Care Home: The Camden Care Home

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What the care home does well People told us they were encouraged to visit the service in order to familiarise themselves with the building, and to enable them to make a informed choice about their future. People told us they thought the home has a `homely atmosphere and relaxed setting`. People said the routines were flexible and they choose how they wish to spend their day. People told us they are "well looked after". They told us the staff team were: "lovely, caring and friendly", and provided "care the way they wanted it". People told us they liked the food and the social activities provided. People especially enjoyed the trips and meals out. People told us they were "happy and satisfied with living at this service", which they said "meets all of our needs" People are supported by a stable and trained staff team who are dedicated to ensuring peoples needs are met to a good standard. People have opportunities to provide feedback about the service, through the quality assurance systems in place. The service have received many compliment cards and some of the comments made recently include: "Thankyou for all of your care" "Thank you for all of your care and devotion in the way you have looked after my mum". What has improved since the last inspection? The manager has addressed all outstanding requirements from their last inspection report. The following improvements have been made: The care plans are now more detailed and include peoples preferences to make sure people receive person centred care. The storage of controlled drugs has been confirmed as meeting current primary legislation, so therefore it is safe to use. All staff who have worked at the service for a long period of time have now had enhanced police checks carried out to ensure they are suitable to work at this service. Training is being arranged for staff around the requirements of the mental capacity act. This will provide staff with the knowledge and skills to support people to make decisions about their lives.A delegate of the provider now visits the service on an monthly basis to monitor the standards in place and they complete a report of their findings. What the care home could do better: We have made one requirement following this visit. This relates to people not being provided with updated information about the service, and the change of provider, which occurred two years ago. We have made some good practice recommendations which if taken on board will enhance the service provided to people. Key inspection report Care homes for older people Name: Address: The Camden Care Home 85 Nottingham Road Long Eaton Nottinghamshire NG10 2BU     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: Claire Williams     Date: 1 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Camden Care Home 85 Nottingham Road Long Eaton Nottinghamshire NG10 2BU 01159736468 01159723737 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Camden Care Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 18 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Camden Care Home is a detached house that has been considerably adapted to provide residential care. It provides social and personal care for 18 people aged 65 years and over. The service is also registered to provide support to up 3 people with dementia within the maximum number of people it is registered for. The service is situated close to the centre of Long Eaton, and provides care across two floors and has 12 single and 3 double bedrooms. Access to the first floor is by two staircases or by one of the two stair lifts; the home has no passenger lift. The service Care Homes for Older People Page 4 of 28 3 0 Over 65 0 15 Brief description of the care home has three lounges and a dining room, all of which are situated on the ground floor. Their is also a small garden at the rear of the building and a small care park at the side. The charges made for a room at this service range from £344.82 to £376 a week. These charges to not include the provision or newspapers, personal toiletries, hairdresser fees and chiropodist. Information about the availability of the inspection report is included in the Service user guide, which is provided to all people. Care Homes for Older People Page 5 of 28 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 inspection was unannounced and involved a visit to the site which lasted for a period of a day. This service was planned to have an annual service review this year, but due to the concerns we had about the financial viability of this service, we changed our inspection plan and undertook a key inspection. The previous key inspection was undertaken on 15th July 2008. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Where possible, we include evidence from other sources, notably District Nurses and Social Workers. We also use information gathered throughout the year, to support our judgments. This may include notifications from the provider, complaints or concerns Care Homes for Older People Page 6 of 28 and the pre-inspection annual quality assurance questionnaire, which the provider is required to complete prior to a visit to the service. The main method of inspection used during the visit to this service was case tracking. This involved selecting three people who use the service and looking at the care they receive through the review of their records, discussion with them where possible, the care staff and observation of care practices. