Inspection on 13/08/09 for Bowmans Lodge

This inspection was carried out on 13th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bowmans Lodge 14/12/09

Bowmans Lodge 20/08/07

Bowmans Lodge 13/09/06

Bowmans Lodge 24/01/06

Bowmans Lodge 05/07/05

Bowmans Lodge 10/01/05

Bowmans Lodge 13/09/04

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Bowmans Lodge 46 Coombes Road London Colney Hertfordshire AL2 1ND     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: Sheila Knopp     Date: 1 3 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 28 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 28 Information about the care home Name of care home: Address: Bowmans Lodge 46 Coombes Road London Colney Hertfordshire AL2 1ND 01727823273 01727823273FP bowmanslodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr V Pyneandee,Mrs M Pyneandee care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Bowmans Lodge is a privately owned and run care home, registered to provide care and accommodation for up to three younger adults with a learning disability or with a mental health disorder. The home aims to offer a supportive environment, to enable service users to gain or regain skills and to recover the confidence necessary for them to be able to move on and live independently within the community. The home is a semi-detached house, situated in a residential area of London Colney. The accommodation is on two floors and includes communal areas and office/sleep-in Care Homes for Adults (18-65 years) Page 4 of 28 3 3 Over 65 0 0 Brief description of the care home provision for staff. The home operates a no smoking policy although a covered area is provided adjacent to the garden, where residents may smoke if they choose to. he front garden has hard standing for car parking; the rear garden provides additional seating areas for residents. The current fees for the residents who are all sponsored by a local authority range from 650 pounds - 770 pounds per week. Information regarding the service is available in the Statement of Purpose and Service User Guide, these and a copy of the most recent CSCI inspection report are available on request from the service provider. Care Homes for Adults (18-65 years) Page 5 of 28 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 last full inspection of this service took place on 30/8/07. At that time Bowmans Lodge was assessed as providing a good service. This meant we carried out an annual service review during 2008 that did not involve a visit to the house and looked at the information available and an assessment of risk. The information in this report is based on an unannounced visit to Bowmans Lodge at the time people were arriving home from the community facilities they take themselves to during the day. To make sure we have included the views of people who live at Bowmans Lodge and people who support them we sent them survey forms to service users and invited them to pass one on to their relatives if they wished. We also invited staff and community health and social care professionals who visit and support the people living at Bowmans Lodge to give us their views. We received completed surveys from 3 Care Homes for Adults (18-65 years) Page 6 of 28 residents, 3 relatives and 3 staff. We have also reviewed the information we have received about this service since our last review. This includes notifications about events occurring within the service and the managers annual quality assurance assessment (AQAA). The AQAA tells us how well outcomes for people using the service are being met. It also provides us with some numerical data. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 28 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be involved in an assessment of their needs, involving other people who know them, before they come to stay to make sure Bowmans Lodge is right for them. Evidence: To look at how people are involved in choosing to live at Bowmans Lodge we had conversations with two of the people who live there and reviewed relevant records. The people living at Bowmans Lodge confirmed they were able to visit the home and meet other residents before making their decision to stay. Before people come to stay the manager receives information from other health and social care professionals about the support each person needs and carries out his own assessment to make sure Bowmans Lodge can offer a suitable service. We have advised the manager to update the information available about the service to include the new contact details for the Care Quality Commission Care Homes for Adults (18-65 years) Page 11 of 28 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. The people living at Bowmans Lodge are involved in deciding how they wish to organise their lives and receive support to make decisions and manage risks. Evidence: The people we spoke to confirmed they are involved in making decisions about their lives. The managers self assessment (AQAA) states that the well-being and safety of the residents in the home and while out in the community are supported by risk assessments. Each person living at Bowmans Lodge has a plan of care they have agreed and is kept up to date. This includes an assessment of risk. Annual reviews (CPA) involving service users and the community professionals who support them are up to date and confirm their needs are being met at Bowmans Lodge. Care Homes for Adults (18-65 years) Page 12 of 28 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 are supported to lead a life that encourages them to use their talents and skills according to their individual circumstances. Evidence: We had discussions with two of the people living at Bowmans Lodge and the staff who support them to find out whether service users are encouraged to lead fulfilling lives that support their social and cultural expectations. We found each person had very individual but flexible routines. People are able to make use of community facilities independently and follow their own interests. This includes opportunities for continuing with adult education and spending time with relatives. One person particularly enjoyed a recent barbecue that relatives were invited to attend. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: People are able to come and go from their home as they wish and have their own key. They confirmed their privacy was respected and staff knock on their doors if they need to speak with them. People are involved in organising the food they wish to eat. One person told us there is always food provided for a vegetarian diet. People confirmed the food was good and varied. Care Homes for Adults (18-65 years) Page 14 of 28 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. People are given support to maintain their dignity and are involved in decisions about their health. However they need to be assured that the manager will keep important areas up to date so staff are working in line with current professional practice and continue to maintain good outcomes for people using the service. Evidence: We spoke with the people living at Bowmans Lodge, the staff who support them and reviewed relevant care records, policies and procedures and the systems for making sure people have their prescribed medicines. People are prompted to achieve good standards of personal hygiene where this is needed. People confirmed they received a good service from the local doctors surgery they visit. We were able to see that people had access to other community services such as dentists. The regular multi-disciplinary reviews (CPA) confirm that each person has regular health checks to assess their mental and physical well-being. Each persons care plan has details of when appointments and specific tests are due so they are not Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: missed. A relative told us they will always inform me if there is a problem and during the weekend visits phone to ensure pills are taken on time and there seems to be good liaison with others who are treating my relative. People are receiving their prescribed medicines and are involved in collecting prescriptions and supplies. There is a procedure for people wishing to manage their own medicines if this is appropriate and subject to an assessment of risk. Our review of the medication systems within the home found that the polices and procedures in place had not kept up to date with changing practice. The manager did not have access to the latest guidance for care homes written by the Royal Pharmaceutical Society. Staff are giving medicines from a compliance aid (dosette box) that has been filled by the manager from the containers issued by the community pharmacist. The boxes are not labeled with details of the medicines they contain. This practice, termed secondary dispensing, increases the risk of errors. We have asked the manager to discuss this with the dispensing pharmacist to come up with a solution that meets national guidance but supports each individuals specific needs in terms of their independence and access to their medicines. The manager will need to update the homes policies and procedures in light of the guidance and make sure staff are trained in its use. When people are prescribed medicines which can be taken on a when required basis staff need clear guidelines on the circumstances under which they are used and when they can be given. We have also advised the manager to keep a daily record of the storage temperatures to demonstrate medicines being looked after on behalf of service users are being kept at the correct temperature. The manager did not have a training and development plan in place to demonstrate staff receive the training they need to support the current service users. We would advise that the medication competency assessments are reviewed annually to make sure staff are still working within safe practice. Care Homes for Adults (18-65 years) Page 16 of 28 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 can be confident that there are opportunities to raise any concerns they may have through the people who support them within the home and during their contact with other services. There are also procedures in place to protect them from harm but these need up dating to include new contact details. Evidence: The three service users who completed our survey confirmed they knew how to make a complaint. We have also received positive comments from relatives about the service provided. We have not received any complaints between our key inspections and are not aware of any incidents or investigations which would raise concerns about peoples safety and well-being. The manager reported he had attended training on the implications of the Mental Capacity Act. The service user reviews confirm people are involved in making their own decisions in various aspects of their lives and there are no current issues around their capacity to do this. A whistle blowing procedure is available to remind staff what action to take if they are concerned about practices within the service. This needs updating to include current contact details for the authorities concerned. We are told staff receive training in Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: safeguarding of vulnerable adults but this is not supported by the training records. We have referred to this further in the staffing section of this report. Service users manage their own finances so this is an area staff are not involved in. Care Homes for Adults (18-65 years) Page 18 of 28 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 are living in a comfortable domestic style home that gives them good access to the local community. This would be further improved by redecoration of the hall, stairs and landing. We have been told plans for this work are already in hand. Evidence: Each person living at Bowmans Lodge has their own room with wash hand basin. They are able to add their own belongings to make their rooms more personal. There is a shared kitchen - dining room, television lounge and bathroom. Steps lead down from the back of the house to a well screened garden, which has a lawn, patio and greenhouse. There is an annexe for smoking outside the kitchen. People are involved in the day to day running of the house and it was was found to be fresh and clean. Work to upgrade the fire safety systems was required by the local fire authority. This work has been completed and confirmation received that it meets the necessary standards. The hall, stairs and landing now need decorating to complete the work and remove areas of where the paint work has become marked. The manager reported that this work is planned and other areas have been decorated to maintain standards. Care Homes for Adults (18-65 years) Page 19 of 28 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. People are supported by a regular team of staff that they know and who respect them. However they need to be assured staff are receiving the training they need to work safely as the training records have not been kept up to date. Evidence: We spoke to the people who live at Bowmans Lodge about the staffing arrangements and looked at relevant staff records. The people who live at Bowmans Lodge feel confident in the support and approach they receive from staff. They are being supported by regular staff they know. Staff are available or accessible to them when they are at home. There are