Inspection on 17/12/08 for Moston Grange Nursing Home

This inspection was carried out on 17th December 2008.

CSCI 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

Moston Grange Nursing Home 02/02/07

Moston Grange Nursing Home 20/09/05

Moston Grange Nursing Home 12/03/05

Moston Grange Nursing Home 14/02/05

Moston Grange Nursing Home 04/08/04

Moston Grange Nursing Home 25/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Moston Grange Nursing Home 29 High Peak Street Newton Heath Manchester M40 3AJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Val Bell     Date: 1 8 1 2 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Moston Grange Nursing Home 29 High Peak Street Newton Heath Manchester M40 3AJ 01612191300 01612191118 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : EHC Moston Grange Limited care home 64 Number of places (if applicable): Under 65 Over 65 1 dementia Additional conditions: 0 That the home provides accommodation for service users on four separate nursing units, each accommodating up to 16, with discrete and identifiable staff groups. That the number of persons requiring nursing care by reason of dementia at any one time shall not exceed 64 aged less than 65 years at the time of their referral, except for a variation granted in respect of age for one named individual. When a non - nurse is employed as the manager of the home, a nurse registered on either Part 3 or 13 of the Nursing and Midwifery Council Register is employed as the care to be professionally responsible for the delivery of nursing care. Date of last inspection Brief description of the care home Moston Grange Nursing Home provides accommodation with nursing care for a maximum of 64 adults with dementia. The premises are owned by E.H.C Moston Grange Limited, which is a wholly owned subsidiary of Equilibrium Healthcare Limited. The home is situated in the North of Manchester City Centre close to main transport routes to and from the city with local shops and amenities within walking distance. The home offers single storey accommodation within bungalow style buildings and all bedrooms are single with en-suite facilities. Off-the-road parking is available for Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home approximately 15 vehicles and gardens were accessible to the people living in the home. 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: This was a key inspection carried out over two days. The visit was unannounced, which means that the manager was not informed beforehand that we were coming. During the visits we spent time talking to people living in the home, visiting relatives, nursing and care staff, the manager, two clinical nurse managers and the chef. We later had a telephone conversation with the operational manager. We looked at various records and walked around all parts of the home during our visits. We also considered other information received by the Commission since we last visited the home. An Annual Quality Assurance Assessment (AQAA), which is a self-assessment document, was completed by the manager and handed to us on the first days visit. Six Care Homes for Adults (18-65 years) Page 6 of 29 staff and one person living in the home completed and returned satisfaction surveys to the Commission. What the care home does well: What has improved since the last inspection? What they could do better: We found no evidence of consistency in empowering people using the service to be actively involved in the care planning process and this appears to be related to the current staffing situation. This denies people the right to make decisions that affect how their care is to be provided and how the home is run. Concerns had not always been responded to in line with the homes policy and procedures on dealing with complaints. We also found that safeguarding incidents had not consistently been referred to the relevant authorities for investigation. This placed people at risk of not being able to have their concerns investigated and to be protected from harmful situations. The provision of activities had seriously deteriorated since we last visited. The people we spoke to shared the view that this was a result of short staffing. Rosters did not Care Homes for Adults (18-65 years) Page 8 of 29 provide evidence that sufficient staff were being consistently deployed in line with the managers stated minimum staffing levels. Failure to provide regular opportunity for stimulation and interest, denies people the right to lead meaningful lives. Furthermore, in not having the right number of staff, people using this service are potentially placed at risk of harm. As one member of staff said, Its like a time bomb waiting to go off. We also found that the staffing situation had left some staff feeling undervalued. One staff member commented in a survey, We sometimes work short staffed. A thank you would be nice every now and then. This situation had generally had a negative effect on staff morale and communication between the care team and management. It was encouraging that the operations manager told us of her commitment to providing further support for the manager to develop his skills in these areas. We need to be told how this is progressing and have asked for monthly reports to be sent to us. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust systems are in place to assess, monitor and meet the needs of people moving into the home. Evidence: We looked at care records belonging to eight people living in the home. It was pleasing to find that the good standard of needs assessment had been maintained since our last visit. One member of staff told us that when a new person is admitted they have a briefing session with one of the clinical managers to discuss the best way of meeting their needs. This member of staff also said that the correct equipment relating to disability would be ordered. This robust system of assessment ensures that people being admitted to the home can be confident that staff understand their needs and will receive support from management to ensure they will be met. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not providing consistent care and support to enable people to exert their rights to make choices and state their preferences in how they would like to receive the service. Evidence: We looked at eight care plans and found these to have generally been reviewed on a regular basis. When we last visited, care plans demonstrated an emphasis on recording how staff had consulted with each person to find out how they would like their needs to be met. This is referred to as person-centred care planning. During this visit we found there to be less evidence that this person-centred approach was still happening. One care plan gave us cause for concern. The person receiving this service had attended a Care Programme Approach (CPA) review in May 2008. The professionals responsible for her care under the Mental Health Act had made several recommendations in relation to the care and support that should be provided to her at Moston Grange. Records stated that regular reviews had taken place, although none of Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: the recommendations had been included in her care plan and there was no evidence that she had been consulted or given a copy of her CPA review. In conversation with this person we were told that she is uncertain of the reasons why she must continue to live in the home. Had she been given a copy of the CPA review, she would have access to important information relating to decisions that have been taken on her behalf, along with contact information if she decided to speak to the mental health professionals about her circumstances. In failing to provide this information and follow the advice of mental health professionals, this person has been denied opportunities to make choices and decisions that are important to her. The eight care plans contained evidence that risks had been identified at the preadmission assessment. The risks had been assessed and clear written guidance had been provided to inform staff of the action they must take to keep people safe. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of consistent provision of interesting and stimulating activities. This denies people using this service opportunities for personal growth, meaningful occupation and integration into community life and leisure activities. Evidence: It was disappointing to find that the good standard previously achieved in providing interesting and stimulating activities had not been maintained. When we last visited staff told us that activities were taking place daily. This time staff said activities were constantly being cancelled because they were short staffed due to sickness and holidays. Staff and relatives spoken to suggested that it was difficult to provide structured activities when the units were often understaffed. The manager told us about how many staff should be on duty to meet the assessed needs of people living in the home. When we looked at the rosters we were concerned to find that these Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: numbers of staff had not been provided at all times. One member of staff was particularly concerned that people living in the home were not being offered the opportunity to go out as determined by their care plans. She felt that a change of scenery and physical activity would be good for individuals health and welfare. During our two visits we did not observe any structured activities taking place. We noticed that a person living on one of the units had asked to go out to the shop. He had to wait for some considerable time before a member of staff became free to escort him. People living in the home and their relatives told us that visiting times were flexible and some people enjoyed home visits at weekends and special occasions. A four week menu was provided and special diets were being catered for. The chef had a good understanding of individuals dietary needs. The current menu had recently been revised and updated following consultation with people living in the home. We joined people for lunch on our first days visit. A hot meal was provided and we found it appetising and well presented. We observed staff assisting and encouraging people to eat. This was done in an unobtrusive way. Staff spoke to people in a respectful way. People living in the home told us that they were pleased with the meals provided. One person said, I enjoy my food. You can ask for more if youre still hungry. 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. Promotion of health is taken seriously and peoples welfare is monitored and health needs are met. Evidence: We looked at eight care plans and found evidence that people receive good support to access healthcare services in the local community. We looked at how medication was being administered to two people living on one of the units. The medication systems being used were designed to ensure that people received their medication safely and as directed by their doctors. Records appeared to be accurate and the amount of medication held for the two people balanced accurately with the records. A senior member of staff checked the medications systems every month to ensure that they were accurate. This is evidence of good practice. 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. Failure to consistently follow the homes policies and procedures for investigating complaints and safeguarding measures, potentially places the welfare and safety of people using the service at risk. Evidence: We looked at the system in place for investigating and responding to concerns expressed by people using the service and their representatives. Policies and procedures clearly set out the action to be taken for responding to complaints in a timely manner and this had been communicated to visitors and people living in the home. The self-assessment document completed by the manager informed us that there had been eleven complaints during the previous twelve months and that nine of these had been responded to within the prescribed timescale. We found that complaints had been recorded with written details of how these had been investigated. The majority of complainants had been responded to in writing in a timely manner. However, we had concerns in relation to some of these complaints. Two complaints related to allegations of harm experienced by two people using the service. There was no evidence to demonstrate that these issues had been referred to the local authority for investigation under their safeguarding adults procedures or notified to the Commission as required by the Care Homes Regulations. We were told by a relative that he had made several complaints to management about his wife being left unattended in a lounge due to short staffing on the unit. We found no evidence that Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: this had been recorded or formally investigated. The relative stated that he felt management had not taken his complaints seriously and that the situation had not improved. During conversations with another relative and staff we were informed of similar concerns relating to insufficient staffing levels on certain units that potentially placed people at risk of harm. We also found several written examples of breakdown in communication at management level that had resulted in negative outcomes for people using the service. Other incidents occurring within the home had been notified to the Commission and the manager had more recently made an appropriate safeguarding referral to the local authority after taking advice from his inspector. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People accommodated in the home are provided with a safe, clean and hygienic living environment. Evidence: We toured the home with the manager to assess health and safety, cleanliness, hygiene and general maintenance. We found all areas of the home to be clean and hygienic. The decor, equipment and furniture had been well maintained, although some areas had been subject to wear and tear. One of the relatives said that he did not consider the home to be as clean as it should be and described the environment as unloved. Other people we spoke to did not share these concerns and we found no evidence to support this view during our visit. It was generally accepted that the home accommodates people that present exceptional challenges to service delivery and this can have an adverse effect on the environment at times. We found that the regular auditing undertaken had identified when action was needed to make improvements. The manager told us that a number of improvements had been planned for the environment. These included the replacing of floorings on units, modernising staff rest facilities, upgrading of furniture and extending the garden facilities. Additionally, the home had a rolling programme of redecoration to ensure that a pleasant and Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: comfortable environment was maintained for the people accommodated. Suitable laundry facilities were in place and staff had been trained to follow procedures for the control of infection. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The deployment of staff in this home is insufficient and this places the welfare and safety of people using the service at risk. Evidence: We examined four staff files for evidence that suitable checks had been obtained before selecting people to work in the home. These records provided clear evidence of the required pre-employment checks having been undertaken before confirming staff in post. This means that staff working in the home had been carefully selected to ensure that they had the right personal qualities, skills and experience to work safely with people using this service. We recommend that the dates and certificate numbers of Criminal Record Bureau checks are held in personnel files. Following appointment, staff had undergone an induction programme and ongoing training to ensure that they continued to develop the knowledge and skills needed to provide the right kind of care and support to people living in the home. Staff spoken to confirmed that they had regular opportunities to discuss their performance with their line managers. The care team was made up of qualified nurses and support staff. It was pleasing to find that thirty-two care staff had achieved a National Vocational Qualification in care at level 2 or above. Several visitors spoken to praised the Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: commitment of the care team. They were described as caring, helpful, friendly and understanding of the needs of the people they cared for. Concerns were raised during our visit by a relative who told us about his dissatisfaction with the way the home was being staffed. He had expressed concerns about this to the management on several occasions as he felt that his wife was at risk of harm from other people using the service that exhibited challenging behaviour. This relative did not consider that his concerns had been taken seriously or that any action had been taken to improve the situation. He stressed that his concern was not related to the actions of nursing or care staff, but to the way that staffing was being deployed in the home. We also listened to the views of staff and other relatives on this matter and found that people generally agreed that staff were not always being deployed in sufficient numbers to meet the assessed needs of the people accommodated. One member of staff expressed the view that, Its like a time bomb waiting to go off. They explained that staff were working under extreme pressure and they were concerned that, Somebody might get hurt. The manager told us that there should be a minimum of one nurse and three care staff on each of three units during the day, while the fourth unit should be staffed by a nurse and two carers. Examination of the rosters for all four units did not provide evidence that these minimum staffing levels were being consistently maintained. Furthermore, the rosters did not clearly identify where staff had been deployed as in some cases staff names had been duplicated on different unit rosters. Failure to provide sufficient staff at all times potentially places the health and safety of the people accommodated at risk of harm. 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. Shortfalls in managing staff deployment, communication and complaints potentially place the people accommodated in the home at risk of not having their assessed needs met in a safe way. Evidence: The current manager was new in post and had been appointed following the resignation of the registered manager earlier in 2008. He was an experienced and qualified nurse and had achieved the registered managers award. The manager was supported by two full-time clinical nurse managers and the self-assessment document told us that on-call support was provided outside normal office hours. Several of the concerns recorded and incidents occurring in the home related directly to the management of the staff rosters and the changes in the way staff were redeployed to cover for sickness absences. Relationships between management and the care team appeared to be strained, as some staff were feeling undervalued and unsupported at times of staff shortages. One member of staff said in a survey, We Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: sometimes work short staffed. A thank you would be nice every now and then. We discussed this situation with the organsiations operations manager. She expressed a commitment to providing additional support to the manager to enable him to develop his management skills in communication, staff deployment and dealing with complaints. A quality assurance system was in place. This included auditing of policies, procedures and systems used within the home. The AQAA stated that people living in the home expressed their views at regular meetings. There was no evidence that people using the service or their representatives had been asked their views. We examined a sample of health and safety records. These were found to be accurate and up to date. 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 6 15 Care plans must be kept under review and amended as needs change. A copy of the plan must be made available to people using this service. People using the service can be empowered to take responsibility for their own welfare by supplying them with accurate and up to date written information in the form of plans of care. 27/02/2009 2 7 12 People using the service must be empowered to make decisions that affect how their care and support is to be provided. People using the service have the right to express choices and preferences in the way they would like to be supported. 27/02/2009 Care Homes for Adults (18-65 years) Page 26 of 29 3 13 16 Arrangements must be made to enable people to engage in social, leisure and community activities. People have the right to lead meaningful lives and to participate in and contribute to the communities where they live. 27/02/2009 4 22 22 A record must be held of all complaints, how these have been investigated and the action that has been taken to resolve them. People using the service and their representatives have the right to express concerns and should be confident that these will be investigated and responded to appropriately. 17/02/2009 5 23 13 Allegations or suspicions of harm must be reported to the local authority as required by their safeguarding adults procedures. People using the service have the right to expect that their welfare and safety will be protected. 17/02/2009 6 33 12 Provision must be made to protect the health and welfare of people living in the home by deploying sufficient staff at all times. Sufficient staff must be on duty at all times to ensure that the assessed needs of 17/02/2009 Care Homes for Adults (18-65 years) Page 27 of 29 people living in the home can be met. 7 43 26 The responsible individual must arrange for written reports on the conduct of the care home to be submitted to the Commission each month. This enables the service to provide evidence of the action that is being taken to improve the quality of the service provided to people living in the home. 17/02/2009 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 8 People using the service should be provided with opportunities to participate in and contribute to decisions that affect how the home is run. Personnel files should contain a record of the dates and certificate numbers of Criminal Record Bureau disclosures obtained for staff during the recruitment process. 2 34 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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