Inspection on 03/09/08 for Alma Lodge

This inspection was carried out on 3rd September 2008.

CSCI found this care home to be providing an Good 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

Alma Lodge 04/10/06

Alma Lodge 15/11/05

Alma Lodge 05/05/05

Alma Lodge 22/12/04

Alma Lodge 28/04/04

Alma Lodge 05/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 22/11/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Alma Lodge 15/17 Alma Road Sheerness Kent ME12 2NZ     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: Sue McGrath     Date: 0 3 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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.csci.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: Alma Lodge 15/17 Alma Road Sheerness Kent ME12 2NZ 01795669824 F/P01795669824 philip.pinagapany@almalodge.biz Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Jean-Philip Pinagapany Type of registration: Number of places registered: Mr Jean-Philip Pinagapany care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Alma Lodge is a home for people with severe Learning Disabilities. The Home can accommodate up to 10 service users. The Home is a house that has been converted and is on several floors. The Home does have a lift for those who have mobility problems. There is a small garden to the rear with a building, which is accessible to the service users and is well maintained. The Home itself is in Sheerness very close to the sea front and is in walking distance of the Town Centre, which affords access to some High Street stores. The Home is also within walking distance of a bus route and a short ride from the main line railway station. There is parking available in the street outside the home. The Home has no off-road parking. The weekly range of fees for the service is 700 pounds to 1,000 pounds per week. The overall quality of the service is good. 11 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 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: This was a Key Unannounced inspection that took place in accordance with the Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and the outcomes are promoting the best interests of the people living in the home. The IBL process for a key inspection involves a pre- inspection assessment of service information obtained from a variety of sources including an annual self- assessment and surveys. Is now a legal requirement for service to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at looking at how services are performing and achieving outcomes for people. Care Homes for Adults (18-65 years) Page 6 of 29 Judgments have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgments have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. The actual site visit to the service was carried out over one day by Sue McGrath who was in the home from approximately 09:30 to 15:30. The main focus of the visit was to review any improvements made since the last visit and the well-being of any of the service users. Time was spent touring the building, talking to people living in the home where possible, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Prior to the site visit the AQAA had been returned and some surveys had been sent out to service users, families and professionals to gain further feedback as to their opinions of the service. A small number of surveys had been returned. At all times the Team Leader on duty was helpful and demonstrated a pro-active approach to ensuring that service users were being supported by staff to the best of their abilities and resources. Overall this was a positive inspection with good outcomes for people who live in the home. The inspector on leaving the home was satisfied that the people who live in the home were both safe and well cared for and wishes to thank the staff for their assistance and hospitality. Due to the nature of the service it is difficult to reliably incorporate accurate reflections of some of the residents views in the report and therefore greater emphasis has been given to relatives/representatives views of the service provided. Responses received from relatives, representatives and commissioning staff indicated people were generally very satisfied with the standards of care provided. What the care home does well: What has improved since the last inspection? What they could do better: All staff need to have regular and structured supervision. There are gaps in staff training and knowledge and this needs to be managed well. All staff should have training in Adult Protection. NVQ qualifications need to be promoted. Senior staff would benefit from in depth medication administration training. Care Homes for Adults (18-65 years) Page 8 of 29 The home is strongly advised to complete a first aid risk assessment to ensure they have sufficiently trained staff on duty at all times with the relevant first aid training. The home must endeavour to maintain a stable staffing group. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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. Prospective sevice users are provided with the majority of the information they need to make an informed choice about where to live prior to admission and are provided with a statement of terms and conditions of residency. Prospective service users have an opportunity to visit the home prior to admission. Evidence: Any prospective service user and or their families would be given a statement of purpose, however this document needs to be updated to accurately reflect what is offered by the home. Minor changes need to be made to what activities are on offer and it is also advised that the fire precautions for the home are added to the document as required by Schedule One of the Care Standards Act 2001. The home has not admitted any new service users recently but the Team Leader on duty explained the process that would be used and this included a full needs assessment prior to admission. The home would work closely with care managers and Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: families to ensure it could meet the assessed needs of the prospective service user. The Team leader also confirmed trial visits would be encouraged. Where a placement had been agreed a contract was in place and where possible the service user signed it. In relaity these were normally signed by relatives. 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 live in the home have their changing needs reflected in their individual care plans. People who live in the home are consulted where possible to make decisions in their daily lives. People who live in the home are supported to take risks as part of an independent lifestyle Evidence: Three of the care plans were viewed during the inspection and these were found to be robust and informative. They were clearly written and gave good instructions to staff on how best to care for the individual. It was evident when speaking to staff that they encouraged service users to remain as Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: independent as possible and were seen to give choices over daily living skills. With the level of disability in the home it was difficult for the service users to attend and participate in regular residents meetings, but staff were proactive in supporting them and in ensuring the home was run in their best interests. Evidence was seen that the management team undertake risk assessment to ensure the safety of the service users. It was also evident that the level of risk assessment did not hamper the service users living an independent life within the homes risk management strategies. All information relating to each service user was maintained and stored in a secure and confidential manner. Staff spoken with were aware of their responsibilities regarding confidentiality and the home had policies in place for them to follow. 