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Inspection on 23/02/09 for 134 Blurton Road

Also see our care home review for 134 Blurton Road for more information

This inspection was carried out on 23rd February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 134 Blurton Road 134 Blurton Road Blurton Stoke-on-Trent Staffordshire ST3 2DG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Jones     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: 134 Blurton Road 134 Blurton Road Blurton Stoke-on-Trent Staffordshire ST3 2DG 01782775050 01782313508 highcross.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Strathmore Care Services Name of registered manager (if applicable) Ms Barbara Ann MacBryde Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 Date of last inspection Brief description of the care home 134 Blurton Road is a semi-detached property in a residential area of Blurton, Stoke -on -Trent. The home is managed by Craegmoor Healthcare Services. The property is an ordinary house, which is in keeping with other properties in the immediate area and provides the service user group with accommodation based upon the principals of normalisation. The service provides accommodation for up to three people who have a degree of learning disability and are striving to live an independent life style. All three have part time employment and/or attend the local college. They are supported by the Care Homes for Adults (18-65 years) Page 4 of 29 care home 3 Over 65 0 3 Brief description of the care home staff from Highcross, a larger residential care home just across the road. The accommodation consists of one ground floor and two first floor bedrooms, a bathroom, lounge and kitchen diner. A further bedroom situated on the first floor is used as a staff sleeping in room. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good, quality outcomes. This was a key inspection site visit of this service undertaken on 11 March 2009. In total we spent approximately 3 hours in the home and a further 7 hours at High Cross House from which the service is managed. Where we looked at documentation and talked to staff and the manager for the service. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. Care Homes for Adults (18-65 years) Page 6 of 29 The visit included checking that any requirements and recommendations of the previous inspection visit of 20 January 2007 have been acted upon; looking at information the service provides for prospective users of the service, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menus, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The manager, staff and people who use the service were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided its own assessment of its performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent to the service for distribution to people who use the service, relatives, any professional that has involvement in the service and staff. The main points are included in this report. Since the last key visit we have carried out an Annual Service Review (ASR). We do an annual service review when there has been no major inspection of the service (we call this a key inspection) in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review. Throughout this report we have referred to people using the service as residents, as we established from discussion that this is the term they have agreed they prefer. What the care home does well: What has improved since the last inspection? The service has introduced person centered planning and the staff are working to ensure that the documentation is completed in consultation with relatives and people using the service. The recommendations made at the last visit have been addressed satisfactorily. Care Homes for Adults (18-65 years) Page 8 of 29 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have access to a range of documentation that provides information about the service and what they can expect, but can not always be sure that it is in a format they can easily understand. Evidence: The service told us in the AQAA that, The home has a Statement of Purpose which is reviewed and updated as required. There is a Service User Guide available in an easy to read pictorial format. The services Statement of Purpose is on display in the home, but both people we spoke to were not sure what it was and couldnt be sure that they had seen a service user guide. One person has moved out of the service due to the breakdown of the placement and another person has moved in. We spoke to the newer admission about her life and experience of admission to the home. We have been told that, I was told about a Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: place at 134 and was glad I had the chance to come here. The manager, Barbara aksed me if I wanted to move in. I knew people who lived here and want to have my own place eventually. We looked at the records of people using the service and we spoke to them about their lives. Another person said, we were told that some one else wanted to move in, but because we knew her there wasnt a problem. Relatives have said in surveys, that they received enough information about the service prior their relative choosing to move in. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service can be confident that records maintained on their behalf are up to date and provide detailed information. But should have more easy access to them. Evidence: The service told us in the AQAA that, Completion and implementation of comprehensive, well documented person centred care plans and risk assessments that were devised with the full involvement of all residents and families and relevant others where possible. The care records for people living at 134 Blurton Road are kept at High Cross for reasons of confidentiality. We spoke to two people about their records and support plans and have been told that, My key worker helps me with the things I need support with, but I dont know for sure what my records say. I know that staff have to write down things about what I do, they ask me what Ive been doing. We would Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: recommend that people have more easy access to their PCPs, or their own copies if they want them. We saw in records that risk assessments have been undertaken and reviewed regularly and that a daily record of events is kept in the home as recommended at the last inspection visit. We looked at a sample of care plans and person centered plans while at High Cross and saw that they gave a good account of the needs of people. The manager said, Weve worked hard to gather the information we need to complete the plans, but are concerned that the records currently dont have a section to show the progress people have made, and therefore at the moment we are using some of the older documentation we have to evidence this. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a wide range of opportunities to access activities intended to broaden their experiences and which they value. But the service should further promote the person centered philosophy it says it does. Evidence: The service told us in the AQAA that, Residents access community facilities and travel independently. Residents are able to access college courses, work placements, social and recreational activities of their choice e.g. sports, drama group, craft, floristry, aerobics, cinema, theatre, pubs, meals out, holidays etc. We spoke to people using the service and have been told that, I work one day a week at the moment, Id like to work for more days. and I work for three days. I play for the basket ball team (Special Olympics), I go to the gym regularly(independently) and Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: sometimes meet friends from work. I have a boy friend at the moment and would like to see him more often if I could, I have my own mobile phone and speak to him regularly. We looked at records of residents meetings and saw that they are held monthly. The organisation supports user participation in decision making and has introduced a self adcocacy group your voice. A representative from High Cross house attends on behalf of both homes. 134 Blurtion road is seen as an extension to High cross house, sharing a staff team and policies and procedures. And although it is seen as the next step towards independence it doesnt have its own identity which is a shame. There is an emphasis on group decision making which has its place but the service could work harder to promote the person centred principles it says it does. Both people we spoke to told us that they made their own decisions about their own meals, Ive decided Im having a curry tonight, Ive done my own shopping and will cook it later. Im having something else. Staff said in surveys, We continue to strive to provide the highest standard of provision to its service user group. Continues to involve s/u in all aspects of the business. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be sure that their health needs are known and they will be supported to access and receive health services. Evidence: The service told us in the AQAA that, Residents health is monitored, recorded and relevant action taken, with their agreement/involvement Residents have regular medication reviews. We saw records that show people have accessed health care services and are supported to do so by the staff team. We spoke to one person who is independent in administering her medication and keeps it in a lockable facility in her bedroom. She confirmed that the staff team support her and offer any advice should she need it. The service does not have other medication storage facilities, it is understood that one of the criteria for admission to 134 Blurton Road is for people to be independent in this area. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: The GP said in a survey, I feel they take care of the residents well. They come across as a caring people. I do not have any experience with in house care. Relatives said, The staff keep us informed of important events and appointments. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that any concerns they have will be listened to and acted upon by the manager and her team, and they will be protected from the risk of abuse. Evidence: The service told us in the AQAA that, Staff are aware of, understand and adhere to the policies and procedures relating to complaints, concerns and protection. People using the service told us, If I have a complaint Ill tell the staff about it. Surveys confirmed that residents know what to do if they have any concerns. The service has a complaints procedure that has been produced in a format that people using the service find easy to understand and is on display in the home. While we were at High Cross House we saw the record of the complaints the home has received and noted that there are two entries since the last key visit to the service. We saw that the record shows the action the service took to look into the matters raised and how they had been resolved. A relative said, I have no concerns about the service my relative receives. The manager is approachable and if I had any concerns would not hesitate to contact her. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Another said, I have complete confidence in the service. Staff said, If you cant approach the manager there is a whistleblowing policy to follow, or you could approach the area manager. We have good procedures in place to deal with any concerns I would also speak to my manager and colleagues to infom them. We saw in the staff training records(located at High Cross House) that all staff have received training in recognising and reporting suspected abuse. We have not been alerted to any safeguarding issues relating to people living at the home. We looked at sample of staff recruitment records and saw that the procedures are robust. We are kept informed of incidents and accidents and according to our records there hasnt been a reported incident since the last key visit. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that the home they live in is clean and properly heated. Evidence: The service told us in the AQAA that, Residents choose to personalise their rooms to their individual taste, including choice of decor, furniture and fittings if appropriate. Residents are involved in the choice of redecoration, refurbishment, equipment etc. The house is homely, warm, clean and welcoming. We saw that people who live at 134 Blurton Road, have their own front door and bedroom door keys. They are independent in their environment and share responsibilities in relation to cleaning and maintaining the home. They told us that they have reported a draught from the front door and a damp patch in the main hallway. They told and showed us that the first floor carpet has two holes in it and they would like it replaced. They told us and showed us that there is a hole in the rear garden gate. People said and showed us that they had chosen the decor in their own bedrooms the bedrooms we saw are very pleasantly decorated and the two people we spoke to Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: clearly take pride in maintaining a clean and tidy environment. Since the last inspection the kitchen/dining room has been refurbished to a good standard. One person said, We have everything we need, but the chopping boards are becoming worn now and we need them to be replaced. Id also like a holder for them so we can have them on the work surface and to hand rather than in the cupboard. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that staff are properly recruited and well trained, this should give them confidence that they are provided with a good quality service. Evidence: The service told us in the AQAA that, Adequate staffing levels are maintained at all times. Supervisions are completed every two months, along with an annual appraisal. The home manager and deputy are available at any other time to discuss any concerns or problems. The home manager ensures that she sees every member of staff on a weekly basis where possible so that issues can be dealt with promptly. The service has a well established staff team with very little turnover of staff, the team is based at High Cross house but provides support for the people living at 134 Blurton Road. We couldnt tell from the staff rosters we have seen, how many staffing hours the service provides per week, but understand from the AQAA that staff provide sleepin support every night. People using the service confirmed this was the case. They also contact High Cross for additional support if they need it and visit it to be involved in meetings etc. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: The manager provided an overview of the staff training and reported that the organisation has a good record for providing training opportunities. We spoke to one member of staff about supervision and the support she received she confirmed that she meets with the management regularly and commented that the training opportunities provided by the organisation have improved and any training needs identified have been provided. In the staff surveys, comments included, There are staff of all ages and experiences that work at High Cross and I feel that there is always someone that has the right experience, knowledge or understanding to support the service users. Staff also said, I was given all the most important info that I would need when I first started. All other info was gained during my induction period. I was not allowed to start work until CRB checks was passed and my references where checked out. We looked at a sample of two staff recuitment and training records and can confirm there is evidence that the service has robust recruitment procedures in place. We saw that 5/8 staff have been trained to National Vocational Qualification (NVQ) at level two or above, this exceeds the minimum standards recommended. We saw that the staff training information shows that there are good standards relating to mandatory training. We saw that 80 of the staff team have received training in Person Centered Thinking and spoke to one member of staff who demonstrated her understanding of what this means. But our evidence during this visit, indicates that there is further work needed in this area. Relatives said, We have no hesitation in contacting the staff to talk about issues that affect our daughter and find that they are supportive. People using the service said, My key worker is great, if I need her to help me she always listens to me. We spoke to one member of staff who confirmed that she meets regularly with a manager for one to one supervision sessions. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that the service is well managed and staff and the manager know what they need to do to improve it. Evidence: The service told us in the AQAA that, The home manager is dedicated, professional and well qualified, holding NVQ4 and RMA and has twenty-nine years of experience in the care industry.There is a stable, experienced, consistent and committed staff team who support each other well and go the extra mile to ensure the health, safety and welfare of the residents and provide them with a satisfying and challenging quality of life. One relative said, My son is very happy at 134 Blurton Road and the staff support him to be as independent as he can be. They have supported me at times as well. Another said, The manager is great, she is always available when we need to speak to her and understands our concerns about our daughters future. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Staff said, I have a very good working relationship with my manager and I am not afraid to voice my opinion I have a good standard of support from her and the rest of the team. We also have regular staff and key worker meetings. The area manager is extremely supportive and visits the unit regularly including monthly reg 26 visits. We looked at the most recent copies of the monthly reports on the conduct of the service we ask the provider to carry out and saw that no significant issues had been reported. We are aware that the organisation undertakes regular audits of the service and produces action plans for the service to address any areas of deficit identified. We understand that the service seeks the views of people using the service about the quality of the service they receive, but could not tell if residents are informed of the outcome of the quality audits. We saw that the last financial audit had awarded the service 82 and that was an improvement on the previous audit. We looked at a sample of financial records, we saw that the balance checked against the money saved on behalf of people. We saw that records are properly maintained, and that regular audits of records are carried out by the manager and the organisation. We did not check the records of fire safety during this visit but spoke to people using the service and have been assured that they know what action to take if the fire alarm goes off. We saw the staff training records that 90 of the staff team have attended fire training this year. The service returned the AQAA when we asked for it, we saw that it provides relevant information and identifies areas the service needs to improve in. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The service should ensure that people are familiar with the contents of the service user guide and the terms and conditions under which they have agreed to live at the home. The service should provide people with copies of their PCPs if they want them. Information should be provided in a format that people using the service can more easily understand. The service should ensure that people living at the service have opportunities to make their own decisions. The service needs to take action to make the repairs as identified, this includes, repairs to the rear garden gate, to the front door, to address the damp patch at the front of the property and repair or replace the damaged carpet. The service should replace the worn and badly marked chopping boards. The outcomes of the quality audits of the service should be included in the Service users Guide. 2 3 4 5 6 6 12 23 6 7 23 39 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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