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Care Home: The Hollies Nursing Home

  • Drake Lane Dursley GL11 5HA
  • Tel: 01453541400
  • Fax:

The Hollies is a new purpose built care home situated close to the small market town of Dursley. The home provides social care and nursing care for fiftyfive older people. The accommodation is on three floors and has assisted communal bathing adaptations for people with physically disabilities. The bedrooms are all single with ensuite shower facilities and are well appointed with appropriate furniture and fittings to provide comfortable and safe accommodation. All bedrooms have adjustable electric beds and those on the first floor have ceiling hoists. Portable hoists are also available for other rooms in the home. Each bedroom has access to a telephone, the Internet and some Sky television channels, and doors can be held open electronically but close they automatically when the fire alarm rings. The home has underfloor heating which can be controlled in each room. Some first 9102008 floor rooms have patio doors onto a courtyard area, as the home is built near a hillside. The main dining room and lounge area on the ground floor is spacious and attractive. The first floor also has an attractive lounge where people can dine if they wish, and the second floor has two lounges and a dining area. Two passenger lifts provide access to all floors including the lower ground floor where there are offices, a laundry room and activity room. The home is approached from a long driveway where there is parking for visitors at the front of the home and an outside area with seating accessed from within the home on the first floor. There is also a raised covered patio area at the rear of the home with access for wheelchairs that has far reaching views of the surrounding countryside. The accomodation fees range from £650.00 to £850.00 per week depending on peoples care needs, and fee information is available in the homes service user guide in relation to part of nursing care fees that are paid from the Registered Nursing Care Contribution fund.

  • Latitude: 51.682998657227
    Longitude: -2.3499999046326
  • Manager: Manager post vacant
  • Price p/w: £750
  • UK
  • Total Capacity: 55
  • Type: Care home with nursing
  • Provider: Littlecombe Park Limited
  • Ownership: Private
  • Care Home ID: 15990
Residents Needs:
Old age, not falling within any other category

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for The Hollies Nursing Home.

Key inspection report Care homes for older people Name: Address: The Hollies Nursing Home Drake Lane Dursley GL11 5HA     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: Kathryn Silvey     Date: 2 7 1 0 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 42 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 42 Information about the care home Name of care home: Address: The Hollies Nursing Home Drake Lane Dursley GL11 5HA 01453541400 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Charlotte@littlecombepark.com 01453546183 Littlecombe Park Limited care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the category: Old age,not falling within any other category - (Code OP) Date of last inspection Brief description of the care home The Hollies is a new purpose built care home situated close to the small market town of Dursley. The home provides social care and nursing care for fiftyfive older people. The accommodation is on three floors and has assisted communal bathing adaptations for people with physically disabilities. The bedrooms are all single with ensuite shower facilities and are well appointed with appropriate furniture and fittings to provide comfortable and safe accommodation. All bedrooms have adjustable electric beds and those on the first floor have ceiling hoists. Portable hoists are also available for other rooms in the home. Each bedroom has access to a telephone, the Internet and some Sky television channels, and doors can be held open electronically but close they automatically when the fire alarm rings. The home has underfloor heating which can be controlled in each room. Some first Care Homes for Older People Page 4 of 42 Over 65 55 0 2 9 1 0 2 0 0 8 Brief description of the care home floor rooms have patio doors onto a courtyard area, as the home is built near a hillside. The main dining room and lounge area on the ground floor is spacious and attractive. The first floor also has an attractive lounge where people can dine if they wish, and the second floor has two lounges and a dining area. Two passenger lifts provide access to all floors including the lower ground floor where there are offices, a laundry room and activity room. The home is approached from a long driveway where there is parking for visitors at the front of the home and an outside area with seating accessed from within the home on the first floor. There is also a raised covered patio area at the rear of the home with access for wheelchairs that has far reaching views of the surrounding countryside. The accomodation fees range from £650.00 to £850.00 per week depending on peoples care needs, and fee information is available in the homes service user guide in relation to part of nursing care fees that are paid from the Registered Nursing Care Contribution fund. Care Homes for Older People Page 5 of 42 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 last key inspection was on 29 October 2008. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. We, The Care Quality Commission (CQC) completed this inspection over three days. As part of this key inspection, on a separate day, one of our CQC pharmacist inspectors specifically examined some of the arrangements for the handling of medicines. We looked at some stocks and storage arrangements for medicines, samples of various records about medication and saw staff helping people living in the home to take their medicines at lunchtime. We visited some bedrooms and spoke to people who were in their rooms. During the pharmacy inspection we spoke to the manager and two registered nurses about medication. The pharmacist provided verbal feedback to the Care Homes for Older People Page 6 of 42 manager at the end of the pharmacy inspection, which took place during a seven hour period. The regulatory inspector completed the other two days of the inspection. During this time we had direct contact with the registered manager, the Responsible Individual, two registered nurses, three care staff, the fulltime chef, the activity co-ordinator, the house keeper, the laundry person, one relative visiting the home and five people living in the home. We also spoke briefly to some people living in the home when we looked at the environment to help ensure that people knew we were completing an inspection. Verbal feedback was given to the registered manager on the final day of the inspection. We had six completed surveys returned to us from people living in the home, and two from healthcare professionals. We looked at care records, recruitment records and some policies and procedures. The manager had completed an Annual Quality Assurance Assessment (AQAA), which provided us with information about the home and what has changed in the previous twelve months. Care Homes for Older People Page 7 of 42 What the care home does well: What has improved since the last inspection? The care planning system has changed and the records seen were well documented with a lot of detailed information to help ensure that peoples needs are well met. The home was more organised and staff felt supported by the new manager and people were receiving the care they needed in a dignified and unhurried manner. A new computerised call bell logging system has been added, to help record and monitor staff response times, identifying where improvements can be made. Care Homes for Older People Page 8 of 42 The single medication trolley has been replaced by three trolleys to help improve the safe practice of administration. The activities have improved and people were able to choose from a variety of pastimes and visiting entertainers. We looked at the activity room where crafts can be completed, and improvements there included new storage and a sink unit, with access to a computer in another room. The new mini bus provides regular trips out where people can be part of the community. The October activities included the following; bulb planting, card making, a trip to Portbury Farm, a pub lunch, games, memory board, two singalongs with different entertainers, exercises, artwork, cooking for a sweet tooth, poetry and prose, quizzes and individual reminiscence. Church of England holy communion is held every month by visiting clergy. A raised patio areas has been provided with access for disabled people with wide reaching views of the surrounding countryside. There is also a shop in the home run by relative volunteers, which is open one day a week to sell mainly toiletries and confectionery. Since the last inspection various paintings and ornaments have been added to decorate the home, making it an attractive and welcoming environment. The home has fresh floral displays delivered weekly and new people have a bouquet in their room. Regular meetings are held for all levels of staff to include trained staff, carers, night staff, kitchen staff and heads of department. We were provided with the minutes of many of the recent meetings and there was some good evidence of improving standards, and staff working towards making sure peoples needs are well met. The home has also started regular meetings for residents and their relatives. What they could do better: Care plans had not been reviewed regularly to help ensure that changing needs are always well met, however, they had all been recently rewritten for the new care planning system. Medication is managed using separate trolleys for each floor and a new monitored dosage system was being used. There were some shortfalls identified in medication administration that require changes to records of how the nursing staff make decisions. Medication training is recommended for all nursing staff. We spoke to two care staff that knew about protecting adults from abuse, however, all staff must be trained in the protection of vulnerable adults as part of their mandatory training. Staff training has not been provided as required this year. The new manager is trying to rectify this situation and has made some recent good progress to help ensure that staff have adequate training and are well supported. Staffing levels are continually reviewed by the manager as new people are admitted to the home. A review of the night staffing levels may be required to ensure peoples needs are met and that fire safety is addressed. The providers remain involved in day to day running of the home, and are able to give the manager some support. However, the manager has identified a need for a deputy Care Homes for Older People Page 9 of 42 manager or a head of care to help with her responsibilities, and the recruitment process has begun to help find a suitable person. 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 10 of 42 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 11 of 42 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a service user guide before they move in, which contains all the relevant information. The manger or a registered nurse assess people before admission to the home to help ensure that the home can meet all their needs. Evidence: We looked at the latest service users guide, that was available in each persons bedroom, and it had all relevant information. The home also has a comprehensive website on the internet, which is updated regularly to include contact details, news and information. The website address is: www.littlecombepark.com and the home email address is: enquiries@littlecombepark.com. The manager or a registered nurse assess people before they move into the home, and they are encouraged to visit the home with their families and sample the menu. A short term stay is also available to try the homes facilities prior to admission. We looked at some examples of the new pre-admission format. A minor revision of the format should ensure that all areas in Care Homes for Older People Page 12 of 42 Evidence: Standard 3 of the national minimum standards are included, and that there is more space for the assessor to make individual comments about peoples needs and preferences. The AQAA told us that a care plan is requested from the social worker when appropriate and that family, friends or an advocate are involved in the care planning where the person agrees. All people admitted to the home receive a written contract setting out their rights and responsibilities. A dedicated room is available for people that require respite care, however intermediate care is not provided. Care Homes for Older People Page 13 of 42 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. There were good assessments and care plans for each person with detailed individual information, however, monthly reviews had not been completed regularly to help ensure changing needs are well met. People are well supported by healthcare professionals, and the staff respect their privacy and idgnity. There were generally suitable arrangements for handling medication but the inspection identified some weaknesses that need action and more attention to detail so as to reduce risks with medicines. Evidence: We looked at four care plans and spoke to people about their care. The AQAA told us that a new care planning system was introduced on 1st September 2009 to replace the previous documentation. The nurses each have a group of people to assess, and update the care plans monthly. The care home support team have helped the staff with the care planning. The AQAA also told us that the care plans are constructed Care Homes for Older People Page 14 of 42 Evidence: using the initial assessment tool to help form the basis of the care plan and includes peoples views of the care they want. The assessments completed were well documented with a lot of detail about peoples needs and preferences, and the care plans contained good individual actions for staff to follow to ensure that peoples needs were well met. The healthcare professional visits were