Care Home: The Coach House

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What the care home does well The focus of the inspection was to assess the care practice and ensure that people are not at risk of harm or abuse. Therefore we did not look at many aspects of the service and may not therefore have identified some positive things about the home. The next key inspection will provide us with the chance to look at the broader picture of the service and what it is like for the people who live there. However during our visit we found some positive examples of care. People are provided with meals which are based on their preferences and needs and which they enjoy. Staff supports people in making choices about their social and recreational interests. The activities programme has increased the opportunities for people to engage in meaningful and interesting activity. There is some good work currently being compiled on the individual interests of people through the one to one meetings. People who need support with their hygiene needs looked clean and dressed appropriately. Accommodation is spacious and well maintained with pleasant garden facilities for people to enjoy. We are happy to report that following our visit we had a prompt response to our findings from Select Healthcare Group. Whilst the provider is not required to submit an improvement plan following a random visit, it is evident they recognise the areas that still need to improve. They have detailed the ways in which they are planning to make improvements in their action plan, which will improve outcomes for the people who use the service. What the care home could do better: The service must make proper provision for the health and safety and the welfare of people who live at the home to ensure they receive the care and support and monitoring that their needs require. Care plans must include all areas of need and outline in detail the action required by staff to meet peoples needs effectively. Where a risk is identified the care plan should specify how that risk is to be managed. It is important that where a person is identified as at risk of dehydration that fluid records are consistently maintained and reflect regular hydration is offered.Incidents have occurred, with little evidence of follow up action being taken and CQC or other relevant persons have not been notified. People living and working at the home are not being safeguarded from the risk of abuse. The recording and review of incidents needs to be more robust to ensure an accurate and timely overview of the level of incidents and strategies for minimizing them identified. The service needs to ensure that where staff are required to utilise holding techniques they do so only after having relevant training in this area. The service must ensure that we are notified of Deprivation of Liberty authorisations. The service needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The service needs to ensure that care plans have all the information about why a medicine was prescribed. Why a medicine was discontinued and on how to administer when required medicines safely and effectively. The service must ensure that all medicines are stored securely and at the correct temperature. The service must ensure that the administration practices do not place people at risk. The service must ensure that the staff administering medication to the people who use the service are safe and competent to do so. The service must ensure that medication is administered only to the person it was prescribed labelled and supplied for. Random inspection report Care homes for older people Name: Address: The Coach House 48-60 Goldthorne Hill Wolverhampton West Midlands WV2 3HU two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Monica Heaselgrave Date: 0 9 0 8 2 0 1 0 Information about the care home Name of care home: Address: The Coach House 48-60 Goldthorne Hill Wolverhampton West Midlands WV2 3HU 01902343000 01902331000 goldthorncourt@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Magdalena Nona Roskell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Select Health Care (2006) Limited care home 66 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 66 66 The maximum number of service users who can be accommodated is: 66 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: Mental Disorder, excluding learning disability or dementia - Code MD - maximum number of places 66, Dementia - Code DE - maximum number of places 66. Date of last inspection Care Homes for Older People Page 2 of 18 Brief description of the care home The Coach House is a purpose built care home providing accommodation, nursing and personal care for up to sixty six people of all age groups. In June 2006 the home was registered with Select Healthcare Ltd as new providers for the service. The home has a variety of communal lounge and dining areas, all bedrooms are single occupancy with en suite facilities. The home is located at Goldthorn Hill, Wolverhampton and is within easy walking distance of the local shops and amenities. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have been revised and are readily available. The reader may wish to obtain more information of the differing level of fees from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Care Homes for Older People Page 3 of 18 What we found: This unannounced random inspection was carried out over two days in total. Two compliance inspectors visited on the 9th August 2010 and our pharmacist inspector visited on the 12th August to look at the management of medicines within the home. The home did not know we were going to visit. Our inspection had been triggered following concerns reported to us by a member of the public. The information indicated that hoist equipment had not been serviced and that staff are manually lifting people. We were informed staff are using lifting equipment they are not trained to use. Concerns were also expressed about staff conduct and behaviour and that people living there did not always receive their medication as they should do. Our own records showed a number of notifications sent to us regarding the use of restraint. We also learned that the council supervisory body had turned down some Deprivation of Liberty applications from The Coach House during the past year. As a result of this information we considered a random visit needed to take place to assess the care practice and ensure that people are not at risk of harm or abuse. We spent time meeting and speaking with some of the people who live at The Coach House to find out their experiences of living at the home. Other people we met were not fully able to comment on the care and support they receive so we observed the support given by staff and how staff interacted with them. We also