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? The manager has addressed all outstanding requirements from their last inspection report. The following improvements have been made: The care plans are now more detailed and include peoples preferences to make sure people receive person centred care. The storage of controlled drugs has been confirmed as meeting current primary legislation, so therefore it is safe to use. All staff who have worked at the service for a long period of time have now had enhanced police checks carried out to ensure they are suitable to work at this service. Training is being arranged for staff around the requirements of the mental capacity act. This will provide staff with the knowledge and skills to support people to make decisions about their lives. Care Homes for Older People Page 8 of 28 A delegate of the provider now visits the service on an monthly basis to monitor the standards in place and they complete a report of their findings. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have access to updated information, to assist them to make an informed choice about moving into this service. Evidence: The acting manager told us in the information supplied about the service, how they provide a service user guide and a statement of purpose, to all people. They preassess people who wish to move into the service, to ensure they can meet their needs. She also told us they invite people to come and have a look around the home and spend some time, and have a meal with people. People we spoke to told us they were provided with information, on their arrival to the service. However this information continues to be out of date as an updated copy reflecting the change in the provider has not yet been provided to people. This means people do not have access to updated information about the way the service is now managed and the individuals responsible. Care Homes for Older People Page 11 of 28 Evidence: The contract and terms and conditions of residency are also out of date. This means people who are self funding are provided with old information which does not reflect the current situation, and therefore people are not fully aware of their rights under the new providers. People who spoke with us told us they were encouraged to visit the service in order to famalise themselves with the routines and to meet the staff and people. One person told us: I came for a visit and this helped me to make my decision. We looked at the records in three peoples files, and these demonstrated that an assessment of their needs had been undertaken before they moved in. The service had confirmed in writing that based on this assessment they were able to meet peoples assessed needs. This ensures people move into a service that is right for them and their needs. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a plan of support which covers their personal, health and social care needs. This ensures support is provided based on their preferences. Evidence: The acting manager told us in the information supplied about the service that each person has a person centred care plan. She told us they respect and encourage peoples independence and they are respectful of peoples privacy and dignity. The manager told us they are pro-active in arranging appointments, visits or advice from general practitioners, district nurses or the mental health team. They told us they are open and friendly with visitors aiming to give the home the friendly and warm welcome that people feel comfortable in. We looked at three peoples care more closely and looked at their care files. As stated in the information we received, the acting manager is in the process of changing the format of the care plans to one that focuses on a person centred approach. Each file we looked at contained an updated plan of care, which had been completed on the new format. They were completed in sufficient detail to inform the delivery of the Care Homes for Older People Page 13 of 28 Evidence: persons care. Some additional information was provided within the care plan to reflect peoples preferences on how they would like to be supported. This ensures people receive individualised care which meets their expectations. Each care plan that we sampled contained the required risk assessments that should be undertaken to monitor peoples mobility, pressure areas, nutrition and falls. These were reviewed as required. The care records that we sampled and discussions with people confirmed that contact with external health care services is routinely made. There was evidence in the files to support that the plan of care is reviewed on a regular basis. People told us they are consulted about their plan of care and the records seen demonstrated this. We did not have the opportunity to speak with any visitors during our visit, but we did receive some surveys which were completed by relatives on behalf of people who live in this service. Some of the comments made include: The staff are very kind, and when I visit they are always very welcoming to me. My relative told me they are happy, and they couldnt be in a better place, its so nice The staff are really good and very caring, my relative said they are quite happy. All of the people we spoke to told us they receive support which is provided in a safe, respectful and dignified manner, and our observations, supported this. When we looked at the arrangements for the handling and management of peoples medicines by the service, we found these to be satisfactory and people were receiving their medication as prescribed. The staff told us they had received training which included a practice observation and the records supported this. Care Homes for Older People Page 14 of 28 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 find the lifestyle experienced in the service meets their expectations and preferences Evidence: The acting manager told us in the information supplied about the service; they provide entertainment twice a week, and arrange monthly trips to the local pub for a meal and game of bingo where they meet other care homes. They told us they have a exercise instructor once a fortnight to provide armchair exercise, and have other events periodically such as coffee mornings, musical entertainment, and