recorded in the daily records, we recommend that they are recorded separately, perhaps with the doctors notes, to enhance continuity of care and to be able to retrieve the information easily. The daily records were informative and highlighted any improvements or changes in peoples care needs. There were no daily records completed by the night staff, which could provide information about any care needs that may effect care during the following day. A person nursed in bed had their position regularly changed and this was recorded. One manual handling risk assessemnt required updating as the person was no longer fully mobile, however, the care plan had been updated to say supervison was required. There was some good information regarding percutaneouse endoscopic gastrostomy (PEG) feeds, which included information that the Speech And Language Therapy (SALT) team had reviewed the care and advised the staff. We spoke to one person with a PEG feed who also had a pureed diet, and she was able to say that she was well cared for and that she can make her own decisions about what she does each day. We observed that the care staff were helping this person with the pureed diet in a calm and appropriate manner. The new care planning system had been completed recently therefore there were no monthly reviews recorded. However, we looked at the previous system and very few monthly reviews had been recorded. Meaningful monthly reviews of peoples care must be recorded to help ensure that any changing needs are met. A nutritional assessment tool is used and people are weighed on admission and their weight is monitored and recorded in their care plan monthly. The doctor is made aware of any changes in weight, and a referral to a dietitian is made when required. We found that people at risk from malnutrition had fluid and food charts completed. We spoke to people who told us they were well cared for and we observed staff providing care in a dignified manner respecting peoples wishes. Risk assessments, to include fall risk assessments are completed and updated as Care Homes for Older People Page 15 of 42 Evidence: necessary, these were displayed in peoples bedrooms to help inform the care staff. The information recorded was good and comments of how to reduce risks were included. However, personal information about people should not be on display without their consent as their privacy and dignity must be upheld at all times. A domiciliary optician visits the home annually or as required, and an audiologist, dentist and a chiropodist visit at 6 weekly intervals. The local doctor visits the home weekly and has access to the information on the doctors surgery computer in the home. The home is taking part in advanced care planning training for end of life care, and the person delivering this support was visiting the home during the inspection. The manager was pleased that the staff were going to benefit from good practice guidance for end of life care, which will help ensure people receive a high standard of care when they most need it. We received two completed health care professional surveys that contained the following comments; when I have been in the home I have noticed that privacy and dignity have been foremost, I have had good discussions with the care team and staff seek out advice from the care home support team and the community mental health team, recording always seems to be on top, the home owners are always seeking to strive for the best possible service, and the staff are friendly and take an interest in residents A new computerised call bell logging system has been added, to help record and monitor staff response times, identifying where improvements can be made. The following is the CQC pharmacist inspectors report about medication arrangements. Registered nurses were responsible for handling and administering medicines for people in the home. The manager told us she wants to organise training about the safe handling of medicines. This is a good objective as it does not seem that this training has been provided since the home opened. This home has a procedure to sometimes support people to look after and administer medicines themselves, where a risk assessment showed this was safe for everyone in the home. On the day of the inspection the nurses told us they were supporting two people in this way. This information is included in the homes guide, however, the way in which it is written could lead people to understand that the home would prefer they did not self administer, rather than emphasising how the home would find out about peoples choices for medicines and help them to achieve these. Staff described how Care Homes for Older People Page 16 of 42 Evidence: they found out about their choices when people first came to the home. We also discussed if there were any cultural or equality and diversity issues affecting medication for people living in this home as these can sometimes affect treatment with some medicines. Staff told us that there was nothing related to medication they have identified at the moment. Most people living in this home were totally dependent on the staff to handle and administer their medicines for them. A number of changes have been put in place since the last inspection so that the nurses can administer medicines more efficiently; this had been identified as a problem at the last inspection. Four medicine trolleys were in use now so safe practices can be followed. On the day of this inspection we saw that the medicines were administered promptly. At lunch time we watched the nurse administering medicines for some people. We noted that generally the nurse followed good practice in using the trolley but we pointed out that it was not good practice in one case to take just a pot of medicines to one person through a long corridor without the records or medicine packs as this increased the risk of mistakes. We also discussed the times medicines were administered and the importance of making sure there were proper intervals between doses particularly a minimum of four hours for certain medicines. The times printed on the charts did just allow this in some cases. The nurses would need to note should the medicine times run late on any occasion so that the subsequent times could be adjusted. The home have recently changed to a more local pharmacy so new systems and records were in use and the manager told us this was better. There were suitable arrangements for keeping records about medication received, administered and leaving the home or disposed of (as no longer needed) for each person living in the home. Accurate, clear and complete records about medication are very important in a care home where during a day a number of different staff will administer a lot of medicines. This helps to make sure that people are not at risk from mistakes with their medicines and that there is a full account of the medicines the home is responsible for on behalf of the people living there. We found the sample of medicine administration records we looked at complete and up to date with one exception, which the nurse on duty had already identified and contacted