Care Home: The Dairy House

What the care home does well The home has been built, decorated and furnished to a very high standard. It provides a light airy environment for people. The home cares for people with complex needs and specialist equipment has been put in place which is appropriate to each individual. There is also a hydro therapy pool on site which people are able to use regularly. People living at the home have access to a range of health care professionals and staff assist people to attend appointments outside the home. Anyone wishing to move in has their needs assessed and if it is considered that the Dairy House may be suitable, staff receive additional training to ensure that they have the skills and knowledge to meet any specialist needs. Throughout the day staff appeared well motivated and professional. It was observed that there was constant interaction between people living and working at the home. People were able to take part in a range of social and leisure activities and all appeared animated and content. Under the heading `What does the home do well?` one person wrote on their questionnaire "Exemplary standards of care; dedicated and professional staff; excellent activity programme; exceptionally clean and comfortable homely environment." What has improved since the last inspection? This is the first inspection since the home was registered. What the care home could do better: On the homes Annual Quality Assurance Assessment they state that they wish to "Continue to support the staff team to increase their levels of knowledge and existing skills though achievement of NVQ and training." It is recommended further training includes training in the Mental Capacity Act 2005 to ensure that where people are unable to make decisions for themselves then decisions made on their behalf are in line with current legislation. As yet the home has no formal quality assurance systems in place and it is required that to ensure quality is monitored, and the views of interested parties are sought, these systems must be put in place. Key inspection report Care homes for adults (18-65 years) Name: Address: The Dairy House Longrun House Bishops Hull Taunton Somerset TA1 5AY     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: Jane Poole     Date: 0 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Dairy House Longrun House Bishops Hull Taunton Somerset TA1 5AY 01823272633 01823339335 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cream Residential Care Name of registered manager (if applicable) Mr Stephen John Petts Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 11. The registered person may provide the following category of service only: Care home only (code PC) to service users of either gender whose primary care needs on admission to the home are within the following categories: learning disability (codeLD) - maximum number 11 Physical disability (code PD) - maixmum number 11 Date of last inspection Brief description of the care home The Dairy House is a purpose built home located in a semi rural location but within easy reach of Taunton town centre and public transport links. The home is registered to provide care to up to 11 people who require care due to a learning or physical disability. All rooms are on the ground floor and are for single Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 0 11 11 Brief description of the care home occupancy, all have full en suite bathrooms. There is ample inside and outdoor communal space. The home is owned by Cream Residential Care and the registered manager is Stephen Petts. Current fees (9/03/10) range from £1550 to £2949 per week. Care Homes for Adults (18-65 years) Page 5 of 27 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. The Care Quality Commission Methodology states that a service can not be awarded an excellent quality rating at the first key inspection. This inspection was carried out over a one day period. During this time We, The Commission, were able to meet people living and working at the home, observe care practices, tour the building and view records. Care Homes for Adults (18-65 years) Page 6 of 27 Prior to the inspection the home manager completed an Annual Quality Assurance Assessment (AQAA). The home has been open since October 2009 and at the time of this inspection 8 people were living at the home. Questionnaires were sent to the home and 5 completed questionnaires were returned. As many of the people who live at the home are unable to fully express their views these questionnaires were completed by relatives on their behalf. Some comments from questionnaires have been incorporated into this report. We were given unrestricted access to all areas of the home and all records requested were made available. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to move in have their needs assessed to ensure that the Dairy House is the right place for them. People are able to spend time in the home before deciding to take up residence. Evidence: The home has a statement of purpose that clearly sets out the facilities and services offered. Anyone wishing to move in is initially seen by the companys liaison manager who carries out an assessment of the persons needs. If at this stage it is felt that the Dairy House may be a suitable home for the person then arrangements are made for the manager of the home to meet with them. The manager gave evidence that when looking at the suitability of a new person they consider their compatibility with the existing group as well as their individual needs. People wishing to move in and/or their representatives are able to visit on more than Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: one occasion before making a decision to take up residence. At the time of the inspection one person was spending time in the home with a view to moving in in the future. Staff spoken with during the inspection stated that they received training before a new person moved in to ensure that they are able to meet their specific needs. The contract states that the first four weeks of a stay is considered a trial period to ensure that the home is able to meet the persons needs and expectations. Everyone who completed a questionnaire said that they were given enough information about the home before they moved in so that they could decide if it was the right place for them. One person wrote received excellent support and information before my move and during my transition period. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Everyone living at the home has an up to date care plan that is personal to them. The home uses a variety of communication methods to ensure people are offered choices. Evidence: Everyone living at the home has a care plan that is personal to them and a day to day book. During the inspection we looked at three personal files. All contained information about the persons needs, likes and dislikes. The plans covered areas such as personal care, diet, communication, mobility and specific medical needs. In addition to the full care plan there is also a brief pen picture of each person which gives an overview of their likes and needs. All staff are asked to read each care plan and sign to say that they have read and understood it. Records are kept for each person daily and these give details of the persons mood, health and significant events. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Specific risk assessments have been drawn up for people to ensure that they are able to take part in day to day activities with the minimum risk to themselves or others. Many people living at the home have no verbal communication and the staff use a variety of methods to ensure that people are able to make decisions about their day to day life. Some staff spoken with said that they are receiving training in assistive technology to enhance the ways that people are able to make choices and decisions. One person wrote on their questionnaire Staff make every effort to understand the needs and interests of each resident. Offer as many opportunities for choice as possible throughout the day, eg for meal times and activities. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a wide range of leisure and social activities at the home and in the community. People enjoy a variety of good quality food. Evidence: People living at the home have opportunities to take part in a variety of activities at the home and in the wider community. Daily routines are flexible in line with peoples wishes and activities. Staff spoken with said that they assisted people to get up at a time of their choosing and there were no strict routines through the day. The home has a number of vehicles to ensure that people are able to access community facilities. The AQAA states Staff support residents to go horse riding, Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: carriage riding, cinema, bowling, church, shopping, college including volunteering courses. During the inspection some people had gone shopping, one person had gone to visit family and others were enjoying one to one attention at the home. In the afternoon a large group of people were taking part in a card making session. The home has a multi sensory hydrotherapy pool which most people use several times a week. Everyone who completed a questionnaire said that they were able to choose what they did during the day, in the evenings and at weekends. The home assist people to keep in touch with friends and family. They provide transport, and staff support if required, for visits to family and provide ongoing communication by phone, text and email. All staff said that visitors were always welcome. At the time of the inspection the home was arranging a social event for families on mothers day. The main meal of the day is at lunch time with a lighter meal in the evening. There is a set menu that provides a large variety of food. Although there is only one set meal on the menu the cook stated that they provide alternatives for anyone needing a specialist diet or who wishes to have something different. Examples of this were seen on the day of the inspection. The cook stated that there is no strict budget for food and that they were able to purchase good quality fresh food. It was noted that the kitchen was well stocked with high quality food products. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People living at the home have access to a range of health care professionals in line with their individual needs. Care plans give details of the support that people require with personal care and specialist equipment is provided where appropriate. Evidence: Care plans contain clear information about the support that people require with personal care. The home employs both male and female care staff which enables people to have some choice about the gender of the person who assists them with intimate personal care. Each person has their own full size bathroom and equipment is in place to ensure that their needs can be fully met. There is ceiling tracking to enable staff to assist people to move comfortably from their bedroom to bathroom and appropriate specialist equipment for bathing and showering had been made available in line with individual needs. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: The home has access to health care professionals such as GP, physiotherapist, speech and language therapist and an access technology consultant. People are also able to access other specialists according to their individual needs. Staff assist people to attend appointments outside the home and on the day of inspection one person was accompanied to a hospital appointment. All appointments are recorded in care plans. Staff spoken with said that they had received training in specialist medical needs that were specific to individuals. The home records all food and fluid taken by individuals and records show that adequate diets are received. Weight records seen showed that people are maintaining steady weights with some small increases. Many of the food and fluid charts did not demonstrate that snacks were offered during the evening. In one instance it appeared that no food or drink had been offered between tea time one evening and 10am the following morning. Some people living at the home are wheelchair users and there are care plans in place to ensure that people are assisted to change position to reduce the risk of pressure damage. The home uses a monitored dosage system for medication. All staff have received training in the safe administration of medication and further training in this area is planned. No one currently living at the home administers their own medication and all medication is administered by senior staff. There are protocols in place for the use of epilepsy rescue medication and all staff spoken with confirmed that they had received training in this area. There are adequate storage facilities for medication. Medication Administration Records (MARs) were viewed. These showed that all medication is signed for when it enters the home and when administered or refused, this gives a clear audit trail. One care plan seen demonstrated that a doctor had given permission for medication to be put in food. There was no evidence that this decision had been made in line with the Mental Capacity Act and no best interest checklist was in place. Where a person lacks the capacity to make a decision for themselves and a decision is made on their behalf it must be made in line with the Mental Capacity Act guidelines. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The home has appropriate policies to deal with complaints and allegations of abuse. People feel that any concerns raised would be listened to and acted upon. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Care staff spoken with said that they had received training in the protection of vulnerable adults and all asked were aware of the whistle blowing policy. People who completed questionnaires said that they knew who to speak with if they were unhappy and how to make a formal complaint. Everyone said that carers listened and acted on what they said. No complaints have been made to the Dairy House or the Commission since the home opened. Care Homes for Adults (18-65 years) Page 18 of 27 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Dairy House provides a spacious and light environment which has been furnished and decorated to a very high standard. Standards of cleanliness throughout the home are very good. Evidence: The Dairy House has been purpose built to accommodate up to 11 people in ground floor en suite rooms. It is set in a semi rural location although has easy access to Taunton town centre and public transport links. There is a range of communal areas including internal courtyards with seating. All areas are furnished and decorated to a very high standard creating a spacious light environment. Outside the main gardens are in the process of being landscaped to create an accessible sensory experience. A sample of bedrooms was seen. All were large and had been personalised to reflect the needs and tastes of the occupant. The manager explained that as new people moved in they were able to choose colour schemes and decor for their personal room. Aids and adaptations have been incorporated into the home to ensure that peoples Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: needs are met. There is also a large hydro therapy pool on the site which has been fitted with sensory equipment. There is a laundry which is appropriate to the size of the home and the needs of the people who live there. All areas seen were clean and fresh. Care Homes for Adults (18-65 years) Page 20 of 27 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 living at the home are supported by a well motivated and professional staff team. Recruitment policies and procedures minimise the risk of abuse to the people who live at the home. Evidence: The home employs 33 care staff, 19 (58 ) have a National Vocational Qualification (NVQ) or equivalent, in care at level 2 or above. Staff spoken with, and observed, during the inspection were well motivated and enthusiastic about their jobs. All said that they enjoyed their jobs and worked flexibly to accommodate the needs of the people living at the home . All staff complete an in depth induction programme which covers statutory subjects such as food hygiene, moving and handling, fire safety and other subjects appropriate to the people who live at the home. Everyone asked was happy with the ongoing training available. The recruitment files of three members of staff were viewed. These gave evidence of a Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: robust recruitment procedure that minimises the risks of abuse to people who live at the home. All staff had been undergone a Criminal Records Bureau check and written references had been received before they began work. Staff files also showed evidence of supervision sessions where people were able to talk about their work and any training or guidance that they felt they needed to enhance their knowledge and skills. Throughout the day it was observed that there was constant interaction between people living and working at the home. Interactions were friendly, warm and professional. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed. There are opportunities for staff to share opinions and ideas but no formal quality assurances systems have yet been put in place. All areas are maintained to a high standard to ensure the health and safety of people living and working at the home. Evidence: The registered manager of the home is Stephen Petts, but the home is managed on a day to day basis by a home manager. The home manager has the qualifications and experience to manage the home. There is a clear management structure in place. In addition to the home manager there is a deputy and 6 team leaders. Staff confirmed that there is always a senior member of staff on duty giving clear lines of responsibility and accountability. The home manager was available throughout the inspection and demonstrated a sense of Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: direction for the home and a good knowledge of the people being supported. There are regular staff meetings where people are able to share views and opinions. Minutes of meetings showed a wide range of subjects are discussed. Staff said that the management in the home was open and approachable and they would feel confident to share ideas with them. As the home has only been open a few months they have not yet put formal quality assurance systems in place to monitor standards and seek the views of all interested parties. The company that owns the home acts as a corporate appointee for some people and the home holds small amounts of personal money on site. This ensures that people have access to their money when they require it. Records are kept of all transactions and receipts are retained. Records seen clearly demonstrated incomings and outgoings and money checked correlated with records kept. A maintenance manager is employed to ensure that the environment is maintained to a high standard and all areas remain safe. A fire detection and emergency lighting system is fitted throughout the home and this is regularly tested. Lifting equipment in the home was purchased when the home was opened and they have made arrangements for it to be serviced on a 6 monthly basis. Certificates relating to the gas and electrical installations were inspected during the registration process. Up to date certificates of insurance and registration are available in the home. Care Homes for Adults (18-65 years) Page 24 of 27 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 Adults (18-65 years) Page 25 of 27 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 20 12 (1) Where a person lacks capacity to make decisions and decisions are made on their behalf this must be done in line with the Mental Capacity Act 2005. To ensure that peoples rights are protected. 30/04/2010 2 39 24 (1) The home must put formal quality assurance systems in place . To ensure that there are systems to monitor and improve the quality of care provided. 30/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 Food and fluid charts should demonstrate that food and drink is offered during the evening even when it is refused by the individual. Care Homes for Adults (18-65 years) Page 26 of 27 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. 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