clothes sales. A hairdresser visits weekly and people have access to a shop to purchase any items. They said that peoples families are invited to join them occasionally at meal times, and one family member joins them for lunch 2-3 times a week. People we spoke to and the feedback provided in the surveys confirmed the information provided in the self assessment. People told us they were happy with the provision of activities provided, and they confirmed they were consulted about what activities they would like to participant in. This ensures their social needs and preferences are met. People told us they particular enjoy a game of bingo, and the trips and meal out. Care Homes for Older People Page 15 of 28 Evidence: People told us they were able to choose how they wished to spend their day, and if this resulted in them remaining in their room, this decision was respected. During our visit we observed people playing dominoes, and listening to music. We joined people for their lunch-time meal. The tables were set with tablecloths and condiments so people could help themselves. People told us they have choices, at each meal time and observations supported this. We visited the kitchen and spoke with the catering staff who were able to show us records of peoples dietary requirements. Care Homes for Older People Page 16 of 28 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. Systems in place ensure people have confidence to raise their concerns, and are safeguarded from harm. Evidence: In the self assessment we received, the acting manager told us if they receive a complaint they act quickly to resolve the issue as soon as possible. They have provided a suggestion and comments box in the hallway for people to advise on any improvements that could be made to the service. They told us the complaint procedure is displayed in the entrance hall and all complaints are fully recorded including outcomes. During our discussions with people they told us they knew how to complain and they said they would not hesitate to raise any issues with the staff team or manager. The feedback provided in the surveys also confirmed that people was aware of how to raise any concerns. People told us they have access to the complaints procedure in the information they have been provided with and as stated in the self assessment the procedure is displayed in the service. The service has received 6 complaints since our last visit. Issues raised include some of the following; the fire doors being heavy to open, food preferences, a person Care Homes for Older People Page 17 of 28 Evidence: wanting more trips out, person being cold at night, light bulb- needing replacing, and people wanting pork pie. All of these issues have been responded to, and the records demonstrated this. The staff we spoke to demonstrated their awareness of both the complaints procedure and their role and responsibilities concerned with dealing with any potential abusive incidents. The staff and the records we looked at demonstrated they had received training in these areas. The service have not had any safeguarding incidents since our last visit. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a clean, and safe building. However several areas would benefit from an upgrade to make them homely in design. Evidence: The manager told us in the information supplied about the service they provide a safe and comfortable environment, which they are improving all the time. They said they encourage people to make their rooms personal, with photos pictures knickknacks and small items of their own furniture We undertook a brief tour of the building and all areas we visited were found to be clean, comfortable, homely, warm and well lit. All areas were furnished and decorated to a satisfactory standard apart from the toilet areas, which would benefit from being renewed as they are looking worn and not homely. People confirmed they are encouraged to personalise their bedrooms and those visited reflected peoples preferences. People told us the building suited their needs, and they confirmed they had access to equipment which encouraged and promoted their independence. People confirmed they were offered a key when they moved into this service to enable them to lock their bedroom door. People told us they would like to access the garden Care Homes for Older People Page 19 of 28 Evidence: area more. There is a paved area at the top of the garden near the entrance, but the rest of the garden is not accessible due to the lack of paving slabs and rails to support people with their mobility. Care Homes for Older People Page 20 of 28 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. People are supported by a competent staff team, who have been recruited to ensure they are safeguarded from any harm. Evidence: The acting manager told us in the information supplied about the service, how they have a very low staff turnover, and they have good working relationships between staff and residents. They told us they provide adequate staff at all times, and provide training in mandatory areas and encourage extra training for all staff. We were told the service operate a thorough recruitment process, seeking 2 references and CRB (police check), and sending out applications forms prior to interviews During our visit we observed that sufficient staff members were on duty in order to meet peoples dependency needs. However additional support would be beneficial at lunchtime to support people with supervision, and prompts to eat their meals. We received positive feedback in the surveys and in the discussions we had with people, about the standard of care provided and some of these include: The staff are marvelous and very good at their job. The staff are caring and treat me with respect. Care Homes for Older People Page 21 of 28 Evidence: I like living here, this is a good home and the staff are good at their job, and