Care Home: Wellfield House

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What the care home does well Wellfield House provides a comfortable, homely environment for the people who live there. Communal spaces, including the garden are accessible to people with all levels of mobility. All areas of the home are maintained to a reasonable standard and standards of cleanliness throughout the building are good. People are able to make choices about their day to day lives, including the food that they eat. The majority of people were happy with the food served in the home and meals seen were well presented with ample portions. Visitors are welcome at anytime and many people continue to enjoy trips out with family and friends. What has improved since the last inspection? Since the last inspection the home has worked extremely hard to make improvements in line with the requirements set. This had led to a higher standard of care for people. One person living at the home said "We`ve been in turmoil but things are improving now." The home put in place a comprehensive training package for all staff to ensure that staff have the skills and knowledge to appropriately care for people. Staff stated that the training had been very useful and had given then greater confidence in their jobs. Systems have been put in place to support the manager who is now more confident in their role and providing leadership and direction to the home. The manager has begun a training course in leadership and management. Regular visits are being carried out by the providers and written records of these visits were seen. At the last inspection concerns were raised that people were not always being treated with respect. Action has been taken to address this issue and at this inspection everyone felt that they were treated with respect and dignity. We observed polite and friendly interactions between staff and people living at the home. To ensure the safety of people living and working at the home staff have completed training in various health and safety matters. This ensures that practises in the home are based on up to date good practise guidelines. Staff have also undertaken training in recognising abuse and are now aware of the whistle blowing policy and the local procedure for safeguarding vulnerable people. All staff now receive formal recorded supervision which enables them to raise any concerns and identify training needs. Since the last inspection a residents meeting has been held.As a result of this some events have been planned for the summer and some changes to the menu have been made. What the care home could do better: Staff training needs to be ongoing to ensure that practise is kept up to date and that all staff have the skills and confidence to support people living at the home. One health and social care professional who completed a questionnaire wrote " The home need to maintain the level of training it is now giving to staff." Quality assurance systems need to be expanded to ensure that the quality of care is monitored and that there are planned ongoing improvements. Quality assurance systems need to seek the views of people living at the home and all other interested parties. The home should put regular audits in place check that records and practises are kept up to date. Currently although there is a system for carrying out pre admission assessments this is not being done. Anyone wishing to move to the home should have their needs fully assessed to ensure that the home is able to meet their needs and expectations. Key inspection report Care homes for older people Name: Address: Wellfield House Manor Road Catcott Bridgwater Somerset TA7 9HT     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 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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 26 Information about the care home Name of care home: Address: Wellfield House Manor Road Catcott Bridgwater Somerset TA7 9HT 01278722405 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Farrington Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Wellfield House is located in the centre of Catcott Village, approximately 8 miles from Street and Bridgwater. The home provides accomodation over two floors. The home is registered to provide care for up to 21 people over the age of 65. 18 people can be accommodated in the main house and there are a further 3 rooms in a cottage annexe. It is owned by Farrington Care Ltd and the responsible individual is Kiran Nathwani. There is currently no registered manager at the home. 2 5 0 3 2 0 0 9 0 Over 65 21 Care Homes for Older People Page 4 of 26 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 peterchart Environment Staffing Management and administration 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 service users and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. The last key inspection was carried out on the 19th January 2009. Since this time two random inspections have been carried out to monitor progress being made to meet requirements set. The Commission has also had an opportunity to meet with the providers of the service to discuss their plans for improvement. This report contains information gathered at the key inspection and also makes reference to information acquired during random inspections. Care Homes for Older People Page 5 of 26 Questionnaires were sent out to interested parties in April 2009. 3 were completed by people living at the home, 4 by health and social care professionals and 4 by staff members. Some of the findings and comments have been incorporated into this report. This inspection was carried out over a one day period. During this time We, the Commission were able to talk with people living, working and visiting the home. Care practises were observed, records were viewed and a tour of the building was undertaken. The manager was available throughout the inspection and all records requested were made available. At the time of the inspection there were 14 people living at the home. Although only one person carried out the inspection it was carried out on behalf of the commission and the term we will be used throughout the report. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? Since the last inspection the home has worked extremely hard to make improvements in line with the requirements set. This had led to a higher standard of care for people. One person living at the home said Weve been in turmoil but things are improving now. The home put in place a comprehensive training package for all staff to ensure that staff have the skills and knowledge to appropriately care for people. Staff stated that the training had been very useful and had given then greater confidence in their jobs. Systems have been put in place to support the manager who is now more confident in their role and providing leadership and direction to the home. The manager has begun a training course in leadership and management. Regular visits are being carried out by the providers and written records of these visits were seen. At the last inspection concerns were raised that people were not always being treated with respect. Action has been taken to address this issue and at this inspection everyone felt that they were treated with respect and dignity. We observed polite and friendly interactions between staff and people living at the home. To ensure the safety of people living and working at the home staff have completed training in various health and safety matters. This ensures that practises in the home are based on up to date good practise guidelines. Staff have also undertaken training in recognising abuse and are now aware of the whistle blowing policy and the local procedure for safeguarding vulnerable people. All staff now receive formal recorded supervision which enables them to raise any concerns and identify training needs. Since the last inspection a residents meeting has been held.As a result of this some events have been planned for the summer and some changes to the menu have been made. Care Homes for Older People Page 7 of 26 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 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 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive pre admission assessments are not being carried out by the home, therefore it is not clear how the home determines that they will be able to meet the needs and expectations of new people moving in. People are able to visit the home before deciding to make it their home. Intermediate care is not provided. Evidence: Since the last key inspection the home has up dated the statement of pupose and service user guide and made it available to everyone at the home. This now accurately reflects the services and facilities offered. The home has a pre admission assessment format that should be completed before anyone is offered a place at the home. Since the last inspection one new person has Care Homes for Older People Page 10 of 26 Evidence: been admitted, the manager met with the person and their representative but a comprehensive assessment was not carried out. Everyone moving to the home has a contract that states that the first month of any stay is a trial period. This ensures that the home is able to meet the persons needs and that the home meets the expectations of the new person. People are able to view the home before deciding to move in. People spoken with during the inspection said that they, or their representative, had visited the home before they moved in. Care Homes for Older People Page 11 of 26 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. A programme of staff training has improved skills to ensure that people living at the home receive appropriate care. Privacy is respected and people receive care in a manner that promotes their dignity. Evidence: Since the last inspection all staff have undertaken training to ensure that they have the appropriate skills to care for people. One healthcare professional wrote on their questionnaire staff have been able to attend quite a lot of training, which they are keen to use to improve the lives of service users. Everyone living at the home has a care plan that is personal to them. Two care plans were looked at as part of this inspection. Both contained brief social histories and assessments of need. The care plans gave basic details about the care that people required. There are currently no care plans in place to give details of peoples night time needs and routines. Care staff spoken with at this, and previous random inspections, demonstrated a good knowledge of individuals living at the home. All three people who completed questionnaires in April answered YES to the question Do you receive the care and Care Homes for Older People Page 12 of 26 Evidence: support that you need? People living at the home have access to healthcare professionals according to their individual need. People spoken with said that the home were always quick to call professionals if they were unwell. Health and social care professionals who completed questionnaires all answered ALWAYS to the question Does the home seek advice and act upon it to improve individuals health care needs? Healthcare professionals commented that communication is excellent and Staff always ask for advice. All appointments with professionals are recorded. The home uses a Monitored Dosage System for medication. There are suitable storage facilities available. Currently no one living at the home administers their own medication. Since the last inspection all staff who administer medication have received training in this area to ensure that practises are up to date and safe. Medication administration records were seen and all were correctly