Inspection on 23/07/09 for Newton House

This inspection was carried out on 23rd July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Newton House 30/07/07

Newton House 13/06/06

Newton House 07/11/05

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Newton House 47 Prospect Road Leicester LE5 3RR     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: Helen Abel     Date: 2 3 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 32 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 32 Information about the care home Name of care home: Address: Newton House 47 Prospect Road Leicester LE5 3RR 01162516112 01162516112 easterncare.ltd@tiscali.co.uk 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) : Eastern Care Ltd care home 26 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 5 26 Service User Numbers No person falling within categories MD/LD may be admitted to the home unless she/he also falls within category MD - ie dual disability. Service user numbers No person falling within categories MD/LD may be admitted to the home where there are 5 persons in total of these combined already accommodated within the home. Date of last inspection Brief description of the care home Newton House is registered to provide care for twenty-six people with a mental disorder, including five people with additional learning disabilities. In the main home the majority of the bedrooms are single, with five shared bedrooms located throughout the three floors of the home. The service users have access to two lounges, one being allocated to residents who smoke. The dining room leads onto the kitchen where the residents meals are prepared. In the two smaller wings of the home there are three places in each, both providing one double and one single bedroom with additional lounge and personal space, the registration categories remain the same as the main home. Street parking is available. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home The home is situated in a multi-cultural area close to local amenities and a fifteenminute bus journey to the city centre. There are local shops, community centres, places of worship and a cinema within walking distance to the home. The range of fees charged is £233.11 to £590.00 per week. The current inspection report is available from the office for prospective residents and their relatives for information purposes. The Employers Liability insurance is displayed in the hallway. Care Homes for Adults (18-65 years) Page 5 of 32 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 Care Quality Commission inspected Newton House against the Care Standards Act 2000. In planning our visit we examined the service history, last key inspection, Annual Service Review (ASR), surveys and the Annual Quality Assurance Assessment (AQAA). People that live at Newton House prefer to be called service users. The focus of inspections undertaken is upon outcomes for service users and their views of the service provided. This process considers Newton Houses capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that may need further development. Care Homes for Adults (18-65 years) Page 6 of 32 This was an unannounced inspection, which took place over five hours to complete with the support of an Interpreter. The visit was held on a Thursday morning at 8.20 around breakfast time. Service users were observed taking breakfast and getting ready for the day. The primary method of inspection used was case tracking which involved selecting three service users and tracking the care they received. Records were reviewed and discussions took place with the two of the three service users. Time was spent speaking to staff that had a good knowledge of this service users needs and looking at their support and care records. Seven service users spoke at length with the Inspector via the Interpreter and gave their opinions of life at Newton House. The quality rating for this service is 1 star. This means the people that use this service experience adequate quality outcomes. 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 following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 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 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with an adequate assessment process. Evidence: Staff told us there is written information available in English about the aims, objectives and philosophy of the home, its services and facilities. A detailed brochure is being drawn up. A Service User Guide was held in the office but was not made available to the Inspector when requested. Such documents must be provided to the Care Quality Commission (CQC) and provided to each service user. The written information (Service User Guide) must be reviewed to ensure it meets all the requirements and is presented in formats appropriate to the needs of Asian service users. Each service user should receive a copy. A needs assessment was sampled and included guidance from consultants and other health professionals. This will help ensure the service users needs can be well met before the actual service is provided. Care Homes for Adults (18-65 years) Page 11 of 32 Care Homes for Adults (18-65 years) Page 12 of 32 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. Care planning is not robust or up to date. Care planning does not consider and address in a person centred way, or reflect each service users current situation. Evidence: Care plans were difficult for staff to locate and found to be bound together in large folders and could be better organised. Care plans and risks assessment sampled had not been reviewed since January 2009. One service user had complex needs and had been in and out of the home for treatment, but care plans had not been updated to reflect changes in service delivery. Service users are not assured that their changing needs will be met. Care plans did not include any personal goals or personal future plans. The Inspector gave staff examples of how this could be done. The service should look at developing person centred planning and thinking. This would ensure care plans are written with the individual and includes information that is important to them, such as their goals Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: and aspirations, their skills and abilities, and how to makes choices in their life. The Inspector noted the front door was kept locked. This could be seen as a restriction of choice, a deprivation of liberty. Each service users should be risk assessed and their care plan reviewed to include any restrictions imposed. Service users must be assured their freedom and choices are not being restricted unnecessarily. There is a mixed staff group of women and men. The Inspector observed staff speak to service users in their community language and offering support and reassurance. A service users told us, I am happy with the carers. They are all good to me. Care Homes for Adults (18-65 years) Page 14 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users choose and participate in suitable leisure facilities. They receive healthy and varied meals that respect their culture and religious requirements. Evidence: Service users told us they have been out to day trips, the seaside, college, special womens groups, day centres, and to visit their relatives. They go to local places of worship and shops to buy clothes and personal items. Visitors can come and visit at any time and are involved in the life