a colleague to find out what had happened. We told the manager about some other things that needed attention. Staff must make sure they always record the actual dose given where the prescription allows a variable dose (one or two tablets for example). Care Homes for Older People Page 17 of 42 Evidence: Records for treatment with eye drops must be clear about which eye or eyes are treated. This was not always the case but staff were able, for example, to tell us for one person that only the left eye was treated. Eye drops must be discarded after four weeks in use to prevent problems from contamination. Most eye drops we looked at had this information but there was one container that had no date and another that had been in use for nearly six weeks. We looked at some of the arrangements for people prescribed anticoagulants and saw suitable records were in place but any dose changes must be obtained in writing in accordance with the National Patient Safety Agency Alert 18. Each person using this type of medicine must also have their own standard yellow anticoagulant therapy book. This was not the case for one person although others did have this. Where staff administer medicines through a feeding tube this direction should be included on the prescriptions (via PEG for example) so that there is clear direction from the doctor for nurses to administer in this way . This also makes the pharmacy aware so they can advise if there are more suitable types of medicines. Various health professionals were involved in supporting these people. We looked at the information and records in place for people needing this type of treatment and the nurses clearly described how they administer the medicines. For complicated procedures like this a full written protocol is needed for all staff to follow. Some records were made on daily fluid balance charts. We pointed out that a chart for one person for the day of the inspection was missing. A number of people were prescribed medication to use as required and/or with a variable dose. Staff gave us some explanation about how they would use some of these medicines and that in some cases the person would be able to state their need for a particular medicine. Staff must have clear written guidance on how to make a decision to administer a particular medicine at a particular dose in order to meet identified needs in a consistent way. This must include consideration of the provisions of the Mental Capacity Act 2005, and whether the person is able to state their need for a particular medicine or dose and consent to this. This was sometimes mentioned in care plans but not always in sufficient detail. We discussed straightforward ways to achieve this. Records for a few medicines received were not in place, which meant that it would be hard to account for all medicines. The arrangements for handling and recording prescribed medicines applied to the skin such as creams and ointments needed some improvement. The manager showed us different records she was considering introducing which should be better if they are properly kept. The home had also Care Homes for Older People Page 18 of 42 Evidence: recently changed records for some people. We publish information about this on our website (ww.cqc.org.uk). We looked at some creams that were in use and kept in bedrooms and found that good practices were not always followed. Photos were kept with some medicine charts to help any nurse make sure they gave the medicines to the right person. Some photos were missing; the manager told us these were in the office waiting to go into the records. Care records showed regular contact with various other health professionals and the nurses told us that there are regular doctor visits. Generally a designated nurse ordered the medicines people needed each month from the local surgeries. Best practice is for staff in the home then to review the prescriptions before sending them to pharmacy. The home then has more control over what is ordered and can check that the prescriptions contain what they ordered before the pharmacy dispenses these. This can also help wastage and overstocking. The pharmacy supplied many medicines in special packs called a monitored dose system. The packs we looked at indicated that people had received their medicines as prescribed and this agreed with the record charts. Some medicines could not be supplied in these packs. We could not always carry out audit checks for all of these medicines as staff did not always write the date on the packs when the first dose was taken as is good practice. This also allows proper stock rotation of certain medicines that have a limited shelf life after opening as well as being able to make checks that people have received the right doses. The pharmacy had provided standard information about recommended discard dates but the date of first opening must be known in order to achieve this. We also discussed other monthly recorded checks that should be made of medicines, that are not regularly used, to make sure that these are properly accounted for and new supplies are only ordered when needed so as to reduce wastage. Medicines no longer needed were correctly disposed of using a company with a waste management licence and there were records for this. Sometimes two staff signed as witnessing this but it is best if this always happens. There were a lot of medicines awaiting disposal. Careful ordering and stock control can help to avoid wasting NHS resources. There were suitable arrangements provided to store medicines safely. The medicine fridge, however, was not operating within the right temperature range for medicines. On the day of the inspection the temperature was below freezing and the daily temperature records showed this had been the case on previous days. Fortunately at the time of the inspection only a couple of tubes of cream were kept in the fridge but this must be attended to as storing medicines at the wrong temperature leads to loss Care Homes for Older People Page 19 of 42 Evidence: of potency which could put people in the home at risk. Staff must realise if they record a temperature outside of the proper range they need to do something about this. The fridge control was altered during the inspection but this may not be sufficient. The arrangements for controlled medicines must be revised to be in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973 as the cupboard was not fixed to the wall with the proper bolts. The manager showed us new cabinets that were waiting to be fixed as she was changing storage arrangements. We publish information about this on our website (ww.cqc.org.uk) so this must be followed. There was a proper controlled medicine record book in place. We carried out some spot checks and the recorded quantities agreed with what we found in stock. We were concerned that there were no routine recorded checks of these medicines, as is good practice, except when a dose was given. Two staff always sign to witness the administration of this type of medication but when two nurses were not on duty we were told that a carer would sign. It is important that any carer asked to do this