signed when administered or refused. Everyone asked felt that their privacy and dignity was respected by staff working at the home. During the inspection it was observed that people were able to spend time in communal areas or in the privacy of their rooms. Staff interacted with people in a kind and respectful manner. Care Homes for Older People Page 13 of 26 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 are able to make choices about their daily routines and visitors are always made welcome. There is a varied menu that provides a choice of food at each meal. Evidence: People living at the home said that they were able to make choices about what time they got up, when they went to bed and how they spent their day. One person said Its very good here, I can do what I want. At the last key inspection a recommendation was made to expand the activities programme to ensure that it caters for all tastes and interests. The home has begun to look at ways of enhancing the activity programme and this work is ongoing. Since the last inspection the home has held a residents meeting and given people an opportunity to suggest activities that they would like to take part in. As a result some events have been arranged for the summer. The home needs to ensure that there is also social stimulation available on a one to one basis for people who do not enjoy group activities. One person said that they would like to have activities arranged that were mentally stimulating. Care Homes for Older People Page 14 of 26 Evidence: On the day of this inspection many people were enjoying spending time in the garden chatting and socialising. Two visitors were spoken with, both said that they were able to visit at any time and were always made welcome. Many people said that they continued to enjoy going out with family and friends. One person said that they used public transport to visit a local town. People have newspapers and magazines delivered. The mobile library visits on a regular basis and a representative from the local church holds holy communion at the home. There is a four week menu that offers a choice of food at each meal. The main meal of the day is at lunch time with a lighter meal in the evening. People spoken with were generally happy with the food on offer. The main meal of the day was observed. Food was well presented and portions were ample. One person said The food is very good and the puddings are out of this world. As a result of the recent residents meeting the home has now made cooked breakfasts available every day for those people who request it. Care Homes for Older People Page 15 of 26 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. People living at the home feel comfortable to raise any concerns or worries with a member of staff. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Since the last inspection all staff have received training in the protection of vulnerable adults. The whistle blowing policy and local safeguarding procedure has been made available to everyone. No complaints have been received by the home since the last inspection. One concern has been raised with the commission, this concern has been investigated and no evidence to support it was found. People spoken with during the inspection stated that they were happy with the service that they received but all said that they would be comfortable to raise any concerns or worries with a member of staff. All 3 people who completed questionnaires answered YES to the question Do the staff listen and act on what you say? It was observed that everyone living at the home had unrestricted access to their rooms and indoor and outdoor communal space. Care Homes for Older People Page 16 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wellfield House provides a comfortable, homely environment for the people who live there. Throughout the home standards of cleanliness are good. Evidence: Wellfield House is an older style property that has been extended over the years to provide accommodation for up to 21 people. 18 people can be accommodated in the main part of the home and a further three rooms are available in a cottage annexe. All areas of the home are fitted with a fire detection and call bell system. Various aids and adaptations have been put in place to enable people to maintain independence where possible. These include, assisted bathing facilities, a walk in shower, hand rails and raised toilets. It was noted that one bath was badly marked and would benefit from replacement. Communal areas are located on the ground floor, they consist of a large lounge/ diner and a smaller quiet lounge. The quiet lounge is set away from the other communal area and is not well used. Outside there is a pleasant courtyard style garden with a summer house, tables and Care Homes for Older People Page 17 of 26 Evidence: chairs. On the day of the inspection many people were enjoying spending time in the garden. One person living at the home takes an active role in taking care of the garden. Bedrooms are located on the ground and first floor with a stair lift giving access to the first floor. All rooms are for single occupancy and many have en suite facilities. A sample of bedrooms was viewed, all had been personalised to reflect the tastes and needs of the individual. All areas of the home are reasonably maintained. There is a small laundry that is appropriate to meet the needs of the home. Standards of cleanliness throughout the home are good. Some people living at the home commented that all areas of the home were always clean and fresh. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive training programme for staff has improved skills and given staff more confidence in their jobs. Staff are kind and treat people with respect. Evidence: As a result of the last key inspection the home put in place an extensive training programme for all staff. This has included training in health and safety issues such as infection control, fire safety, moving and handling and food hygiene. Other training has included recognising abuse and dementia awareness. Staff spoken with at this and previous random inspections, said that they had found the training very useful and now felt more confident in their jobs. All 4 care staff who completed questionnairres said that they were now receiving training that was appropriate to their role. Currently the home employs 12 care staff, 6 (50 ) have a National Vocational Qualification (NVQ) in care at level 2 or above. A further 4 people are currently studying towards this award. Generally people felt that there were sufficient staff on duty at all times and that staff were available when they needed assistance. Everyone asked said that call bells were Care Homes for Older People Page 19 of 26 Evidence: always answered promptly. One person said that staff were often rushed and didnt have time to socialise. No new staff have been employed since the last inspection but the manager was able to give details of a robust recruitment procedure that minimises the risks of abuse to people living at the home. People made positive comments about the staff who supported them, one person said that They are all polite and nothing is ever too much trouble for them, another person said The staff are gorgeous, theyll do anything for you. One person commented on their questionnairre that staff were friendly and helpful. Care Homes for Older People Page 20 of 26 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 is now being effectively managed and a commitment to ongoing improvement has been demonstrated. Systems are in place to ensure the health and safety of people living and working at the home. Evidence: There is currently no registered manager at the home. A manager is is post who is planning to apply to be registered with the Care Quality Commission. The manager has limited experience of management. At the last inspection concerns were raised about the ongoing support for the manager from the company. Since this time a support system has been put in place to ensure that the manager has access to advice and support at all times. Internet access has been provided to make communication between the home and the registered providers easier and to give access to up to date information. Care Homes for Older People Page 21 of 26 Evidence: The manager has undertaken the full training programme that was put in place for staff and has begun a management training course - Leadership and management for care services. Since the last key inspection the manager and providers have worked extremely hard to meet all requirements set and raise the standard of care within the home. The registered providers are now carrying out regular visits to the home and written records of these visits were seen. All staff have received formal recorded supervision since the last inspection. Records of supervisions viewed showed that staff feel content in their jobs and have no concerns about the home. There are some quality assurance systems in place but these would benefit from being expanded to ensure that the home is constantly monitoring the quality of care and working towards continued improvement. The home sent out questionnaires to people living at the home and their relatives at the beginning of the year and completed surveys showed a high level of satisfaction. Since the last inspection a residents meeting has been held and a staff meeting is being planned. The home does not act as a power of attorney or financial appointee for anyone living at the home but there is a facility for people to deposit money for safekeeping. Records are maintained of all transactions. Records viewed during this inspection correlated with monies held. The home takes reasonable steps to ensure the health and safety of people living and working at the home. The building is maintained to a good standard and appropriate checks are carried out. As previously mentioned staff have now received training in health and safety matters. The fire officer, who inspected the home earlier in the year, was happy with the systems in place. Fire alarms are tested on a weekly basis and emergency lighting is tested three monthly by outside contractors. All accidents are recorded but records are not audited to ascertain trends or look at where changes need to be made to improve safety in the home. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ 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 23 of 26 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 3 14 (1) Comprehensive pre 10/07/2009 admission assessments must be carried out before people are offered a place at the home. To ensure that the home is able to meet the needs and expectations of new people moving in. 2 33 24 The home must put in place robust quality assurance systems. This is to ensure that the quality of care is monitored and that there are systems in place to facilitate ongoing improvements in care and services. 28/08/2009 Care Homes for Older People Page 24 of 26 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 Everyone living at the home should have a care plan outlining their night time needs to ensure that they receive care and support in their chosen manner throughout the day and night. The bath in the downstairs bathroom is badly marked and would benefit from replacement. There should be an ongoing training programme for all staff to ensure skills and knowledge are kept up to date and reflect good practice guidelines. All accident records should be audited to identify trends and improve safety. 2 3 21 30 4 38 Care Homes for Older People Page 25 of 26 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 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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