Care Home: The Cambridge Nursing Centre

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What the care home does well The atmosphere throughout the home was calm. The number of staff on duty was sufficient to ensure people were attended to when they required it. The menus were displayed in the corridor outside the dining areas in each unit. What has improved since the last inspection? Staff have received training in a variety of areas detailed in the report. There was a record on file of valuables kept in the safe. The recruitment procedures in the home had been followed to ensure the safety of people living there. A new activities co-ordinator had been appointed and details of December activities were good. The hot water issue had been resolved and there are now no problems with the system. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.2 The furniture seen in communal rooms and people’s bedrooms was in a good state of repair. Call bells were accessible to most people seen during the inspection. Staff were aware of types of abuse and what they must do if they suspect abuse has taken place. The meals have improved and people said they enjoyed them. The serving of meals is completed by the chef and other kitchen staff, allowing nurses and carers time to assist people to eat their meals. Charts for recording food, fluid and turning are kept and details recorded. Blood sugar levels are usually being recorded as detailed in the care plan. What the care home could do better: Training records still need to be put in place. There are some staff who still need training in abuse and other areas and this is discussed in the report. Care plans need to contain more information when people have behavioural or other specific issues that staff need to be aware of ; together with how to deal with those issues in a positive way. Changes in medication must be accurately recorded. Supervision must be given by people who have received the appropriate training. Key inspection report CARE HOMES FOR OLDER PEOPLE The Cambridge Nursing Centre 5 High Street Chesterton Cambridgeshire CB4 1NQ Lead Inspector Alison Hilton Key Unannounced Inspection 29th December 2009 08:15 DS0000024271.V378812.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.2 Page 2 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 The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cambridge Nursing Centre Address 5 High Street Chesterton Cambridgeshire CB4 1NQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01223 323774 robert.york@ansplc.co.uk www.bupa.co.uk BUPA Care Homes (ANS) Ltd Manager Post Vacant Care Home 90 Category(ies) of Dementia (90), Old age, not falling within any registration, with number other category (90) of places The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Older people, not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD (maximum number - 1) The maximum number of service users who can be accommodated is: 90 2. Date of last inspection Brief Description of the Service: Cambridge Nursing Care Centre is a purpose built nursing home on two floors with the upper floor accessed by passenger lifts. It is situated just off the junction of Elizabeth Way and Chesterton High Street not far from the centre of Cambridge. The home is light and airy and has attractive gardens that are accessible to those living in the home. All bedrooms are spacious and have ensuite facilities. All rooms are single. The home is arranged in units with each unit having a sitting room and dining room. The home has two dementia care units totalling 40 residents. Details of the fees can be requested from the manager of the home. Copies of CQC inspection reports are kept in the entrance of the home and are available for residents and visitors to the home should they wish to read them. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means people who use this service experience adequate outcomes. We the Care Quality Commission (CQC) carried out a key unannounced inspection on Tuesday 29th December between the hours of 08:15 and 16:35, using the Commission’s methodology described below. This report makes judgements about the service based on the evidence we have gathered. An Annual Quality Assurance Assessment had been completed and used at the previous inspection on 10th September 2009 and another was not requested. Staff, people who live in the home and the acting manager were spoken to. There were 72 people living in the home on the day of inspection. A number of records were seen together with two staff files and four files of people living in the home. What the service does well: The atmosphere throughout the home was calm. The number of staff on duty was sufficient to ensure people were attended to when they required it. The menus were displayed in the corridor outside the dining areas in each unit. What has improved since the last inspection? Staff have received training in a variety of areas detailed in the report. There was a record on file of valuables kept in the safe. The recruitment procedures in the home had been followed to ensure the safety of people living there. A new activities co-ordinator had been appointed and details of December activities were good. The hot water issue had been resolved and there are now no problems with the system. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.2 Page 6 The furniture seen in communal rooms and people’s bedrooms was in a good state of repair. Call bells were accessible to most people seen during the inspection. Staff were aware of types of abuse and what they must do if they suspect abuse has taken place. The meals have improved and people said they enjoyed them. The serving of meals is completed by the chef and other kitchen staff, allowing nurses and carers time to assist people to eat their meals. Charts for recording food, fluid and turning are kept and details recorded. Blood sugar levels are usually being recorded as detailed in the care plan. 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. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 area. People using the service experience good quality outcomes in this People are assessed before they move into the home, which ensures the staff and facilities can meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home does not provide intermediate care and so Standard 6 does not apply. The pre-admission assessments completed by the home and placing authorities were seen on the files looked at as part of this inspection. The information they provided was sufficient for the acting manager to decide if the home was suitable to meet the needs of those people. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. Changes to medication must be recorded to ensure the health and wellbeing of people in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: It was evident from the files seen that health professionals are called when necessary and a variety of appointments with the GP, Chiropodist, Optician and Dietician were noted. Changes in medication must be recorded when they have been made by the GP or other professional to ensure the health and well being of those living in the home. This relates to the level of Lithium one person was taking, which in The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 10 the notes said was changed on 17/12/09 but the MAR sheets indicated it was changed before November but the actual date and details could not be found by the nurse in charge of the unit or the acting manager. When completing daily notes staff must explain in more detail the use of the word ‘aggression’ by describing exactly what the behaviour deemed ‘aggressive’ was and how it was handled. The entries seen were not informative enough to enable nurses to decide if it was appropriate to administer PRN medication. This is medication that should be given ‘when necessary’ and there should be clear guidelines as to when administration is needed. There were details in some MAR charts about PRN medication and when it should be given, but this information must be available for medications used to help mental health conditions to avoid subjective administration. There was no information in the care plans and no risk assessments completed where someone had been noted as ‘aggressive’; or about what impact this had on their day to day care. Staff had no information on how to help the person when they became anxious and their behaviour changed. The acting manager was made aware of the lack of information and stated she would ensure the areas would be fully documented as soon as possible. One person in the home had been taken off food and fluid charts as staff told us she was eating well and her weight was stable. A dietetic assistant had visited on 29/10/09. One person’s file showed they should have blood sugar levels checked once a week and this had been done with one omission during the Christmas week. The nurse in charge of the unit and the manager were informed and they said this would be done immediately. The information about the checks was put in with the MAR charts to ensure it was done correctly in the future. Care plans are recorded using a system, and staff said they are usually completed by the nurses or senior staff. The acting manager said she intends to train care staff to complete care plans and other paperwork in the future. Staff were heard and observed treating people in a respectful manner and personal care was completed in the privacy of their bedroom or bathroom. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 this area. People using the service experience good quality outcomes in Improvements to the menus ensure a balanced and appealing diet for people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We went to see one person who was eating their lunch to check if they had been provided with large handled cutlery as detailed in the care plan, and they had. In discussion with the person he said he was very happy with the standard of the food and had never had to see if there was an alternative as he enjoyed the meals provided. Another person was seen in his room and he said he did not like the lunch so we asked staff to provide him with something different. The lunch was gammon, cheese sauce, potatoes, green beans and sweetcorn and for dessert it was sponge pudding and custard, yoghurt or fruit. Most people said they liked the meals and that the food had improved. The The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 12 acting manager said that the kitchen staff were more involved with the serving of the food at lunch time, which freed care staff to assist people eat their meals. The chef talked to people living in the home about their preferences and created menus and made changes to menus as necessary. The acting manager said a new activities co-ordinator had been appointed and they were discussing activities in the two units where people with dementia live as the quality of activities in those units have been recognised as being poor. The activities list for December was seen and there was a good variety of things available to people. However Christmas is a time when lots of outside groups visit and activities are easy to supply and it will be maintaining that level and choice of activity for those living in the home in the future that will show whether their needs are met. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 this area. People using the service experience good quality outcomes in Staff were aware of the correct procedure to follow if they suspect abuse which means people living in the home are protected from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The acting manager said she had been in discussions with the Safeguarding trainer in the local authority who has been unable to provide training to staff at the home this year. She said that a meeting had been arranged with the trainer to ensure staff received local authority training and some staff became trainers. The acting manager has given some training on safeguarding, completed a flow chart on how to deal with allegations of abuse and gone through it with staff to ensure they have a good level of understanding of their roles and responsibilities in relation to this issue. We spoke to staff who were clear about safeguarding and knew who they would inform if they suspected abuse. The acting manager said she had involved the Age Concern Advocacy service with three people living in the home who have mental capacity and best The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 14 interest issues. This means people have independent advocates to work on their behalf. The complaints file was seen and there was evidence that the acting manager had dealt with complaints according to the company procedures. There are leaflets available in reception about how to complain. The paperwork for two safeguarding incidents was inspected and the incidents had been appropriately dealt with by staff who had informed the correct authorities. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 area. People using the service experience good quality outcomes in this The environment provides people with a safe and comfortable place to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home was clean and there were only slight odours in some areas early in the inspection. The furniture, seen in the communal areas as well as in the rooms of people living in the home, was reasonably well kept and there was nothing seen that was in need of repair. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 16 The acting manager said that the room with doors that led out onto the garden has keys and the person now living in the room has them in their possession. Call bells were in reach of most people seen in their own rooms and where people sat in lounges there were alarms that people could access in the event of an accident or incident. One person did not have his call bell but staff said he was unable to use it but they checked on him regularly to ensure he was comfortable. One lady had difficulty pressing her call bell and this was brought to the attention of the acting manager who said she would look into an alternative method of attracting staff attention. It was noted that staff answered the call bell very quickly when we pressed it for the lady in question; although she commented she thought they had been a long time. There was evidence on file that contractors had been brought in to overhaul the hot water system and staff said there was no problem now. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. Staffing levels are adequate to meet the needs of people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The acting manager said that there were currently vacancies for a deputy manager and cleaning staff. Some staff had been employed but not started work as they are waiting for the Criminal Record Bureau checks to be returned. Two staff files were seen and they contained all the necessary checks and paperwork. One person had a poor reference but the acting manager was able to explain this and had made further enquiries about the issue. A new activities co-ordinator started in December but was on holiday on the day of inspection. We looked at the activities provided for December and they were varied and held on different units each time. The manager said that there would be more activities arranged for those who have memory problems, The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 18 but since the co-ordinator was new to the post there still needed to be discussions over the exact way they will be provided. The acting manager said that staff who had done care work before received one weeks training and if they had not then they had two weeks training and worked with seniors before they worked alone. The acting manager said that there was no up to date record of what training staff had received and that she was starting to compile this information and would request staff to bring in certificates so they could be copied and placed on their file. Staff said they felt the running of the home had improved since the acting manager had taken over. They had received some training in moving & handling, Fire Safety, infection control and started to complete ‘personal best’ which is the induction provided by the company but based on Skills for Care outcomes in line with National Vocational Qualifications (NVQ). The acting manager said that all staff will be undertaking the ‘personal best’ induction no matter what level they were or how long ago they started. Currently it is new staff who are completing it but the books were not available as they keep them until the induction has been completed and they are agreed as competent by the acting manager. Some staff (nurses, carers, cleaners and housekeeper) said they had received Safeguarding training and told us what they would do in the event of suspected abuse. The acting manager gave us a flow chart that shows the steps a person must take in the event of suspected abuse and she stated all staff have a copy and have been informed of the process. She is in contact with the local authority safeguarding trainer (see complaints and protection). The paperwork for two safeguarding incidents was seen and found to be in order (see complaints and protection). The acting manager said that all registered nurses are First Aid trained as well as some care staff and people in the kitchen. There was a list of trained staff and the location of first aid boxes and any specialist equipment they contained. Staff rotas showed that there were sufficient staff available to ensure the needs of those on the units could be met. On the day of inspection there were five staff am and three staff pm on Churchill; six am and five pm on Downing; five am and 3 pm on Trinity and six am and seven pm on Fitzwilliam. Overnight there are four nurses and five care staff in the building split between the units. The acting manager was made aware that tippex must not be used on any documents and any changes should be crossed through but still be legible. She will ensure staff are made aware of this. Where some changes had been made there were initials to say who had changed it, and all names had the full name shown. As part of the inspection we observed how long staff took to answer call bells and people were seen quite quickly, however one lady was trying to press her bell and nothing was happening. On closer inspection it was because she was not pressing in exactly the right place to activate the bell. When we did this for her a member of staff was there within a minute but The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 19 the lady felt this had been a long wait. The issue of being able to press the call bell was raised with the acting manager who said she would look at the suitability of the current bells. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 outcomes in this area. People using the service experience good quality The acting manager has made improvements but needs to consolidate these to ensure the health and welfare of people who live in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The maintenance man was in the building and during the inspection there was a fault on the fire alarm system which he dealt with. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 21 There was evidence on file that the water system had been repaired by contractors and all areas had hot water and were well heated. Details of valuables kept in the safe are recorded and available to staff who can provide this information to people living in the home who may forget they have given an item in for safe keeping. Staff said they were receiving supervision, but one nurse who gives supervision said they had not received training to do this. The accident/incident book was seen and there had been 15 accidents in December. Although some were well written others needed to provide more detail and the manager agreed that this was the case. The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must provide clear guidance for staff to enable them to meet the needs of people living in the home who have behavioural or other issues. Staff must accurately record changes in medication to ensure the wellbeing of people living in the home. Details of when and under what circumstances PRN medication should be given must be detailed to ensure appropriate administration. A record of all training must be kept to ensure staff maintain their skills to meet the needs of those living in the home. Staff providing formal supervision must receive the necessary training to do this to ensure best practice. Timescale for action 28/02/10 2. OP8 13 29/12/09 3. OP8 13 29/12/09 4. OP30 17 (2) Schedule 4 18 31/03/10 5. OP36 31/03/10 The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Cambridge Nursing Centre DS0000024271.V378812.R01.S.doc Version 5.3 Page 25 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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