looked at the care records for some of the people to see how staff are identifying and providing the care and support they need. We spoke with staff to find out their views of working at the home and whether they think anything needs to be improved. We looked at the incident log and incident reports to assess how these are managed and whether these are appropriately reported. During our inspection we saw some good staff interactions. For example in one of the lounges on the first floor we saw two people who live at the home being supported by a staff member with painting and drawing. They appeared to be enjoying this activity. People not taking part in this activity were walking around the lounge and corridor watching TV or speaking with staff. On the ground floor we also observed the weekly residents meeting and saw that people are encouraged to express their choices for the weeks planned activities. We heard staff asking people what they wanted to do and respecting the choices they made. We spoke with a number of people both on the ground and first floor who told us they are happy with the support they have from staff and they described staff as being good. We saw that a member of staff was always present in the lounge on both floors to ensure people were supervised. We also saw that the home does checks at regular intervals to establish where people are in the home. For some people we saw that these checks were carried out on a more frequent basis. Some people told us they are able to come and go as they please between the different areas of the home. There are coded doors throughout the home which require a code to be entered. The people we spoke with confirmed this did not impact on what they want to do. They told us and we observed that staff open the coded doors for them. We saw that some individuals exited the home throughout the day to pursue activities. We spoke with some individuals who told us they engage in community activities such as lunch out or pub meals or visits to places of interest. These people told us they are supported by staff to undertake these. Care Homes for Older People Page 4 of 18 We saw in some care files that restrictions of liberty are in place for some individuals. This means they are supervised by staff when outside of the home. One person we spoke with was fully able to describe the impact of this. It was positive to see that she had been supported to understand the implications. Prior to our visit we asked the manager to provide information about Deprivation of Liberty authorisations. We checked this information with the council. We are currently investigating conflicting reports from the Council and the manager about Deprivation of Liberty authorisations to ensure that people unable to make serious decisions have their rights protected. We shall be continuing to monitor these authorisations as part of our regulatory activity. On the day of our visit we observed that most people looked clean and smartly dressed in clothes appropriate for their age and gender. Some individuals clearly required a higher level of support from staff with their hygiene needs and choice of clothes. One person had been out to the hairdresser and confirmed this as a regular feature alongside shopping for clothes. Another person described the support she has for personal care. We spoke with some care staff who had a good understanding of the needs of people in this area and how they encouraged them. They told us that one person needs to have their medicine in the morning to help manage their behaviour before they are supported with their care. We looked at the care records and saw that there were a number of incidents for this person. The staff member said that some of these incidents may have happened because staff had gone to assist the person with their care before the person had their medicine. When we looked at the persons care records there was no care plan to inform and guide staff about this. In other care records we looked at we found there was a significant lack of guidance to staff regarding management of behaviour or concerns. There was little guidance regarding possible trigger factors and the outcomes following incidents. It is important to look at ways to reduce the risk of incidents occurring again in the future thus facilitating better outcomes for the individual. We also found a lack of written information about the medication people take. Information about possible side effects to look for and guidance on the best ways to support the person to take their medicine and the action to take if they decide not to take their medicine was not evident. Some improvement is needed to make sure personal care plans provide clear guidance to staff on the best way to support people. We saw one person had a pressure sore. We visited this person in their bedroom and saw that the equipment necessary to reduce the risk and provide relief was evident. For instance a pressure relieving mattress for improved pressure relief. We looked at the turning chart. This showed regular two hourly pressure relief was consistent for that person. We saw that this individual required regular hydration and nutritional support. We saw that a nutritional supplement was being prescribed and administered. We looked at the fluid monitoring charts which showed a gap of three hours since the person had last had a drink. We asked the nurse about this who said the person may have been offered a drink and refused it. She could not explain why this was not recorded and agreed that the fluid chart did not reflect regular hydration was offered or show what steps were taken if the person did not have sufficient fluids. The nurse was observed to support the person with a drink. The person was visibly dry around the mouth and lips and we asked the nurse if oral care had been provided. She said it had. We spoke to another nurse later who could not confirm that there was an oral care plan for this person. This means people may be at risk of dehydration which could cause discomfort and infections. We consider that the fluid records and oral care plans need to be improved to ensure better outcomes Care Homes for Older People Page 5 of 18 for individuals. When we looked at the care records for two people we became concerned that a high number of incidents such as physical assaults have taken place between people living at the home which we or other relevant agencies have not been notified about. There was no evidence to show that staff had reported these incidents to the local Multi agency Safeguarding Team for investigation under their procedures. We saw one person on the day who had recent facial injuries received from another person but we could not establish if this incident had been reported to the safeguarding team. We saw that