Inspection on 24/03/09 for 6 High Street

This inspection was carried out on 24th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 6 High Street 6 High Street Loftus Saltburn-by-Sea TS13 4HW The quality rating for this care home is: one star adequate 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: Jane Bassett Date: 2 4 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. They reflect the things that people have said are important to them: 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 © (20092008) 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: 6 High Street 6 High Street Loftus Saltburn-by-Sea TS13 4HW 01516511716 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Potensial Limited care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 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 category: Learning Disability, Code LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home The home is a converted victorian house providing service user accomodation on three floors. Each service user has their own bedroom and has access to lounge, dining and kitchen facilities. There are a number of bathrooms, shower rooms and toilets. The home is situated in the centre of Loftus close to all the local amenities and transport. 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: one star adequate 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 Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was an unannounced key inspection. As a key inspection, all of the key standards were looked at or discussed. This was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use services, and that it does what the Care Standards regulations say it must. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The inspection was carried out by one inspector. The inspection lasted a total of four hours. During this time the inspector looked at a range of documentation including, service user and staff files. The inspector spoke to three service users, two staff members and the manager. Five service users returned surveys to CSCI. The manager of the service completed an Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 7 of 29 (AQAA). At the time of the inspection the home was providing services to a total of 6 service users. Fees charged by the home are assessed on an individual basis. What the care home does well Both the staff group and service user group are well established and have been at the home for a number of years. Service users who spoke to the inspector and those who returned surveys to CSCI all said they were happy with the care and support they receive at the home. One person said I like living here, it is good another said I am happy here. All expressed satisfaction with their lifestyles within the home. Staff who spoke to the inspector had a good knowledge of service users needs and how they liked things done. The inspector observed a good rapport between service users and staff, people appeared comfortable and relaxed in their environment. Care Homes for Adults (18-65 years) Page 8 of 29 What has got better from the last inspection What the care home could do better Care plans and risk assessments recording the care and lifestyle of people living in the home must be developed and improved to ensure information is current and accurate. Documentation should include detail of the persons abilities, preferences, needs and how these are to be met. All the records should be reviewed and evaluated on a regular basis. Systems for storing and recording medication should be improved to promote peoples well being and safety. The environment of the home and peoples comfort would benefit from a programme of redecoration and refurbishment that includes all areas of the home. Care Homes for Adults (18-65 years) Page 9 of 29 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jane Bassett 33 Greycoat Street London SW1P 2QF 02079792000 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 10 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 11 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. The home has procedures that should ensure that prospective service users have their needs assessed. Evidence: The manager told the inspector that the home had not admitted a service user since the change of ownership and registration. The last service user to be admitted was three years previously. During discussion with the manager she was able to describe the process that is followed to obtain information about a prospective service users needs including an assessment by staff from the home, visits to the care home by the prospective service user and an assessment from the care manager if that person is funded by a local authority. The manager stated the information would be used to ensure the home could meet that persons needs and preferences. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are able to communicate with service users and understand what their needs are. However care plans include basic information, are not in sufficient detail or person centred. Risk assessments are basic and have not been reviewed for some time. Evidence: During the visit the inspector looked at the files for two people who live at the home. These files contained information and documentation used by the previous registered owner. Documentation seen was disorganised and confusing in the way that it was written. It was not always possible to establish which information was current and relevant. Each file was seen to contain information about that persons activities of daily living. The information contained brief details as to how needs were met. There was little or no information about that persons strengths and preferences. There was evidence that the information had been reviewed, however this was not always on a regular basis and did not contain written evaluation. Risk assessment documentation in files was seen to be basic. There was no evidence that these had been reviewed. Files also contained assessments and information supplied by the local authority funding the care. However this information was seen to be at least three years old. Both files contained assessments carried out by that persons consultant in June 2008. Records are maintained of the daily life of the individual service user within the home Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: and included information on the various activities the service user had taken part in. One file was seen to contain a monthly key worker assessment that has been introduced and commenced since the change in ownership. The manager showed the inspector an action plan that she was working through that included the need to assess and develop the care planning documentation. The inspector spent time with three service users, it was clear from their responses that they were able to make choices in their lifestyles and were happy at the home. One service users said I like living here, it is good. The inspector observed a good rapport between service users and staff. Staff who spent time with the inspector had a good knowledge of service users needs, likes and dislikes. 