is properly trained so that the check is meaningful. For one person changing doses to 8am and 8pm would give a better interval between doses and two nurses would always be on duty at change of shift. Some changes must also be made to the way these medicines are disposed of when no longer needed. They must always be put into a proper denaturing kit and then disposed of via a company with a waste management licence. Any of these medicines that are not denatured immediately must be securely stored as for any controlled medicine. We also publish information about this on our website (ww.cqc.org.uk) so this must be followed. We saw that notices were displayed where people were using oxygen but these should include the full warning details. The medical gas supplier can advise further. There were books about medicines for the nurses to refer to. We noted that a standard reference book was the 2008 edition so should be replaced with the September 2009 edition so that nurses have up to date information when needed. The home have a policy and procedures about medication so that staff have information about how they are supposed to handle and administer medicines in this home. This should be kept more readily available so that staff can easily refer to it as some issues identified at the inspection were clearly included in the policy. We noted some sections needed revision as there was wrong information and some procedures have changed with the new pharmacy service. The procedures also need to include more specific local information about what actually happens in this home rather than general policy statements. Some issues identified at the inspection should also be included. There were some homely remedy medicines with a protocol about when the Care Homes for Older People Page 20 of 42 Evidence: nurses would use these. We checked some of the stock and found there were anomalies to investigate as what was in stock did not agree with the record book. During the year the home has informed us about some incidents with medication. Attention to issues such as identified in this report should reduce the risk of errors occurring. The manager told us she plans to introduce an audit system for medication. This would be good practice and should pick up the type of issues identified at this inspection and so reduce the risk of mistakes with medication for people living in the home. We subsequently looked at the annual medication audit format on another day and we recommend that the random weekly audit format covers more areas to help ensure safe administration. Care Homes for Older People Page 21 of 42 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 have a variety of activities to choose from and are part of the community, enjoying trips out locally. The menus are varied and fresh produce is used to provide a choice of nutritious meals that people enjoy. Evidence: The current activity co-ordinator has completed a comprehensive activities training programme and has been employed since March 2009 for 30 hours each week. A programme of the monthly activities is displayed on the notice board, and individual copies are given to everyone in the home so that they can plan which activity to join. Two outings in the new mini bus are planned each month, and the bus can accommodate eight people, and one person in a wheelchair. The manager ensures that as part of the induction for new care staff they work alongside the activity co-ordinator. This helps staff to realise that keeping people active is part of meeting their needs, and that staff will be able to help the coCare Homes for Older People Page 22 of 42 Evidence: ordinator when required. We spoke to the new activity co-ordinator who was able to tell us how she completes individual activities with people in the home that have some sensory impairment. We also spoke to a person about individual activities and she was able to communicate her satisfaction to us. The activity co-ordinator was very enthusiastic and described to us how, with additional help when required, she will be able to provide a wide variety of activities for everyone. We looked at the activity room where crafts can be completed, and improvements there include new storage and a sink unit, with access to a computer in another room. We spoke to someone providing entertainment related to Halloween, which proved an interesting discussion for many people. One person on respite care told us that they had had a marvellous week going to a pub lunch, doing quizzes and listening to talks. There is also a shop in the home run by volunteer relatives, which is open one day a week to sell mainly toiletries and confectionery. A freelance Reflexologist is available for treatments, and the home has a weekly visit from the local mobile library. The October activities were; bulb planting, card making, a trip to Portbury Farm, a pub lunch, games, memory board, two singalongs with different entertainers, exercises, artwork, cooking for a sweet tooth, poetry and prose, quizzes and individual reminiscence. Church of England holy communion is held every month by visiting clergy. The hairdresser visits twice a week using the homes purpose built hair salon. Pre-lunch drinks are served every Sunday at midday. Fashion shows are held and families are invited, and Shopmobility bring items for people to purchase. Some people attend a bible group for the over 50s in nearby Cam, and Roman Catholic church and Congregational church priests visit the home. Themed days are organised in relation to cultural and religious special events, and the manager told us that virtual cruises are planned where people can dress up. One person is writing his memoirs and the staff help to put this work on the computer, and six peoples life histories have been converted into poems by Gloucestershire County Council for inclusion in a planned book. The activity organiser is making plans for people to have a pen pal, if they wish, to help people stay in touch with other Care Homes for Older People Page 23 of 42 Evidence: people in the community. We were also forwarded the December activities programme, which was packed full of interesting entertainers, for example, a dancing school from Bristol, the local Brownies and guest speakers. There was also beauty therapy, reflexology and Christmas activities that included a trip to see the Cheltenham Christmas lights. The manager told us there are no budgetary restrictions for activities. The AQAA told us about the outside area developed for people to enjoy which is a raised patio area with disabled access that looks out over the surrounding countryside. There are also plans to provide a cafe type seating area near the front door. The six surveys completed told us that four people judged that there were usually activities they can join in with, and two told us always. One person commented that on every level things are done well. A relative told us that the home made good attempts at involving residents in activities but these are still developing. Menus are displayed around the home to help ensure people know what is available and they are asked their preferences the