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 live in the home have the opportunity to participate in age appropriate leisure activities in the community that encourage personal development. People who live in the home are enabled to enjoy appropriate family relationships. People who live in the home have their rights respected in their daily lives and are offered a healthy and nutritious diet. Evidence: There were a variety of different activities for service uses to participate in . These ranged from swimming, pottery, arts and crafts and theatre trips. One service users attended a local adult education centre for four days a week. All had daily individual activity sheet that identified each separate activity and who the lead member of staff Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: was for that activity. Some of the service users regularly attend a local Church and take part in community activities within the Church. One of the service users had a job in a local pub and several others attend the local college for a range of activities. Each service user had a holiday in the last year and recent trips have included Butlins and Centre Parcs. A variety of social activities were also arranged with service users enjoying a range of social activities including Halloween parties, ice skating, ten pin bowling, nature walks and outside entertainment for family members as well. A PAT dog scheme had been introduced encouraging service users who wish to spend time with animals or even to take dogs for a walk. The home is planning to introduce some specialist communication aids for service users who have some problems communicating well. One Care Manager spoken with confirmed she was happy with the level of activities undertaken and that her clients regularly enjoyed trips out. Family contact was encouraged and relatives regularly visit the home and were invited to reviews every six months. Staff were seen to be respectful and supportive of service users during the inspection and the atmosphere was relaxed and cheerful. Service users meals were individually catered for and meal times were flexible to meet the needs of the service users and their daily activities. Menu plans were seen to give choices. The home has sought advise from a Dietitian from Minster Hospital for specialist diets. 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 who live in the home receive personal support in the way they prefer and their health needs are well met. The home has handled the issues of illness and ageing sensitively. Evidence: All service users are registered with a local G.P., Dentist and Optician. Records seen indicated that individual health care needs were being met. Records were maintained of each visit with outcomes recorded and acted upon. None of the service users had the capacity to self medicate their personal medication. The home had a procedure in place that ensured the medication was appropriately dispensed but concerns were raised over the level of training the senior staff had undertaken. Only two members of senior staff had undertaken any training and this only consisted of a half day course. Advise was given on the day regarding more robust training courses and it is strongly advised that senior staff undertake these or similar courses as soon as possible. The home is also strongly advised to obtain a copy Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: of The Royal Pharmaceutical Society of Great Britains Handling of Medicines in Social Care. It is also advised that the homes policy on the safe administration of medication is reviewed and updated to ensure it complies with good guideline practices. Evidence was seen that the home manages illness and the care of the dying in a sensitive and caring manner. 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 living at the home can be confident their views will be listened to and acted upon. People living at the home can be confident they will be protected from abuse by the homes policies and procedures. Evidence: The Team Leader confirmed that any concerns raised by families were dealt with quickly and effectively. One to one communications between families and Alma Lodge takes place on a regular basis and this helps to maintain a good level of trust. Five relatives returned comment cards and all were happy with the service offered. The home has a robust Adult Protection policy in place but more of the staff group require training. The staff spoken with were able to display a good understanding of Adult Abuse and Protection. The home or the Commission has not received any formal complaints since the last inspection. 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 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 benefit from a clean, hygenic and homely environment and have rooms that suit their needs. Evidence: There have been some improvements to the environment of the home and the work is ongoing. New windows had been fitted to the front of the house and two new fire doors had been fitted to the rear of the buidling. The owner confirmed that all of the bedrooms had been decorated since the last inspection. Extensive work had been undertaken on updating the lift for the convenience of the service users. One area of concern was the condition of the hallway and landing on the upper floor. The owner said they had suffered a leak and although the leak had been repaired, the walls now urgently need plastering and decorating. Some staff confirmed this area had been in that condition for a long time and work must now be completed. Most of the bedrooms were viewed and were clean and tidy and mainly well personalised. The lounge and dining areas were comfortable and clean. Some of the Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: furniture in the lounge was in need of replacing, but the manager confirmed they were planning to purchase some new furniture in the very near future. When decorating the home must be carefull not to paint over the intumescent stips around the doors as this may effect the fire protection afforded by the door. A recent fire in the rear alley had damaged the outhouse that was used as a sensory room. No damage was done to the main building. Work has started on replacing the roof and repairing the damage to the interior. The carpet in the lower lounge will need to be replaced soon