of the home with barbecues and cultural celebrations. Staff surveys told us more trips out for service users would be beneficial. Service users were seen asking staffs permission to unlock the front door and leave Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: the home. This restricts freedom of movement and choice. (See Individual Needs and Choice). Service users told us staff knock on their door before entering, and both female and male service users felt comfortable to approach a women or man staff member for support. Some service users were seen using their keys to enter their bedrooms. This promotes service users independence. Surveys from some service users told us, Good food. Tasty food. Service users told us, I like the non vegetarian food, its okay. If I am not well, staff encourage me to eat. Yes the food is alright. One service user wanted more choice for breakfast and staff agreed to look into this soon. Meal records confirm service users are offered a healthy diet of Asian and English meals The Inspector observed breakfast taking place and saw half of the dining room had tables with chairs left on top of them. This is not pleasant to see or comfortable for service users during a meal time. The registered manager agreed to look into this. One service user care plan confirmed a large gradual weight loss and for staff to undertake a weekly weighing programme. This had not taken place and put the service users health at risk. Service users needs around low weight should be kept under review to ensure individuals health and well being. Care Homes for Adults (18-65 years) Page 16 of 32 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. There are gaps in medication and health care practises and procedures which have the potential to put service users care at risk. Evidence: Staff were seen to communicate with service users and understand their needs. Staff were observed knocking on service users bedroom doors and and being respectful and asking if they may enter their bedroom before doing so. Service users were seen wearing clothes, hairstyles, and make up and jewelry to reflect their personality and cultural backgrounds. The Inspector discussed with staff promoting personal support around personal hygiene for a service users in line with person centred planning and thinking. (Person centred Planning was recommended in Outcome Area 2 Individual Needs and Choices). The individual would benefit from more guidance and support from staff to meet personal goals. Medication and health practises were not fully compliant with good practise guidelines. Medication for two service users was seen placed in the office area and signed off on Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: medication records as given. The registered manager looked into this matter straight after our visit. This practise has the potential to put service users health at risk. All other medication practises were in order. Further staff medication training is required to keep service users safe. Service users health care needs were outlined in their care plans but appointments, treatments, and visits from health professionals were not recorded in their care plans. This information was found in the homes diary held in the office area. Service users care needs may not be met as information may become lost, not properly recorded, or monitored. The staff and registered manager agreed to up date records immediately. Care Homes for Adults (18-65 years) Page 18 of 32 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. The service make sure service users are protected from harm. Evidence: The homes complaints procedure was not seen at the home. The Inspector suggested it maybe useful for service users to see the complaints procedure displayed in their community languages around the home. This would give people the confidence to raise concerns before they develop into problems or formal complaints. The Annual Quality Assurance Assessment (AQAA) told us they welcome complaints and this helps them provide a better service. It is recommend the homes complaints procedure is reviewed (including the a copy in the Service User Guide/Statement of Purpose). Service users should be given and/or explained the complaints procedure in an appropriate language/format appropriate to their needs. Service users told us, The staff are fine. No problems. Every things alright here. Service users told us repeatedly they would seek help from two long serving staff members. Staff tell us they have received safeguarding adults training and this is regularly followed through in staff supervisions with discussions. Care Homes for Adults (18-65 years) Page 19 of 32 Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean, pleasant environment which meets their needs. Evidence: Parts of the home have improved with new paint work inside, and colourful features designs upon the walls, and roof repairs. All service users spoken with were satisfied with their bedrooms and communal areas. The small lounge offers Asian television channels and there are some caged love birds. The wooden table under the television in the small lounge was marked and worn and needs replacing. The registered manager agreed to replace this. The large lounge was found to be poorly ventilated. Steps should be taken to improve this. This will ensure this area is kept fresh and free from odours. In the service users outdoor communal outdoor area bags of rubbish have been left and look unsightly. This practise could attract unwanted pests. The storage of rubbish should be reviewed and alternative arrangements made. The Annual Quality Assurance Assessment (AQAA) tells us the homes plans to make improvements in the communal garden area to benefit service users. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: The areas viewed were seen to have basic furnishings, fittings, adaptations and equipment that fulfil their purpose. The home is generally clean. Portable fans were seen in service users bedrooms for use in warmer weather. One service user had no mirror in their bedroom and handles had all come off their wooden chest of drawers, their fan had no evidence of electrical checks. The registered manager agreed to look into all these issues and take action. The registered provider has been asked to risk assess for each service uses around free access in and out of the home. Currently service users have to ask staff to unlock the door. This will ensure service users individual and collective needs are met. See also Outcome Area 2 Individual Needs and Choices. Service users were seen using their bedroom keys and some people have personalised their bedrooms. Information about the number and size of rooms provided for each service user should be set out in the Statement of Purpose and Service User Guide. This will help service users decide if the home is right for them. Care Homes for Adults (18-65 years) Page 22 of 32 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 service has an adequate recruitment process with shortfalls in policy and practise. Staff training needs, present gaps and do not always meet service users needs. Evidence: Service users told us, Staff are caring. I am fine here. I get help to shower and wash my hair. I do my laundry myself. I have been here a long time and the treatment is better know. The staff recruitment records were sampled and were clearly presented. One new care workers records was found with one written