staff were recording incidents on a specific form but have not done anything further such as looking at possible reasons or trigger factors which may have given rise to the incidents occurring to reduce the risk of them happening again. We also saw that there have been a high number of incidents and assaults directed towards staff which suggests that staff are not sufficiently skilled to manage the behaviours shown by some people. We showed a senior nurse a selection of incident reports we had looked at. They agreed that the reports did not show enough information to look at the possible reasons why incidents have happened and the ways to reduce the risk of it happening again. Following our visit to the service we looked at the monthly regulation 26 visits carried out by a representative of the service. During these visits an audit is undertaken and a report compiled to reflect how the home is operating. We looked at three reports for the periods May to August 2010. These showed us that had been a significant number of incidents within the home. The July 2010 report in particular showed forty six incidents had taken place. There were no comments entered to indicate if these incidents had been reviewed or scrutinised in an endeavour to look at triggers or minimize incidents. We were concerned that if the company representative has obtained this information from the incident log held in the home then this information is inaccurate. We found that not all incidents have been logged here but the actual incident forms are kept in individual care records. Those we saw in care records did not all include a code which suggests they had not been identified and put into the log book. We were also concerned that the use of codes does not identify the seriousness of some of the assaults we saw in care records. This seriously diminishes the ability of the managers both internal and external to have an accurate oversight of the level and type of incidents occurring within the service. This compromises the opportunity to report such incidents both to us and other agencies under safeguarding procedures to ensure people are protected from harm or abuse. Consequently we cannot be sure that people are protected from harm and could therefore be at risk. We noted from the regulation 26 reports that a person had been identified as having a pressure sore. The form instructs staff that pressure sores of Grade 2 and above require a statutory notification to be made to CQC. We found that no notification had been sent to us by the service in relation to pressure sores. We also noted that whilst the regulation 26 report shows the number of safeguarding alerts and DOLS applications for that month no notifications from the service had been sent to us about these. The safeguarding notifications received from the home do not match those stated in the Regulation 26 report. After the inspection we made a referral to the local safeguarding team to alert them of our findings because we were concerned that people living at The Coach House are not being safeguarded from the risk of abuse. Care Homes for Older People Page 6 of 18 Whilst looking through one persons care records we saw two written entries in their records describing how they had been made to pay for items they had damaged or broken. We could not see evidence of this being discussed with their representative or social worker and we asked a senior member of nursing staff for more information about this. They told us that it was based on a discussion between the home and the individual and confirmed that the social worker for the individual had not been informed of this. It was also established that there was no record of what the money that had been handed over by the individual had then been used to purchase. This is an unacceptable practice and means that this person has not had their financial interests safeguarded. Our pharmacist inspector also raised concerns when a staff member described how people living at the home are always buying drinks for staff from a vending machine. This too has been raised as a safeguarding issue for follow up. We asked to look at where the home keeps its record of notifications that it has sent to us. We found that the home has not been notifying us and keeping us informed of incidents that affect the welfare of people as it is required to do so. Both the senior nurses on duty were not clear of when and what they should notify us about although we saw that the home had a copy of our guidance which tells staff this information. We consider that the home has not notified us appropriately via regulation 37 reports of all incidents affecting the welfare of the people. In the main office is a folder which we were informed is where staff log and keep a summary record of incidents which have taken place. We found that staff have not included information on all the incidents which we saw have taken place. Thus the log does not provide an accurate record to those reading it. The log requires staff to use a code for different incidents but does not reflect the seriousness of some of the incidents we had seen documented in individual care records. Whilst looking through this folder we found an incident form describing how some strong painkillers had been found under a chair in one of the lounges. It did not indicate that an investigation had taken place or who the incident had been reported to. The deputy manager and senior nurse on duty told us they were not aware of the incident. We requested that an investigation be undertaken and to notify us the outcome of that investigation. We spoke to a number of care staff and nurses about the staffing arrangements. The staff we spoke with viewed that staffing levels were sufficient for the numbers and needs of people currently living at the home. Care staff also told us they have good support from nurses and this was seen to take place during the inspection. The people living at The Coach House told us that there had been a number of incidents involving aggression which did worry them. Some incidents had been directed at staff and some at other people living there. They could identify individuals who they were afraid off. We saw one person with facial injuries received from another person. We saw an incident report in the care file to indicate who had caused the injury but we could not establish from the incident reports or care records if this incident had been reported to the safeguarding team or what steps had been taken to reduce the incidence or protect the person. People living at the Coach House described staff responses to incidents they had witnessed. No one described restraint being used. They told us staff respond to aggressive incidents by trying to calm the individual or take them for walks. They Care Homes