as it has frayed across the doorway and could be a trip hazard, again the manager stated they were aware of the problem and were hoping to replace the carpet soon. The home has taken advise from the Speech and Therapy Team at Maidstone to give input into what colours the home should be using in order to benefit any service user with sight problems. The home has sufficient toilets and bathrooms to promote privacy and to meet individual needs. Due to the layout of the building the home may not be suitable for service users with mobility problems. Care Homes for Adults (18-65 years) Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A high turnover of staff has the potential to put the people who live in the home at risk. Staff training is below the expected level and has the potential to put people who live in the home at risk. Good recruitment policies and procedures are in place to protect the people who live in the home. The care of the people who live in the home may be compromised because staff supervision is not carried out on a regular basis. Evidence: Three staff files were viewed and were found to contain all of the information required by Schedule two of the Care Standards Act 2001. All staff had be supplied with a copy of their job description and these were seen to be signed by the staff member. There was some discussion about the high turnover of staff in the home and different figures were given in the AQAA and during the inspection. The AQAA stated 42 full Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: time staff had left but the manager stated only 15. Clearly these figures were very different. However if the lower figure was taken, it still remains high. This is likely to effect the continuity and consistency of care being provided to the service users and must continue to be monitored by the manager. The home has recently employed five new staff members of staff, some of whom were undertaking their induction programme on the day of the inspection. The induction programme viewed appeared comprehensive and suitable. However, records indicated that this course was meant to be covered over a period of up to six months but was regularly completed in a couple of days. This calls into question the effectiveness of such a course and the home is recommended to review this current practice. Training of staff is also an area of concern and the training matrix submitted on the day indicated some shortfalls in several areas. The home has only one day carer and two night carers who have completed a basic first aid course. One member of the domestic staff and the handyman have also completed a basic first aid course. The National Minimum Standards state a qualified first aider should be available at all times (NMS 42.2 for younger adults). The Commission believes the assessment of first aid provision needs to take a flexible and proportionate approach when inspectors are judging care providers against this standard. It needs to be tailored to the first aid needs of the people who live in the service. The full guidance can be found on CSCI website and advises the providers to complete a thorough first aid risk assessment to include the needs of the service users, how likely first aid will be needed and what type of first aid is likely to be needed. The risk assessment should identify the training requirements needed to meet the needs of the service users. As mentioned earlier in the report medication administration training needs to improve. The levels of completed NVQ in care are very low, with only 2 members of staff having completed their award. This was discussed with the manager who informed the inspector the she was currently arranging with a training provider to start NVQ training for all staff this autumn. Adult protection training is also required. Staff supervision has improved but it was not seen to be consistent with some staff not receiving regular supervision. This is an area where the home needs to improve. Care Homes for Adults (18-65 years) Page 23 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 who live in the home benefit from a well run service and where ever possible their views are listened to and acted upon in the development of the home. The health, safety and welfare of people who live in the home and the staff is promoted and protected. Evidence: On the day of the inspection the Deputy Manager was on annual leave and the inspection was led by the Team Leader. Further discussion with the Provider confirmed the Deputy Manager was not registered with the Commission but was hoping to start her application in the very near future. The Provider was currently registered as the manager but agreed he is not in the home on a daily basis, however he does have a major input into the home. The Deputy Manager was currently completing her Registered Managers Award (RMA) but had not completed any National Vocational Qualification (NVQ) in care or management. The Deputy Manager was spoken with the following week and was enthusiastic and aware of her responsibilities. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Staff at the home all said they felt well supported by the senior team and enjoyed working at the home. The home has a range of policies and procedures in place, most of which had been updated, that safeguard service users rights and best interests. Records seen indicated that service users live in a safe environment with most of the necessary maintenance checks being carried out. Discussion took place regarding the weekly recorded of fire call points and the recording of water temperatures. The Team Leader agreed to start recording both items. All staff had undergone regular fire drills and these were well recorded. Care Homes for Adults (18-65 years) Page 25 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 26 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 1 19 13 The registered person shall 28/11/2008 make suitable arrangements for the recording, handling, safe administration and disposal of medicines received into the home. In that staff who administer medication should be appropriately trained. 2 32 17 The registered provider shall 12/11/2008 ensure that persons employed by the home receive training appropriate to the work they perform. In that staff are trained in Adult Protect, Medication Administration and First Aid. 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 1 It is recomended that the homes statement of purpose be revised to reflect what the home currently offers. Care Homes for Adults (18-65 years) Page 27 of 29 2 3 4 19 32 36 It is recommended that the homes medication policy be reviewed and updated. It is recommended that at least 50 of staff complete a minimum NVQ level 2. It is recommended that all staff receive structured supervision at least six times a year. it is recognised that this has improved since the last inspection. It is recommended the home has a manager in place who is registered with Commission and who is in the home on a daily basis. 5 37 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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