Inspection on 24/08/09 for Boundary House

This inspection was carried out on 24th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Boundary House 01/10/07

Boundary House 27/11/06

Boundary House 12/01/06

Boundary House 16/08/05

Boundary House 04/03/05

Boundary House 15/09/04

Boundary House 11/03/04

Similar services:

Coopers Mill Ltd

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Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Boundary House Haveringland Road Felthorpe Norwich Norfolk NR10 4BZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Hilda Stephenson     Date: 2 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Boundary House Haveringland Road Felthorpe Norwich Norfolk NR10 4BZ 01603754715 01603400418 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Sandra Bridgwood,Mr Canabady Mauree Name of registered manager (if applicable) Mrs Lesley Anne Dack Type of registration: Number of places registered: care home 10 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 10 The registered person may provide the following categories of service only: Care Home only - Code PD, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Boundary House provides residential care for up to 10 adults with learning disabilities, it is situated on the outskirts of the village of Felthorpe, which is a few miles from the city of Norwich. The home is situated in extensive grounds containing portacabins, greenhouses and other outbuildings. Bedrooms are located on the ground and first floors. There are communal lounge, dining and kitchen areas. There are two bathrooms Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 10 Brief description of the care home and one shower room. Service users living in the home access day services, including those operated by the proprietor in North Walsham. The home has its own 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 peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspection undertaken by the Care Quality Commission (CQC) is upon outcomes for people who use the service and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting people who use the service and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The new manager and two members of staff were spoken with as part of the visit, records relating to medication management was also inspected to form an opinion Care Homes for Adults (18-65 years) Page 6 of 29 about the quality of care provided. A partial tour of the building was undertaken which included peoples bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since the last key inspection was considered in planning this visit, which included the Annual Quality Assurance Assessment (AQAA) which was provided by the registered manager, the five responses we received to Have you Say service user surveys, which were completed during the inspection visit. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: There is continuous building work surrounding the home and risk assessments need to be in place to ensure the environment is safe for residents when going outside. The carpet in the lounge needs replacing or cleaning as its current state is rather grubby. One bedroom that has been altered and floor space reduced must comply with the regulated size otherwise this bedroom will need to be deregistered. The provider needs to take on board the comments received regarding the flexibility of funding for staff when accompanying residents out to meals and days out to ensure they are not out of pocket because this is part of their work duties. The manager will need to monitor staff training for the administration of medication to ensure everyone is up to date. The manager will require to attend adult protection training to ensure she understands the local adult protection procedure. The manager must ensure staff do not work over the recommended hours laid down by the European Directive for working hours when they are working overtime. The financial records of residents need to be made safer to eliminate any risk of mistakes. Care Homes for Adults (18-65 years) Page 8 of 29 The provider must also consider residents and staff comments on the transport situation which are not currently meeting the residents needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for 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 residents are given the information and have there needs assessed before moving into the home. Evidence: Two residents who were admitted to Boundary House this year were asked about their experience of the admission process, both were spoken to during this inspection to obtain their views about how they moved in and the admission records were read. One resident said I went to another place before this one and I prefer living here. The admission records contained details of the residents care, social and behavioural needs, the previous manager had visited both people before inviting them to visit the home. New residents follow a transitional staged admission which can take a few weeks to several months depending on each persons individual needs. Reading both admission details the two residents who were case tracked showed that they visited the home to meet the other residents who already lived there, they were shown there room, stayed for a meal and stayed overnight, one made several visits while the other Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: made their decision after the first visit. Both residents confirmed they were given details either in the written format or the picture format of the services that the home offers. 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. Residents have their needs assessed on a regular basis and are supported by the staff team to make their own choices. Evidence: Two residents care plans were read and both residents were spoken to regarding the care they receive at the home. The care plans contained clear information on the residents general personal care needs, social care needs and behavioural needs as well as their preferred lifestyle options. There were good risk assessments in place to enable both residents to live the life they prefer. Evidence of how the staff include the residents in making there own decisions and regularly discuss there care needs at the care plan reviews with the manager and senior support workers. Each care plan is individually based. Comments obtained from five surveys that were completed by residents suggest that they are quite happy with the care and support they receive from the staff. Care Homes for Adults (18-65 years) Page 13 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. Residents