reference. Two reference must be obtained before making an appointment. This is to ensure service users are supported by safe staff. The same requirement was made upon our last visit to the home. The staff group is diverse with women and men from different ages and backgrounds. Staff receive training in language and culture. One of the staff members first language is English and was seen speaking to service users in their community language. Service users benefit were staff can that relate to their language and culture. The Inspector noticed there were no training development plans identified in the Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: homes Annual Quality Assurance Assessment (AQAA). Mental Health training is now being considered but staff tell us they have not received this training before, although the home is registered to provide care for people with mental health difficulties. On the day of our visits a group of staff were attending training for Epilepsy. The AQAA confirms 50 of the staff hold National Vocational Qualifications. This is an achievement for the staff group. Service users will benefit from supportive staff. There is limited understanding of a person centred way of delivering care and support. It is recommended training includes Deprivation of Liberties, Mental Capacity Act and Learning Disabilities. Where staff training is valued service users needs and individual care will improve. Care Homes for Adults (18-65 years) Page 24 of 32 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. Service users are well supported by a consistent staff group, but do not benefit from the current leadership and management approach of the home. Evidence: Before our visit we have received information that the registered manager Mrs Anwar is not present in the home very often, although she does on call duties. She was not present on the day of our visit, although she was set a six hour shift. The staff rota is not accurately show the hours worked by the registered manager. The service users told us the deputy manager and seniors keep the home running and are able to relate to them well. Service users do not benefit from a home run by a registered manager. The registered provider Mr Anwar (wife of Mrs Anwar) confirmed he will make improvements in the registered mangers attendance at the home. The reduced presence of the manager to provide leadership an direction has impacted on the service delivery. Service users and staff do not have confidence in the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: management approach. The staff group are long serving and over 90 of staff have worked at the home for over three years. This ensures service users are supported and cared for on a daily basis by staff that know them and understand their needs well. The Annual Quality Assurance Assessment (AQAA) was not brief and did not respond to all the outcome areas. There is a lack of understanding of the purpose of the AQAA. The home should review the quality assurance monitoring systems to ensure the service mets the aims and outcomes for service users. The AQAA confirms all the required health and safety checks are in place. Staff confirm receiving safe working practise training. Some food hygiene and correct storage issues were feedback to staff for action. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 34 19 The Registered Manager must ensure that all staff records contain a reference from a previous employer wherever possible. In this way residents will be kept safe from potential harm. 30/09/2007 Care Homes for Adults (18-65 years) Page 27 of 32 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 1 5 The registered person shall produce a written guide - a Service User Guide. This should be supplied to the Care Quality Commissions (CQC), and each service user. Service users need full clear and accurate written information so as they can decide whether the home can meet their support and accommodation needs. This information should be tailored to meet the needs of Asian service users 31/10/2009 2 6 15 Risk assessments -The service user plan should be kept under review. Service users will benefit from regular check around risks or restrictions in the care and support they receive. This includes the freedom to come and go from their home. 31/08/2009 Care Homes for Adults (18-65 years) Page 28 of 32 3 6 15 The service users plan should be kept under review. Service users will benefit from an up to date plan that reflects their current needs. 31/08/2009 4 17 12 The registered provider shall 30/07/2009 ensure that the are home is conducted so as to promote and make proper provision for the health and welfare of service users. Weighing programmes for service users should be kept under review to ensure individuals health and well being is regularly checked. 5 18 19 Ensure that persons 30/09/2009 employed by the registered person to work at the care home receive training appropriate to the work they are to perform. Service users health care needs will benefit where staff have received regular medication training 6 19 12 The registered person shall 23/08/2009 ensure the care home is conducted so as to promote and make proper provision for the health and welfare of service users. Service users health must be monitored and and problems identified and prompt referrals made to appropriate specialists; and Care Homes for Adults (18-65 years) Page 29 of 32 associated records must be kept up to date. 7 22 4 The registered person shall 30/09/2009 ensure that the records are kept up to date, and available for inspection. The complaints procedure should be reviewed, including the copy in the Service User Guide/Statement of Purpose. Service users should be given and/or explained the complaints procedure in an appropriate language/format appropriate to their needs. Information and documents 23/08/2009 in respect of person carrying on working at the home should include- two written references. Service users must be cared and supported by safe staff. 9 37 10 The registered provider and 31/08/2009 the registered manager shall have regard to the size of the care home, the statement of purpose, and the number and needs of service users; carry on or manage the care home with sufficient care and competence and skill. The performance of the registered manager is critical to the quality of the home. This will set the standard and ensure service users needs are well met. 8 34 7 Care Homes for Adults (18-65 years) Page 30 of 32 10 39 24 The registered person shall 31/10/2009 establish and main a system for reviewing at appropriate intervals and improving the quality of care. The Annual Quality Assurance Assessment (AQAA) was not very detailed and did not respond to all the outcome areas. The home should review the quality assurance monitoring systems to ensure the service mets the aims and outcomes for service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Providing training to managers and staff in person centred planning would greatly improve service delivery around care planning and meeting service users all round needs. There is limited understanding of a person centred way of delivering care and support. It is recommended training includes, Deprivation of Liberties, Mental Capacity Act, and Learning Disabilities. These aspects would benefit service users needs. 2 35 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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