preceding day. Recently a snack menus has been added where additional light meals can be provided from 11:00 to 19:00 hours. We looked at the menus and spoke to the chef and the hostesses that serve the supper menu. The menus were varied and fresh produce is used to help ensure that nutritious food is provided. The people we spoke to after lunch told us that they enjoyed their meal, and the food looked well presented and there were different sized portions to meet peoples needs. Special diets are catered for including diabetic and pureed food. We observed people, requiring staff help, being fed slowly and with dignity as staff were concentrating on what they were doing. People in the main dining room were enjoying a relaxed and congenial atmosphere and were able to have a variety of juices or wine with their meal. The kitchen was well organised and clean, the kitchen was deep cleaned in September 2009 and the Environmental Health Officer had given the home a 5 star rating this year. The chef was seen preparing fresh soup and the main course for supper. Two new trolleys have been purchased since the last inspection to help ensure that all food is served hot enough on the first and second floor. There were no concerns voiced Care Homes for Older People Page 24 of 42 Evidence: regarding this issue during the inspection. The microwave ovens in the small kitchens upstairs are only used to prepare hot milk for drinks. The chef mentioned that the home was recruiting additional hostess staff and that the manager was completing an audit to ensure that there was sufficient crockery now that the home was almost full. All catering staff had completed intermediate food hygiene training, and some care staff had completed basic food hygiene training provided by an outside company. We looked at a sample of the latest menu survey and the overall findings were that people were satisfied with the food provided. Two relatives commented at a recent resident/relatives meeting that the food is always delicious and well presented. We spoke to two relatives and they both told us the food was very good, as they had stayed for lunch. Care Homes for Older People Page 25 of 42 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. All people have a copy of the homes complaints procedure, and complaints are taken seriously and are well investigated. People are safeguarded by the staff knowledge of the homes procedures, however, not all staff had completed mandatory safeguarding training. Evidence: The home has an appropriate complaints procedure which is included in the statement of purpose and in the service users guide. The manager told us that other formats can be obtained, for example Braille, to help ensure that people with diverse needs have the information they need to make a complaint. There had been one complaint since the last inspection, which the home investigated very well, and was not substantiated. Since we completed the inspection we received another anonymous complaint, which the home investigated well and was largely unsubstantiated. We encourage people to make complaints directly to the home for investigation and recommend that any verbal concerns raised are recorded in peoples daily records to include any action required. The AQAA told us that the homes survey results were very positive with people reporting that they were satisfied. We looked at an April 2009 survey and the following action plan where all the comments made were addressed. In the six surveys returned to us, one person didnt know how to make a complaint, however, Care Homes for Older People Page 26 of 42 Evidence: three people told us that the staff listened to them and always acted on what they said and three said usually listened. The home has an adult protection policy which includes whistle blowing. The care staff spoken to knew what they should do if they suspect abuse. The AQAA told us that adult protection training and updates are part of the staffs mandatory training, and that there is a copy of the Department of Health whistle blowing guidance called No Secrets for staff to refer to. We were informed that an additional five staff have completed safeguarding training. The manager told us that Deprivation Of Liberty Safeguarding (DOLS) training had not been completed yet. Care Homes for Older People Page 27 of 42 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained to a high standard and is clean throughout. The staff follow infection control procedures to help ensure that people are protected. Evidence: The home is well maintained and clean and has appropriate equipment to meet peoples changing needs being fully accessible throughout for people with physical disabilities. Since the last inspection various paintings and ornaments have been added to decorate the home, making it an attractive and welcoming environment. The home has fresh floral displays delivered weekly and new people have a bouquet in their room. There have been changes made to the top floor with regard to safety in preparation for the possible temporary accommodation of people with dementia. The number of bedrooms on the top floor has been reduced by one as another larger lounge area has been created there. The nurses station is now a dining area, and the nurses have a separate room. We spoke to the housekeeper who is in control of the four domestic staff. The home is currently advertising for an additional domestic cleaner. The housekeeper told us that any areas that require specific cleaning are recorded daily and that any spillages are reported directly to her. The staff follow infection control procedures and are trained in Care Homes for Older People Page 28 of 42 Evidence: the Control Of Substances Hazardous to Health (COSHH). We spoke to the laundry person and looked in the laundry, and there was a good system for handling laundry in line with the infection control procedures. Care staff were seen using appropriate protective clothing to promote infection control. People told us in our surveys that the home is always or usually clean. Care Homes for Older People Page 29 of 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager continues to review staffing levels as the home continues to fill up. Additional staff may be required at night. Training records are beginning to be completed, and indicate a shortfall, which the manager is addressing. Recruitment records were complete and well organised to help ensure that people are protected. Evidence: The home was accommodating fortynine people, which included twelve people that need personal care only. There were eight care staff on duty in the morning and two registered nurses, in the afternoon and evening this reduced by one carer. During the night there are three care staff and one registered nurse available. The home will accommodate 54 people when full. We looked at the staff rotas and there were times when a shortfall of carers was seen. The manager told us that agency carers are used to fill any gaps, however, the home avoids using agency nurses The AQAA told us that fortyseven shifts had been covered by agency care staff in the past three months from June to