records should be signed by two staff to check the correct entry has been made. Copies of all prescriptions should be kept by the home so that staff are able to check all medicines against these. Although it is acknowledged that the food is good the home should review practice at breakfast to ensure that people are afforded appropriate choices. Infection control training must be provided for all staff. The quality assurance system should be developed further to make sure that there is clear information about the quality of the service being provided. This process should include regular audits to minimise the spread of infection and a system for auditing Care Homes for Older People Page 8 of 26 medicines. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Before people come to live at Terravis Park they have enough information about the service offered and their needs are assessed to ensure that these can be met. Evidence: Before each person moves into the home a comprehensive pre-admission assessment is completed to ensure that staff are able to meet their needs. Information from the assessment and from relatives and/or care management plans is also used to prepare an individual plan outlining each persons care needs. The records seen at this inspection showed that a resident who had returned from hospital had their needs fully re-asessed to ensure that staff were aware of any changes. Intermediate care is not provided at Terravis Park. 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. Peoples health and personal care needs are identified and met. Medication practices are safe. Evidence: All the people living in the home have a personal plan in place that outlines their care and how these are met. Plans are developed to suit peoples individual needs from the pre-admission assessment and other information collected as their placement proceeds. The plan shows that personal support is responsive to the varied and individual needs and preferences and good information was available in individual plans about how needs are met by staff. Plans had improved since the last random inspection and there was evidence that care plans were reviewed following hospital admissions and when needs had changed. People living in the home said they are consulted about their plans and in some cases have signed to indicate they are happy with them. Assessment tools are used to identify changes in peoples needs and there was evidence in individual plans that these were updated to reflect any changes. Other Care Homes for Older People Page 12 of 26 Evidence: healthcare information is well recorded and evidence was available that good systems are in place to ensure that healthcare needs are well met. Risk assessments were in place and these were up to date and also had changed following a hospital admission. During the inspection it was noted that there was a degree of familiarity and physical contact that could be misunderstood or viewed as inappropriate. A staff member was seen approaching a resident from behind and clasping him round the waist in a hug. This was of particular concern as the person concerned had a history of inappropriate behaviour towards staff and was likely to give mixed messages around acceptable behaviour. Another incident was of a member of staff stroking/patting a residents hair while talking to them. It is acknowledged that care staff and residents can form close relationships, however it is important that peoples privacy and dignity is respected. Two people said that they were well cared for and that the staff were kind. The medicines policy supports good procedures and practice. Medicines records are generally well completed and contain required entries. There is a process in place for staff to arrange for presciptions to be requested from individual residents general practitioners and then the pharmacist collects these to be dispensed. The home does not keep a copy of each prescription or record the contents of the presciption and this means they are unable to audit or track the received medications against the original prescription. It was noted that hand written entries had not always been signed by two staff. It was not evident that a management system was in place to audit medication administration. Staff training has been provided for all staff responsible for administering medicines. Arrangements for the storage of medicines are satisfactory. 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. People are able to make choices about their routines, activities and lifestyle, however this could be developed further. Evidence: There is evidence that the staff in the home involve individuals in making choices when care is being planned. This means that people are supported to make simple, but important decisions such as the time they get up, where they spend their time and whether they take part in social activities. There are opportunities provided for people to take part in planned activities that meet the social needs of all of the residents. At present there is not an activities organiser, but the manager said one had been appointed. However there was evidence that people can participate in art work and musical events. During the visit there was a visiting entertainer who was much enjoyed by the residents and a celebration of St Georges Day was planned for the evening. An example of residents comments was There is always something going on. Good information about peoples social care needs is recorded in care plans to show residents preferences about activities and routines. There is a record kept of those Care Homes for Older People Page 14 of 26 Evidence: attending group activities and of any individual work going on. Information about activities is made available on the notice board and from staff on a daily basis. One person said I can choose to attend activities if I want to, but sometimes I dont go. At breakfast time none of the tables were set or had tablecloths on. People were given cereal, porridge or cooked breakfast and there was a selection of hot and cold drinks available. However all of those people who chose to have toast were served with a slice of toast which was buttered (with Stork margarine) and had lemon curd on a plate. The stork margarine carton was full of crumbs. There was no evidence of choice being offered to either the margarine or lemon curd. People did not have the opportunity to butter their own toast, pour their own tea/coffee and therefore retain their independence. At lunchtime the food was well presented, tables were well set, with cutlery suited to individual needs. Alternatives were available and portion sizes varied according to preferences. All the residents were complementary about the food and appeared to enjoy it. All kitchen staff have undertaken appropriate Food Handling training. Drinks are provided regularly through the day and there is a varied selection offered. A returned survey suggested that more frequent drinks could be offered and although this was not evident during this inspection this could be looked at as part of the quality assurance system. The bedrooms are sited on the ground and first floor. Residents are encouraged to personalise their rooms according to their own taste and to bring in items of furniture or ornaments. Residents said they were happy with their rooms and that they had a lot their own personal items around them. Residents have visitors at any time and are able to use their own rooms, or the lounges to see them. One relative said that they are welcomed into the home. Residents said they were happy with the arrangements for visitors. 