supportive links with another small home locally. A member of staff is available in the home over night. The three staff who completed surveys told us they liked working at Bowmans Lodge. The manager reported that no new staff have started work between our inspections. previous inspections have confirmed that the required recruitment checks to protect people have been carried out. We looked at 3 personnel files and confirmed criminal records checks had been completed. Mr and Mrs Pyneadean who provide the bulk of cover during the day have Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: considerable experience working with people who have mental health problems. They are the only two full time members of staff available. The remaining staff work part time on a sessional basis. Many of the support staff working during the evenings and at night also have professional qualifications in the area of mental health. Our main concern is that the manager has not kept the training records up to date for each member of staff. We were not able to link the list of training detailed in the managers self assessment (AQAA) to the staff who work in the home. The certificates we looked at in the 3 files related to 2006 & 2007. The worker who came on duty confirmed they had received first aid and food hygiene training from another employer. The manager has details of his fire marshall training but was not able to provide information on the staff trained to follow procedures within the home. Putting a training matrix in place would enable the manager to monitor the progress of training throughout the year and identify any gaps that need addressing with staff. We need to recognise the limited hours some staff are working in the amount of supervision they receive. Much of the interaction between the manager and individual staff is on an informal one to one basis as staff are working on their own. Details of annual appraisals were available and 3 monthly supervision. The standards refer to a minimum of six staff meetings a year. The manager told us that meetings had taken place on 12/12/08 and 26/7/09 but the minutes were not available at the time of our visit. It would be advisable to review the frequency of staff meetings and plan a rolling programme of meetings at varying times through out the year so people are able to attend. Minutes should be circulated and signed to keep staff up to date. Care Homes for Adults (18-65 years) Page 21 of 28 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. The people who live at Bowmans Lodge continue to express satisfaction with the support provided to them. However they need to be assured that the management systems, put in place to protect them, will be kept up todate. Evidence: This is a service that has achieved positive outcomes for the people who live there over time. However we are concerned that specific areas of management referred to in this report have not been kept up to date between our inspections. A monthly health & safety audit is carried out and the service records for services and equipment, in use in the home, including the fire safety systems, were up to date. As discussed in the staff sections of this report we have not been able to confirm that staff have had the necessary health and safety updates to support safe working practices as up to date information was not available and there is no training plan. Apart for the health & safety audit all other areas for measuring the quality of the service appear to be informal and based on the day to day direct contact the Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: manager/owners have with the service. The manager sent us the AQAA when we asked for it but it was unreliable in some areas. For example staff training. An audit of staffing records would have identified this as an area for further action Accidents and incidents would be recorded and reported but we have been advised no issues have occurred. There is an up to date insurance certificate in place covering the service. As discussed in other areas of this report policies and procedures need to be updated in light of changing practice and regularly reviewed. The managers AQAA did not provide details of when the policies and procedures were last reviewed. Service users manage their own finances so this is an area staff are not involved in. Care Homes for Adults (18-65 years) Page 23 of 28 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 24 of 28 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 Medicines prescribed for service users and administered by staff must be given out from the original containers provided by the dispensing pharmacist. This is to reduce the risk of errors. 30/09/2009 2 19 13 Regulation 15 also applies. When people are prescribed medication on a when required basis there must be clear guidelines for their use and the reason they are used must be recorded This will protect people from harm and ensure medication is not given inappropriately. 30/09/2009 3 35 18 The registered person is required to put a training and development plan in place for 2009/10 covering; statutory training (fire, first aid, food hygiene, infection 30/11/2009 Care Homes for Adults (18-65 years) Page 25 of 28 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 control), training relevant to the provision of a mental health service and protection of vulnerable adults. This is to make sure staff receive the training they need appropriate to the job they do. 4 35 18 The registered person is required to ensure each member of staff has an up to date training record. This is to make sure staff receive the training they need appropriate to the job they do. 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 30/11/2009 1 19 Record the temperature of the medication storage areas, at intervals appropriate to the assessment of risk. This is to demonstrate medicines are being stored according to the manufacturers instructions and are safe to use. Review the frequency of staff meetings to enable people to meet together as a team and influence the running of the home. Records of meeting should be recorded and circulated so people are kept up to date with discussions and decisions. We would encourage the owners of the service to take advice on how to introduce a quality assurance system, appropriate to the size of the service, that takes account of the views of service users and key people in contact with Page 26 of 28 2 33 3 39 Care Homes for Adults (18-65 years) 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 the service. Care Homes for Adults (18-65 years) Page 27 of 28 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. 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