September 2009. The manager told us that the home is recruiting additional nurses and care staff as there are eight vacancies to fill. Staffing levels should be kept under continual review and a record kept to support decisions made. The people are accommodated over three floors and the night staffing Care Homes for Older People Page 30 of 42 Evidence: levels should be reviewed, we discussed this with the manager with regard to care and fire safety at night. The new manager has started completing folders for all staff to record their mandatory training and there was a shortfall highlighted. The manager has her own Skills for Care induction information and has enrolled eighteen staff on an induction at the local college, which started on 24 September 2009. In addition the following training was planned; four staff to complete Protection Of Vulnerable Adults (POVA), seven to complete manual handling and two to complete first aid. Several care staff have left the home recently, this was discussed with the manager, and this means there are only a total of six staff with NVQ level 2 or above. Six care staff are about to start NVQ level 2 in care training. The nurses have asked for training towards their post registration education and practice (PREP), and this is being planned, as is Mental Capacity Act training as currently none of the staff have knowledge of this important new Act. The local care home support team has helped the staff with training, which included end of life care and care planning. Regular meetings are held for all levels of staff to include nursing staff, carers, night staff, kitchen staff and heads of department. We were provided with the minutes from many of the recent meetings. The information in the minutes provided some good evidence of improving standards and staff working towards making sure peoples needs are well met. We spoke to several staff both nurses and care staff and most thought the manager was supportive and that the home had improved a lot since the last inspection, to include being more organised generally and especially with regard to meal times and medication administration. Some staff were concerned that there had been a lot of staff changes, however, they hoped that the staff team was settling down more now. One carer told us that the manager was excellent and that she felt well supported and had been supervised once, and that most training needs had been planned. Staff also told us that the staff meetings were beneficial in helping to raise standards generally. We observed a much more organised atmosphere in the home than last year where staff were calmly meeting peoples needs. People we spoke to were complimentary about the staff and told us they were kind and respectful when providing care. Five surveys told us that there are always or usually staff available, and one person said sometimes. One survey returned to us from a person living in the home said staff training could Care Homes for Older People Page 31 of 42 Evidence: be better however the survey also told us recruitment and training have improved in the year. Another survey told us that most things are done well. We looked at four recruitment records for new staff appointed and the Criminal Record Bureaux CRB) checks completed since the last inspection. The recruitment records were complete and well organised to include two references, POVA First, CRBs and a comprehensive application form where gaps in employment could be explored. Two records had good interview notes, and we looked at a new format to be used for recording interviews, which will include more space for additional information. Care Homes for Older People Page 32 of 42 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. The home has a well qualified and experienced manager, however, the manager has identified the need for a deputy manager or a head of care to help ensure that all responsibilities are well managed. Quality assurance procedures are good and provide information that may highlight shortfalls for improvement. The staff are well supported and formal supervision has started. The home has safe working practices and polices and procedures for staff to follow Evidence: The manager was appointed in March 2009 and is a first level registered general nurse with eight years experience managing a nursing home. The managers qualifications include the Registered Managers Award and NVQ Level 5 in management. The AQAA told us that the home had recruited a deputy manager, however, this person did not take up the post and there is currently recruitment advertisements for a new deputy manager. The manager has applied to become the homes registered manager and is awaiting her fit person interview with us. Care Homes for Older People Page 33 of 42 Evidence: Two staff we spoke to told us the manager was good and excellent. The providers remain involved in day to day operations and are able to give the manager some support. However, the manager has identified the need for a deputy manager to help with her duties, as there is currently no training organiser to help ensure that this important and time consuming role is completed. The Responsible Individual also drives the homes mini bus at present. There was no record of any formal meetings between the manager and the providers with regard to business planning, where budgets and plans for improvements are made for the year. This is an important record and we need to be sure that plans are made and the manager is aware of budgetary arrangements. Quality assurance procedures are good, and we looked at several surveys completed by the people living in the home and the actions the home had taken to rectify any shortcomings. Generally there was some good results from the last surveys completed. A residents/relatives meeting had been held in October and we looked at the minutes. Two relatives were thanked for helping with the new shop and three other relatives also volunteered to help with the shop. Sixteen relatives, eight people that live in the home and ten staff were at the meeting. The inclusion of relatives is good practice and helps to promote an open and transparent management where people can make comments about how the home is run. We recommend that relatives and healthcare professionals are also included in quality assurance surveys. The manager told us that the results of the surveys are available for people to see. The home is responsible for managing personal monies for two people, the monies and records were correct, however, we recommend that there are two signatures for all transactions to protect everyone involved. The AQAA told us that the home has an an ongoing programme of maintenance and equipment checks in line with safe working practices. The AQAA also told us that all equipment in the home has either been tested or serviced in 2009 as recommended by the manufacturer or other regulatory bodies. The manager told us that the fire officer had visited this year and that all the recommendations are complete with the exception of fire training as new staff are recruited. Seven staff had fire extinguisher training in May 2009 and there