for Older People Page 7 of 18 described leading people by the arms or leaving them where they are to calm down. We spoke to some staff on the two floors about their training and looked at the training matrix. We saw that not all staff has had training in key areas such as holding techniques or Deprivation of Liberty. This is needed to ensure they have the skills and techniques to support people safely. We spoke with a visitor to the home who told us of their satisfaction with how their relative has been looked after since they were admitted to the home. They told us that staff keep them informed about their relatives care and they knew how to make a complaint if they needed to. We were present when lunch was served. We heard staff asking people what they wanted to eat. When a person was not sure if they would like something on the menu staff offered them opportunity to sample small portions to help in their decision making. One person decided they did not want their meal and a staff member was heard offering alternatives to the menu. The people we spoke with told us they are always offered a choice of food and this included cultural preferences. They told us that meals at the home are good and that they enjoy them. CQC had a complaint that the hoist was frequently not working and that staff have to lift people manually which would be unsafe. The manager confirmed with us that all the hoists were serviced and repaired six monthly as required. We saw evidence that staff are trained to use the equipment people need and this included training in moving and handling techniques. We consider that staff has the training and the use of equipment appropriate to support people in this area. The manager provided written evidence that showed disciplinary processes had been used effectively to ensure staff behave in accordance with the code of conduct for the home. Our pharmacist inspector visited the home on the 12th August 2010 to assess how well the home was managing the medicines of people using the service. We found overall that the management of medicines by the home was poor and consequently placed the health and welfare of people who used the service at risk. We found a number of problems with the medication records being kept by the home. We found that the home was not always accurately recording the receipt of medicines entering the home. This was particularly concerning when it was discovered that two batches of the same medicine had been received by the home but only one batch had been recorded upon arrival. We found that one batch had been dispensed by the pharmacy using traditional containers and the other batch had been dispensed into the monitored dosage system. The fact that the two batches had been dispensed into different containers and that only one batch had been recorded upon receipt could potentially lead to both batches being administered at the same time. We also found that some medication which had been carried over from previous months had not been accounted for in the records and therefore the home did not know whether this medication was being used appropriately. We examined a number of MAR charts and found that they were not robust enough to demonstrate that the home had administered all of the medicines as prescribed. We found a number of examples of where the medicines administration record charts were being signed but the medicines were not being administered. An example of this was found with some antibiotic tablets. The records showed that 112 tablets had been Care Homes for Older People Page 8 of 18 received by the home and 47 of these tablets had been administered. We therefore expected to find 65 tablets remaining instead we found 78 tablets. We found numerous signature gaps in the administration record and therefore it could not be confirmed whether the people concerned had received their medicines. We found that where medicines had not been administered and a generic abbreviation had been used there was no definition of the abbreviation and therefore the reason for the non administration was not evident. We also found that where variable doses had been prescribed the records did not show what quantity had been given. The audit of some anticonvulsant medicine showed that there were three tablets less than there should have been. The nurse in charge said that a possible explanation for this was that some tablets from another person on the same medicine had been used. We therefore carried out an audit of this medicine for the other person and we found that there were three tablets less than expected. The sharing of prescribed medicines between people who live in the home contravenes the Medicines Act of 1968. We were particularly concerned about the records for a person who had recently been admitted to the home. We found that the home had continued to use the administration record from the previous home and on this record was two entries for the same medicine. The first entry corresponded to the information displayed on the pharmacy label attached to the bottle of the medicine. The second entry gave direction to give an additional dose for extreme agitation or aggression. We found that the home had no evidence that this extra dose had been authorised by a doctor yet this extra dose had been administered by the home on two separate occasions. This action also contravenes the Medicines Act of 1968. Further audits of the medicines for this person showed that medicines were missing. We found with some sleeping tablets that 29 had been received by the home and 9 of these tablets had been administered. We therefore expected to find 20 tablets remaining but we could only find 7 tablets. We found with some tablets used to treat anxiety that 49 tablets were received by the home and 8 of these had been administered. We therefore expected to find 41 tablets remaining but we could only find 34 tablets present in the home. We also found that one person had not received their tablets used to treat diabetes for a period of three days because the home was out of stock of them. The period of being out of stock may well have been longer because the records showed that 56 tablets had been received but 60 tablets had been administered before the home indicated that this medicine was out of stock. We found some antipsychotic medicine which the prescriber had indicated could be administered by being disguised in food or drink. We found that the medicine had been prescribed by a psychiatrist who had authorised the home to administer this medicine covertly. We found no evidence that this practice had been reached through a multidisciplinary team decision which is essential to safeguard the rights of the person concerned. We also found no evidence of any written process on how this medicine was going to be