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 are able to make choices about their lifestyles within the home and are supported to develop their life skills. Evidence: A number of service users have individually funded and agreed one to one time. The inspector was shown documentation that recorded how this time was used and the activities that took place. Daily records for all service users included some details of other activities that had taken place. A number of service users attend day placements and college which enables them to maintain contact and engage in activities with their peer groups outside the home. The inspector was told there is an open door policy and families can visit when they wish. Service users are involved in decisions within the home e.g. choice of menus and choice of activity. Service users are encouraged to assist with and become involved in meal preparations, daily living tasks such as personal laundry and care of their own bedrooms. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Service users who spent time with the inspector told her of trips out to Redcar and Whitby, regular visits to the bingo, shops and the local public house. All said they were happy with their lives at the home. The inspector was also told that service users are planning a holiday for later in the year. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. However the documetation recording the care does not always reflect this. The principles of respect dignity and privacy are put into practice. Evidence: During the visit the inspector examined the files for two service users. These were found to contain My health review and action plan documents. These had been completed in 2005 by the previous registered owner. There was little or no evidence of a review of information following that date. Both files contained assessments carried out by that persons consultant in June 2008. One of the two files contained a brief summary of past history. The manager told the inspector that service users have access to health care professional such as GP and district nurses. She described a recent interaction with a district nurse in relation to one of the service users health needs. Records seen contained evidence of GP visits. Responses in surveys returned to CSCI indicated people were satisfied with the care they receive at the home. Staff members were seen to communicate effectively with service users. Staff who spoke to the inspector were able to demonstrate a good knowledge of individuals needs and how these are met. Staff spoke of promoting individuals privacy, dignity and independence. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Information contained in the AQAA returned to CSCI indicated the home has policies and procedures in relation to the safe handling of medication. The inspector was told staff involved in the administration of medication had undergone an appropriate training. The home is currently using a NOMAD system. It was seen that medication was being stored in a locked cabinet, however this would not meet the current requirements for storage of medications. A sample audit of Medication Administration Records (MAR) examined were seen to be completed with no gaps in entries. Two staff were seen to sign for each administration. However hand written entries of details of medication and method of administration did not contain signatures of the person recording the information or of a second person confirming the accuracy of detail. The inspector noted there were individual protocols for service users receiving PRN (as required) medication. A number of these had not been reviewed for a considerable time. The manager told the inspector that a new medication system had been agreed and is to implemented from 30th March 2009. This would include suitable storage provision and pre printed MAR sheets supplied by the dispensing pharmacist. The inspector was shown a copy of the service agreement confirming this. 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 are able to express their concerns and have access to a complaints procedure, are protected from abuse and have their rights protected. Evidence: Information in the AQAA returned to CSCI indicated the home has a policies and procedures in relation to handling complaints and safeguarding people from abuse. Staff have access to the Teeswide guidance on no secrets. The policy and procedure on dealing with abuse should be developed further to include details of local arrangements and contacts for reporting concerns. Responses in surveys returned to CSCI indicated people were aware of how to raise any concerns. Further information in the AQAA indicated the home has received no complaints since the change in registered owner. Staff confirmed they had received training on how to deal with the Protection of Vulnerable Adults. Staff who spoke to the inspector were able to demonstrate through response to questions the action they would take if they became aware of a concern. All demonstrated a commitment to protecting service users from abuse. Care Homes for Adults (18-65 years) Page 19 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. The home provides a clean, odour free and homely environment that requires some updating and refurbishment to enhance the environment and promote service users comfort. Evidence: During the visit the inspector walked around the building. The home provides a lounge and dining room for service users to socialise and participate in activities. Service users bedrooms were seen to be personalised to the individuals taste. It was seen that the home provides a clean, odour free and homely environment. However decor, flooring and furniture throughout the home was seen to be old and tired looking. The inspector noted paint work and finishes to doors and woodwork throughout the home was old, marked and stained in places. Wallpaper throughout the home was old and damaged in places. Carpets and flooring to communal areas, corridors and service user bedrooms would benefit from replacement. Walls, flooring and ceilings in bathrooms, shower rooms and toilets would benefit from refurbishment due to damage and staining. The inspector observed areas of damp to the walls in one attic bedroom occupied by a service user. Central heating radiators throughout the building were seen to be exposed and unguarded. Care Homes for Adults (18-65 years) Page 20 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The home has a recruitment procedure that promotes the safety and wellbeing of service users. Evidence: The Registered Manager had the required qualifications and experience to run the home. Service users and staff who spoke to the inspector told her there were sufficient staff on duty to meet current care and social needs. A review of the staffing rota confirmed this. Information in the AQAA indicated the home has a policy and procedure in relation to recruitment. The inspector examined the file for a staff member most recently