were twentytwo staff at a fire drill on 22 September 2009. A fire training officer has been booked to train all staff soon and the manager plans to make some staff fire marshalls. The homes fire risk assessment is being updated, and the home has Ski pads to help Care Homes for Older People Page 34 of 42 Evidence: evacuate people from upstairs. Fire drills and weekly alarm testing is carried out. The AQAA also told us that all accidents are recorded in the accident book and reported within The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) if required. The manager completed a health and safety course in 2007 and the homes health and safety policy is complete. An outside agency is used for employment issues and the home has appropriate insurance. We looked at some supervisions records completed in August by a previous Head of care, this needs to continue to ensure that all staff are supervised regularly. The Regulation 26 monthly visit records, completed by the Responsible Individual (RI), contained some good information and comments from people living in the home, which can help to improve standards and highlight any shortfalls. We recommend that the RI looks at record keeping and issues highlighted in this report during the monthly assessments. Care Homes for Older People Page 35 of 42 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 36 of 42 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 7 15 Regularly review care plans 04/01/2010 to provide continuity of care. This will help ensure that peoples changing care needs are identified and that care plans are updated to provide an accurate record for staff to follow. 2 9 13 Make sure that all records 18/12/2009 for medication kept and administered to people who live in the home are always accurate, clear and complete. (This is to particularly address the issues identified in the report such as recording variable doses and arrangements for treatments applied to the skin). This is to help make sure all medicines are accounted for and that people are not at risk of mistakes with medication because of Care Homes for Older People Page 37 of 42 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 incomplete or inaccurate records. 3 9 13 Make sure that the medicine 18/12/2009 fridge is always kept in the correct temperature range of 2 to 8 degrees centigrade and action is always taken to correct this if it is found to be at the wrong temperature. This is to make sure that medicines are stored at the right temperature as directed by the manufacturers in order to maintain their correct potency and not put people living in the home at risk from using medicines that are no longer stable. 4 9 13 Review medicine records 18/12/2009 and care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is always clear, up to date and detailed written guidance for staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. Care Homes for Older People Page 38 of 42 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 This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. 5 27 18 The registered person must 18/12/2009 ensure that the staffing levels are reviewed regularly to help ensure there are sufficient staff available at all times to meet the needs of the people accommodated. This will help ensure that there are sufficient staff on duty during the night to meet people needs and help keep them safe in the event of a fire. 6 28 18 The registered person must 30/04/2010 ensure that staff are suitably qualified to ensure there are sufficient care staff trained to NVQ level 2 in care. This will ensure that staff have appropriate training for the work they have to perform, and that people are in safe hands at all times. 7 30 18 The registerd person must ensure that care staff have an appropriate induction when they start work. 04/01/2010 Care Homes for Older People Page 39 of 42 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 This will help ensure that people are protected by staff with a knowledge of safe working practices and the principles of care. 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 7 Personal information about people should not be displayed without their consent, as their privacy and dignity must be upheld at all times. The random weekly medication audit format should cover more areas to help ensure safe administration. Review and revise medication procedures and make these easily available for staff to use. Make regular recorded checks of controlled drugs. Wherever possible use two nurses when this medication is administered but if a carer is involved make sure they are properly trained so that they can make an informed check of this procedure and medication. Make arrangements to review the actual repeat prescriptions in the home before they are sent to the pharmacy. Make sure that arrangements for managing anticoagulant therapy take into account the published guidance from the NHS National Patient Safety Agency about actions that can make anticoagulant therapy safer so that the standard yellow anticoagulant record book is used for each person and that dose changes of anticoagulants are confirmed in writing by the prescriber. Make arrangements to write the date on containers of any medicines when they are first opened to use and record the quantity of any stocks of medicines that are carried forward to the next medication cycle. This is to help with good stock Page 40 of 42 2 3 4 9 9 9 5 9 6 9 7 9 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 rotation in accordance with the manufacturers or good practice directions and to enable audit checks that medicines are being used correctly and the right quantities remain in stock. 8 9 10 15 15 16 An audit of the crockery should be completed as the home may require additional crockery. The manager should ensure that there are sufficient hostesses, as agreed with the chef. We recommend that any verbal concerns raised are recorded in peoples daily records, and that all concerns received have a record of any action taken. We recommend that the Responsible Individual looks at record keeping and issues highlighted in this report during the monthly visits. There should be clear lines of accountability with the providers and the manager with regard to business planning, where budgets and plans for improvements are made for the year and reviewed as required. The manager may need a deputy to help with her duties as, for example; there is currently no training organiser to help ensure that this important role is completed. We recommend that relatives and healthcare professionals are also included in the homes quality assurance surveys. We recommend that there are two signatures for all personal monies transactions to protect everyone involved. Staff should have regular supervision for their development and to help ensure that peoples needs are well met by competant staff. 11 31 12 31 13 31 14 15 16 33 35 36 Care Homes for Older People Page 41 of 42 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. Care Homes for Older People Page 42 of 42 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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