the manager is nice. When we spoke with staff they told us they thought the staffing levels were sufficient to enable them to meet peoples needs. However we did receive comments that an additional member of staff would be beneficial during peak times of activity. Discussions with the staff team demonstrated their enthusiasm, commitment and motivation to ensuring they support people to a good standard. Staff told us they have access to positive training opportunities and the records confirmed this. We received surveys from staff and some of their comments they made include: We care for all our residents with heart and understanding We are well supported and have access to good training so we can do our job to a good standard. We encourage people to be independent when they can, and ensure they feel safe in their home. We work well together and we have been a stable staff team for years so we know the residents very well. We looked at two staff members recruitment files. These contained all of the required recruitment information, to demonstrate that all of the checks had been undertaken to ensure these individuals were suitable for their role. We were also provided with information to support that new staff members are provided with an induction to assist them to gain the required skills and knowledge for their role. Care Homes for Older People Page 22 of 28 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. People are consulted about the service to ensure it is managed in their best interests. Evidence: The acting manager told us in the information supplied about the service they operate an open door policy to all people, visitors and health care services, and seek their feedback. They told us the management team work along side staff to promote the best level of care possible. The acting manager has had many years experience of working in her role. An application to register with us has not yet been processed even though the manager has been working at this service for a period of time. We had received some information before our visit, about the financial viability of this service. Part of this visit was to ensure that outcomes were not being affected due to the concerns raised. We found no issues at the time of our visit, and the service was operating satisfactory. People their relatives and feedback provided in the surveys told us that the service Care Homes for Older People Page 23 of 28 Evidence: was managed well and people were consulted about the way it is run. People spoke positively about the management team who they described as approachable, nice and easy to talk. The staff team told us they felt supported in their role, and told us the manager is always available, and the office door is always open, we only have to ask for help. We were informed that surveys have recently been sent out to people and their families in order to obtain feedback. We looked at the report completed of the findings from last years surveys and this demonstrated peoples satisfaction. The service have received many compliment cards and some of the comments made within these include: Thank you all very much for making my mum so welcome and the care you have shown her, thank you for making us welcome and for reassuring us as and when needed. I express my deepest thanks for all of the wonderful care you provide, and the high standards, and excellent quality care. I cannot speak highly enough of you all thank you. People said they were happy with the way their personal money was managed. We looked at the systems in place and these were satisfactory. A delegate of the provider undertakes monthly visits and completes a report of their findings. This is to monitor the standards in the service and to ensure it is meeting peoples needs. The reports covers the required areas and indicated that standards have been maintained on a monthly basis. The service continues to keep us informed of any significant events in the service. They completed their self assessment within the timescale provided and the information was detailed and covered all required areas. Care Homes for Older People Page 24 of 28 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 25 of 28 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 1 6 The statement of purpose 01/09/2009 and service user guide must be updated to include details of the new providers, and any changes to the way the service is provided. This is to ensure people have access to correct information. 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 2 The contract and terms and conditions should be updated to ensure people have access to current information about the providers and fees for this service. The care plans should include information about peoples daily routines, support required throughout the night, medication they are prescribed and any preferences in relation to food requirements or personal care they receive. A timescale for the completion of well bring logs should be agreed with the staff team, so that the records are completed as regular intervals to reflect the care people receive. Page 26 of 28 2 7 3 7 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 15 It would be beneficial to have additional staff support available at meal times so that people can be supported to eat their meals in a relaxed manner. Renewal programme to be developed with timescales for when certain areas will be renewed. The garden area should be developed and made accessible for people to use and enjoy. Staffing levels should be kept under review to ensure sufficient staffing is on duty in accordance with people dependency. The acting manager should apply to register with the Care Quality Commission. Were possible two signatures should be recorded on all financial transactions. 5 6 7 19 19 27 8 9 31 35 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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