are supported to live a fulfilling lifestyle, however experience a reduction with the number of outings they can take during the week. Evidence: Both residents and staff stated that the owner had removed the second mode of transport that had reduced the times that residents could go out. The staff were using there own cars to take residents to GP or other appointments which is not satisfactory, and can be an insurance risk for both staff members and residents. There was now only one minibus and this was used to transport residents to the day centre in North Walsham so reducing times to evenings and weekends for the rest of the residents, hence reducing there choice. Spoke to two residents in detail about what they did during the week. One said he didnt like going out much so stayed in the home most of the time, going out for a Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: drive with another resident at weekends. He watched TV, played games with staff, and took part in some of the painting and crafts the staff organised. The second resident attended the horticultural department behind the home on three days a week, and did small gardening projects for the home and other homes within the company. He gets paid for this work. He also attended City college one day a week to develop his cooking skills. He had a home day during the week and usually went shopping for the homes food and his personal items and usually went out in a staff car for this. He said he goes out at weekends with a member of staff. He takes part in some crafts and plays games with the staff but apart from that he watches TV or plays his music in his room. Both residents activities match up with the details written in the care plan. The manager said that staff tend to cook the evening meal and prepare lunch for the residents, although some residents help with meals if they want to. The kitchen has been redone since the last inspection. It was clean and had the required storage and cooking areas within it. The meals were arranged on a weekly basis after the residents meeting when the menu was discussed. There was some flexibility with alternative meals for those who did not want the main meal, although the manager said that the money put aside for this was a struggle to meet everyones request. The staff had compiled a picture menu of various foodstuff and meal choices to enable those residents with difficulties to be able to make there own choices, which is good practice. The weeks menu showed that a varied diet was planned, with fresh fruit and vegetables used most days. Residents were able to make there own drinks if able, otherwise the staff did this for them. The staff said that when they accompany residents they are allocated a fixed amount to pay for their own meal as part of their duties, this amount was not adequate and staff tended to pay towards their own meal when out with residents. Care Homes for Adults (18-65 years) Page 15 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. Residents are supported by staff to attend appointments with other professionals, and a safe system for medicine administration is in place. Evidence: Both residents who were case tracked were supported by staff with their appointments to visit other professionals. Although the staff tended to take residents out in there own cars as the transport had been reduced, the minibus was used for residents for the day centre. The provider must ensure that current insurance is in place for this to carry on or provide alternate transport for residents to attend appointments. The medication system in place was seen along with checking the medication records and these were found to be satisfactory. Two records were checked, ordering, administration and returning medication was in place. Storage of medicines was secure and all medication was signed for. The training records of staff were not available so the manager must commence a monitoring system to ensure staff are up to date with administering medication. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents complaints must be dealt with in a satisfactory manner and they should be free from harm. Evidence: The manager has a complaints log which contains any complaints or concerns from residents and the action taken. The complaints policy is situated in the hallway and includes a picture format as well as the written document. The manager said that all residents are given a copy of this when they are admitted. There had been several complaints made by people about the building work that had been going on during recent months, both residents, staff and visitors have been rather unsettled during this period. The provider visited during this inspection and said the building work and alterations were nearly completed. One resident said it is dusty and noisy here sometimes. Another resident said I cant get to some areas of the garden because the builders are still busy. Five surveys were received from residents and all five stated that they knew who to complain to and that they knew these would be dealt with. Staff have received adult protection training within the company, this commences at the induction stage with regular annual updates. Staff who were spoken to understood the need for the whistle blowing policy to eliminate bad practice, and were aware when questioned about the protection of Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: vulnerable adults procedure. The manager will need to update her own adult protection training to comply with local procedures. Care Homes for Adults (18-65 years) Page 18 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable home, however the building work has caused some upheaval and noise. One bedroom has been reduced in size and no longer meets the regulations. Evidence: There has been major disruption to residents over the past few months due to major building work going on, a new unit has been added to Boundary House, alterations to three of the residents bedrooms and alteration to the garden and car parking area. The addition of a new eight bed unit is nearly completed, this is attached to the original building. Three bedrooms have had an additional en suite added to there rooms. Unfortunately, one of the bedrooms currently occupied, has been reduced in size and now falls below the minimum requirements so will need to be de-registered by the provider because it no longer meets the regulations. During the tour of the building and grounds, and some of the residents rooms, the home in general, needs some redecoration. Residents rooms were decorated with there own personal colour scheme and contained various amounts of personal possessions. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: The communal areas were homely although the lounge carpet was rather grubby and needs cleaning or replacing. The outside areas need to be safe of risk of personal harm to residents. The kitchen had been replaced and was a large open plan room with the required domestic appliances in place. The laundry was still being done in a separate annex. One resident commented the home is nice and warm. Out of the five surveys returned three said that the home is sometimes fresh and clean and two said that it is always clean. One said the carpet in the sitting room needed cleaning. The AQAA states that all residents have their own key to their rooms and the bedrooms are kept clean, tidy and homely. The accommodation is situated on two floors, with four bedrooms on the ground floor and six bedrooms on the first floor. There is a lounge and bathroom on both floors. 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. Residents are supported by a well trained staff team. Evidence: The rota was seen and this showed that five support workers were on duty during the day from Monday to Friday, two of these carers accompanied residents to the day centre during the week, leaving three support workers with the remaining residents. One of the three left was either a senior or the manager. Four staff were on duty during the evening, reducing to two support staff overnight. During the weekend there were four staff on duty. The manager said that they still use agency staff and the two staff who covered shifts worked at the home on a regular basis so the residents knew them. Staff working hours were sometimes over the recommended forty eight hours and this needed further investigation by the manager to ensure that staff are not working too much overtime. The AQAA states that new staff were recruited by the service manager and the operations director who follow a good clear recruitment procedure. This was checked by reading two staff files, the required vetting of new staff had been carried out appropriately before commencing work. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: All new staff commence the induction programme and have an opportunity to visit Boundary House to meet the residents, before becoming part of the staff team. Staff files showed the training schedules, with several of the staff team having achieved the recommended national vocational qualification (NVQ). Both staff files contained certificates and training records, the infection control training needs to be updated to correspond with current guidelines. The AQAA states that this has been done but no evidence was seen. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that has had some upheaval in recent months, the staff support them to ensure a safe environment. Evidence: There has been a change of manager since the last inspection, the new manager who is currently undergoing the registration process is Lesley Dack. A qualified nurse with experience of working with people with learning difficulties. The home has not had a quality assurance survey carried out and this needs to be completed if the home is to plan for the future especially with the addition of the new unit. Residents, relatives and visiting professionals opinions must be included. The records of residents finances must be recorded on one sheet to reduce the capacity of making a error, where the current system is over two pages. Of the five surveys received from residents, three state that staff always listen to them and act on what they say and two said they usually do. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: All the residents who were spoken to said that the manager is good, and that they speak to her when they can. Both staff and residents confirmed that the new manager holds regular meetings which are minuted, to obtain their views on the day to day running of the home. Staff files showed that they are supervised at regular intervals by either the manager or team leader. The operations director visits the home on a regular basis to audit the records and support the new manager with her role. The provider visits the home to keep residents and staff up to date with the current building work. A sample of the records of maintenance for fire, water, central heating, accidents, security and risk assessments were checked and found to be satisfactory. The registration certificate and insurance certificate were displayed. Care Homes for Adults (18-65 years) Page 24 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 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 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 20 13 Staff training records for the 24/12/2009 administration of medicines must be up to date. The provider must ensure that staff have received training before administration of medicines. 2 23 13 The manager must attend adult protection training to comply with local procedures. . The outside area must be made safe to eliminate risk of harm to residents. Risk assessments must ensure the safety of residents when outside the building. 24/12/2009 3 24 16 26/10/2009 4 24 16 The carpet in the lounge requires cleaning or replacing. 26/10/2009 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 Requirement Timescale for action The carpet in the lounge is stained. 5 25 16 The bedroom that has been reduced in size does not meet the requirements and must not be inhabited. The size of the bedroom does not comply with the minimum standard and should not be used. 6 39 24A The opinions and views of residents, relatives and other professionals must be sought to compile a quality assurance survey. Views of people must be sought to be able to plan for improvement. 7 42 13 Staff require updated infection control training. Staff need to be aware of the up to date training to prevent the spread of infection. 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 21/10/2009 24/12/2009 24/12/2009 1 13 The Provider should consider whether the needs of residents are being met after removing the second mode of transport. 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 3 4 14 33 41 Staff should receive a realistic budget when accompanying residents on outings and meals. The manager must ensure that staff do not work above the recommended hours as set by the European directive. Residents financial records need to be recorded on one sheet to reduce the risk of error. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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