recruited. This was found to contain an application form, three written references and a record of CRB (Criminal Record Bureau) check. This record included the CRB reference number, date obtained and a statement stating all clear. The manager told the inspector the original CRB check is obtained by and held at the companies head office. Staff training records seen by the inspector contained evidence that staff have received the following training since change of ownership, safe handling of medication, mental capacity act, food hygiene, infection control, first aid, protection of vulnerable adults, challenging behaviour, and epilepsy. Staff who spoke to the inspector confirmed this. The manager showed the inspector a letter confirming further training in health & Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: safety, fire safety, care planning, and manual handling has been booked to take place in the next six months. Information given to the inspector indicated 9 of the 10 staff had successfully completed NVQ at level 2 or above. A number of staff are now undertaking level 3 training. Records seen by the inspector indicated staff receive regular supervision. Staff who spoke to the inspector confirmed this. Care Homes for Adults (18-65 years) Page 22 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. The management and administration of the home is based on openness and respect. Service users are satisfied with the care and support they recieve. Evidence: The home changed ownership and registration in August 2008. The manager has been in post since that date. The manager showed the inspector an action plan that she has formulated and is working through. This was seen to cover a number of areas some of which have already been addressed or partly addressed, such as staff training, fire safety, medication systems, and meetings. Other areas that work continues on are care planning, risk assessment and the environment. The manager has set timescales for improvements to be achieved. The manager returned an AQAA document to CSCI prior to this inspection. This was found to contain limited information relating to how the service is provided and the systems used within the home. People who spoke to the inspector told her communication is good. There are now clear lines in communication and support is always available. There is an open door policy and regular meetings are held. Staff who spoke to the inspector told her the team work well together and supported each other. The inspector saw evidence of monthly Regulation 26 visits and reports. The manager Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: told the inspector it is planned to carry out a service user survey. Responses in surveys returned to CSCI indicated people were satisfied with the care they receive at the home. One person stated its the best home I have been in. Accidents were seen to be recorded appropriately, fire alarms are checked weekly and hot water temperatures are checked and recorded on a regular basis. Other records seen indicate there are regular fire drills and fire alarms have been serviced as required. Records of service users personal monies held by the home included details of all transactions, countersigned by the service user where possible. A sample audit of service users monies held by the home found no discrepancies between the amount held and the amount recorded. Information contained in the AQAA returned to CSCI indicated the home has a range of policies and procedures that should promote the safety and well being of service users, and these were reviewed in 2008. Care Homes for Adults (18-65 years) Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes  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 Adults (18-65 years) Page 25 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 Description 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 Description Timescale for action 1 6 15 Plans of care must be 30/06/2009 developed to ensure information is relevant and reflects that persons current circumstances. Information should be reviewed and evaluated on a regular basis. To promote the well being of service users. 2 9 13 30/06/2009 Risk assess must be developed to ensure information recorded is relevant and reflects that persons current circumstances. Information should be reviewed and evaluated on a regular basis. To minimize the risk of injury to service users. Care Homes for Adults (18-65 years) Page 26 of 29 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 Description Timescale for action 3 19 15 Assessment and care plans in 30/06/2009 relation to service users health care needs must be developed and reviewed on a regular basis to ensure information is relevant and reflects that persons current circumstances. To promote the health and well being of service users. 4 20 13 The registered person must 30/06/2009 ensure a suitable cabinet is obtained to store medication. To promote the safety of service users. 5 24 23 30/05/2009 Action must be taken in relation to the areas of damp in one service users bedroom. o promote the service users comfort and safety. 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 6 Plans of care would benefit from the inclusion of further detail of the service users abilities and preferences to promote service users Independence, choice and wellbeing. Care Homes for Adults (18-65 years) Page 27 of 29 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 2 20 Protocols in relation to the use of PRN medication should be evaluated and reviewed on a regular basis to ensure the information is current and accurate. Annual competency checks should take place for all staff who administer medication to promote safe handling for the safety and well being of service users. Hand written entries of details of medication and method of administration should contain the signature of a second person confirming the accuracy of detail, or be detailed on a MAR sheet supplied by the dispensing pharmacist to promote the safety and wellbeing of service users. The policy and procedure on dealing with abuse should be developed further to include details of local arrangements and contacts for reporting concerns. A programme of redecoration and refurbishment should be implemented to improve and enhance the environment, and the service users comfort and safety. The programme should included all areas identified in this report. 3 20 4 20 5 23 6 24 7 8 24 34 Action should be taken to reduce the risk of injury to service users from unguarded radiators. Records of CRB checks should include details of level of check, name of person examining the information and the signature of the person receiving the information at the home. 9 39 Quality assurance systems such as service user surveys should be implemented 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). 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. Care Homes for Adults (18-65 years) Page 29 of 29 - 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. 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