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. People are protected by the homes good systems for dealing with complaints and allegations. Evidence: There is a written complaints procedure that outlines the route for making a complaint and the action that is taken by the organisation in dealing with complaints. There is a system for recording complaints, however no complaints were recorded since the last key inspection. One complaint was referred directly to the provider by the Care Quality Commission and the report from this is kept at the providers office. This was not examined. There are written procedures for dealing with safeguarding matters. One safeguarding referral to the local authority has been made since the last inspection. The provider co-operated in the investigation, and while this was not upheld the provider has taken steps to address issues arising from it. The manager said that all staff have completed safeguarding training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable, and pleasant environment for service users to live. However the systems for auditing the standards of infection control and cleaning arrangements are not adequate. Evidence: Terravis Park is a converted building with an extension to suit its current purpose. It is set in pleasant, attractive garden on the outskirts of Morpeth in a mainly residential area. It is a two storey building with a shaft lift fitted for ease of access to the first floor. The public areas are mainly on the ground floor, although there is a lounge dining area on the first floor, which is rarely used. The home is generally clean and well decorated. At the start of the inspection there was an unpleasant odour in the main hallway, however this was resolved when pointed out to staff. The building is designed to suit the needs of the people living there and provides comfortable accommodation. It is light and spacious with rooms of an appropriate size. The lounges and dining room are well designed with large open windows making the best of the views to the gardens. Residents said that they are comfortable and happy with the quality of the accommodation provided. One person said that she finds her room very comfortable and all the facilities are available that she needs. He said I am happy with my room Care Homes for Older People Page 17 of 26 Evidence: and I have everything I need. I like living here. Maintenance records are kept to show that prompt action is taken to address any repairs. There is an ongoing programme of redecoration and refurbishment. Four extra rooms have been added with en-suite accommodation. During the inspection it was noted that two bathrooms and one shower room had not been adequately cleaned. In bathroom 2 the bath seat was encrusted with dirt and debris. The bath seat strap was dirty and had not been cleaned for some time. The side of the bath was damaged and there was damage to the hoist making it not possible to maintain good infection control standards. The bathroom cupboards were being used to store items that should not have been left there for example a used commode pot and clean continence pads. Pipes were dusty, the waste bin was rusty, had no lid, the soap dispenser was empty and dirty. There was no light shade, the radiator guard was stained and the trolley for laundry was dirty. The alarm pull cords were dirty and tied up out of reach and the bath was dusty. These poor standards were repeated in the other bathroom and the shower room and reflect a lack of attention by staff to maintaining good standards of infection control and hygiene. This was brought to the managers attention and action was taken to clean and tidy each room. There is a plan in place to refit one bathroom. The responsibilities for care and domestic staff are not clearly defined with regard to cleaning the bathrooms and there are no measurable systems in place for auditing or checking the cleanliness of the building. The manager said that this is carried out in an informal way by her touring the home on a regular basis. People are encouraged to personalise their rooms. People said that they liked their rooms and that they are furnished to suit their needs. The laundry was clean and well organised. Staff working in the laundry are aware of infection control procedures. There is sufficient laundry equipment. It was not clear that all staff understand fully infection control procedures. There was evidence of some poor practice and a lack of management procedures to regularly review the working arrangements within the home. 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. There are enough staff employed to meet the needs of people living in the home and safeguard their welfare. Evidence: The staffing levels are sufficient to meet the needs of the people living in the home. People living in the home said that they were happy with the staff and they spoke warmly about the level of support they received. Rotas were organised to ensure that sufficient numbers of staff were on duty and where sickness or holidays occur staff work additional hours. One survey returned said that staff take their breaks at the same time leaving people without supervision. Staff recruitment procedures are clear and define the process to be followed. Records showed that the companys procedures are followed. Appropriate references, Criminal Records Bureau and POVA checks are carried out and records confirmed this. All staff receive relevant training in line with the company policies. Eighty per cent of the staff have achieved national qualifications in care and other staff are working towards completing their training. Staff said that they get enough training opportunities and are well supported by the senior staff. Individual training records are in place and are kept up to date. Care Homes for Older People Page 19 of 26 Evidence: Staff meetings are held regularly with notes available. 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. Satisfactory management arrangements are in place and further development of the quality assurance systems will improve outcomes for people living there. Evidence: The manager has the experience and achieved the qualifications to run the home. She has undertaken periodic training in line with company policy. The company has clear lines of accountability and managers are supported through regular meetings and visits from the provider. There is a senior staff team, however there have been significant changes within the staff team in the past year. The home has a clear statement of purpose that sets out the aims and objectives of the service. There is evidence that the manager and the senior staff team are involved in reviewing and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. There is an annual development plan for the home, which is developed by the provider. Surveys of residents and relatives are used to collect information about their views. The internal auditing systems for Care Homes for Older People Page 21 of 26 Evidence: example medication, cleanliness and care planning are not in place to make sure that the home runs efficiently and in the best interests of the residents. More work is needed in this area to ensure that there is an effective quality assurance system in place. People are encouraged and supported to retain control of their own money. If people are unable to manage their money clear information is kept in their individual records about the reasons for this. All transactions relating to money held are clearly recorded and appropriate procedures for managing residents money are in place so that staff are clear about their responsibilities. Lockable storage is provided in each persons room so that they can keep money or valuables safely. Health and safety policies and risk assessments are in place and staff receive appropriate mandatory training at regular intervals. Regular checks and servicing of fire equipment are carried out and records show staff have received appropriate fire training. Good records are kept of all accidents. 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 26 13 Staff must consistently follow good infection control practices. This will ensure that suitable arrangements are in place to prevent the spread of infection and maintain a safe environment for the residents. 31/08/2010 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 A system for auditing medicines should be devised and implemented as part of the homes ongoing quality assurance system. Hand written entries in medicines records should be signed by two staff to check the correct entry has been made. Copies of all prescriptions should be kept by the home so that staff are able to check all medicines against these. Training should be provided for all staff in strategies for maintaining a professional, respectful relationship with the residents in a way, which is friendly and supportive without compromising their dignity and privacy. Page 24 of 26 2 9 3 10 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 4 5 6 15 26 33 The home should review practice at breakfast to ensure that people are afforded appropriate choices. Suitable arrangements should be put in place including regular audits to minimise the spread of infection. The quality assurance system should be developed further to make sure that there is clear information about the quality of the service being provided. 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. 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