administered or that this process had been checked by a pharmacist to ensure that it did not affect the efficacy of the medicine. We found that the home was failing to ensure that the fridge temperature was being maintained at between 2 and 8 degrees Celsius. As a result the home was advised to discard the contents of the fridge and seek new supplies. We found no evidence that the home had an ongoing programme to assess the Care Homes for Older People Page 9 of 18 competency of the nursing staff to handle and administer medicines safely and in accordance with the homes policies and procedures. We found that the did carry out an audit of the medicines at the end of each monthly cycle however we found that the audit tool and process used was not effective enough to ensure that medicines were being administered safely and in accordance with the prescribers directions. What the care home does well: What they could do better: The service must make proper provision for the health and safety and the welfare of people who live at the home to ensure they receive the care and support and monitoring that their needs require. Care plans must include all areas of need and outline in detail the action required by staff to meet peoples needs effectively. Where a risk is identified the care plan should specify how that risk is to be managed. It is important that where a person is identified as at risk of dehydration that fluid records are consistently maintained and reflect regular hydration is offered. Care Homes for Older People Page 10 of 18 Incidents have occurred, with little evidence of follow up action being taken and CQC or other relevant persons have not been notified. People living and working at the home are not being safeguarded from the risk of abuse. The recording and review of incidents needs to be more robust to ensure an accurate and timely overview of the level of incidents and strategies for minimizing them identified. The service needs to ensure that where staff are required to utilise holding techniques they do so only after having relevant training in this area. The service must ensure that we are notified of Deprivation of Liberty authorisations. The service needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The service needs to ensure that care plans have all the information about why a medicine was prescribed. Why a medicine was discontinued and on how to administer when required medicines safely and effectively. The service must ensure that all medicines are stored securely and at the correct temperature. The service must ensure that the administration practices do not place people at risk. The service must ensure that the staff administering medication to the people who use the service are safe and competent to do so. The service must ensure that medication is administered only to the person it was prescribed labelled and supplied for. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 11 of 18 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 12 of 18 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must include all areas of need and outline in detail the action required by staff to meet peoples needs effectively. Where a risk is identified the care plan should specify how that risk is to be managed. This is to ensure staff can meet the needs of people effectively. 22/10/2010 2 8 12 Systems must be in place to 10/09/2010 ensure people receive an adequate fluid intake. Where this is not occurring medical advice should be sought. This is to ensure people are not at risk of dehydration or further health complications. 3 9 13 The home must ensure that 30/09/2010 the administration practices do not place people at risk. Where medication is administered with food and consent is not possible because of lacking capacity records must be made of the Page 13 of 18 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 multidisciplinary team agreement that the way in which medicines are administered is in the best interests of that particular person. The process of covert administration must also be checked to ensure that it is safe and does not affect the efficacy of the medication concerned. To ensure people are not at risk from medication practices. 4 9 12 To ensure that there is effective systems in place to request obtain and retain adequate supplies of prescribed medicines for people So that people can be given them as and when prescribed. 5 9 13 The service must ensure that 08/10/2010 medication is administered only to the person it was prescribed labelled and supplied for. This is to ensure people only receive medication that is prescribed for them. 6 9 18 To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to people who use the service. 10/10/2010 08/10/2010 Care Homes for Older People Page 14 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This is to ensure people receive their medication safely. 7 9 13 Medication must be stored 10/10/2010 within the temperature range recommended by the manufacturer. To ensure that medication does not loose its potency or become contaminated. 8 9 13 The records of the receipt, 10/10/2010 administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. People receive their medication as prescribed. 9 9 13 Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff knows how to use and monitor all medication including when required and variable dosed medication. This is to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. 10 18 13 Staff must be trained to respond appropriately to 08/10/2010 10/10/2010 Care Homes for Older People Page 15 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 physical and verbal aggression and fully understand the use of physical intervention as a last resort. Staff must not use holding techniques unless they are trained to do so. This is to ensure people are not at risk of harm and that their human rights are protected. 11 18 13 Effective systems must be implemented to ensure all safeguarding issues are referred to the Local Authority safeguarding unit. This is to ensure people are protected from the risk of harm or abuse. 12 38 37 The service must ensure 08/10/2010 notifications are submitted to the Care Quality Commission of any incident that has affected the health, safety or wellbeing of the people at the care home. This is to safeguard the health, well being and safety of people living at the home. 24/09/2010 Care Homes for Older People Page 16 of 18 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 38 To notify the Commission of DOLS authorisations to ensure current restrictions that affect people are known. Care Homes for Older People Page 17 of 18 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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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