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Inspection on 20/04/09 for St Michael's

Also see our care home review for St Michael's for more information

This inspection was carried out on 20th April 2009.

CQC found this care home to be providing an Poor 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The location of the home means that people can easily access all the amenities in the city centre and all public transport systems, thus enhancing independence. The home has a people carrier so that people can go on trips out if they wish to. People have a good choice of meals and said they liked the food. People living in the home said they liked the staff, with one person describing the staff team as "brilliant" and really helpful.

What has improved since the last inspection?

Most of the staff have been trained in safeguarding procedures so they know what to do in the event of people being abused or neglected. The garden is now accessible from the conservatory and there are seats outside for people to use. A smoking room has been created in the conservatory so people can smoke inside without the smoke affecting other people.

What the care home could do better:

Before someone comes to live in a care home an assessment of all aspects of their health and social care needs, including any risk issues, must be carried out. This is to ensure that the home is suitable, that they are compatible with the other people who live in the home, and that the staff team are experienced, skilled, trained and competent to meet the person`s needs. People need to be provided with information about the facilities and services in the home to help them make an informed choice about where to live. The information in this home, the Statement of Purpose and Service User Guide, need to be reviewed and updated to make sure that they contain all the information that will be helpful to people who are considering coming to live in the home, or who already live there. Once a person moves into a care home, or before, a care and support plan has to be developed with that person and/or relatives and representatives to agree on what care the person needs, any risks they may pose to themselves or others, and how the staff team should support them to lead safe and fulfilling lives. These plans must be personcentred, detailed and legible, clearly showing how people`s needs are to be met. The plans should include all aspects of personal, social, emotional, psychological, physical and mental health care needs, as well as short and long term goals and aspirations. These detailed plans are required to make sure that people`s needs are met in a consistent way by the staff team and to enhance personal development and promote independence. Where a person is assessed as presenting risks to themselves or others, these risks must be thoroughly assessed and risk management strategies put into place and documented. This is so that staff know what to do to keep people safe from self-harm, self-neglect, and to prevent abuse or harm to others. The promotion of independence can be enhanced if people participate in all aspects of life in the home, attend educational courses and find employment. Where people do not have access to their own money, because of behaviour associated with their mental health needs, and staff spend it on their behalf, accurate records should be kept so that there is a clear audit trail of where the money has gone to prevent the potential for abuse occurring. Personal information about people must be kept securely at all times and all records should be signed and dated so that it is clear who wrote them and when. People living in care homes should have opportunities to go out of the home on a regular basis so that they can keep in touch with the local community and see any changes as they occur in the local area. Trips should be planned to suit people`s needs and preferences so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. Staff need to ensure that people have access to, and choose from, a range of leisure activities including the opportunity to go on a holiday of their choice. The routines in the home should promote independence, individual choice and freedom of movement, subject to risk assessment. People should be offered a key to their own bedroom and a key to the front door of the house unless this is assessed as posing a risk to that person. People should also have lockable storage in their bedrooms to keep money and valuables safely. People should have opportunities to develop independent living skills such as preparing meals, shopping for food, budgeting money and doing their laundry unless individual risk assessments indicate this would be unsafe. Where medicines are kept in the home and administered by staff there must be robust arrangements in place for the recording, handling, safekeeping and disposal of medicines received into the home. This is to make sure that people are given the correct amount of medication at the correct times. Where medication is prescribed to be taken `as required` there needs to be clear, written guidelines for staff to follow to help them decide when someone may need additional medication and to ensure that people are not given medicines unnecessarily. Despite inadequate recruitment practices being identifed at the previous key, thematic and random inspections, these have deteriorated further since the last key inspection, rather than improved. A robust recruitment procedure is necessary to keep people who live in the home safe from harm. Therefore, before appointing a new staff member, all the required checks and references must be received and a full employment history obtained. This is to ensure that recruitment procedures are robust enough to provide support and protection to the people who live in the home. All new members of staff must receive a formal programme of induction training and ongoing training, particularly in relation to working with people with mental health needs. Staff have to be knowledgeable about people`s needs, and how to manage any risks assoc

Key inspection report Care homes for adults (18-65 years) Name: Address: Priory Gate 129-131 Wingfield Road Stoke Plymouth Devon PL3 4ER     The quality rating for this care home is:   zero star poor 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: Antonia Reynolds     Date: 2 4 0 4 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 38 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 38 Information about the care home Name of care home: Address: Priory Gate 129-131 Wingfield Road Stoke Plymouth Devon PL3 4ER 01752564944 01752563400 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.healthcare-trust.com Stoke HealthCare Ltd care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 37. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia- Code MD Date of last inspection Brief description of the care home Priory Gate is a care home providing personal care and accommodation for a maximum of thirty-seven people, over the age of 18, with mental health needs. At the time of inspection there were only ten people living in one half of the home that accommodates sixteen people in total. Therefore this description only applies to half of the home as the other half was unoccupied at the time of inspection. The home is privately owned by Stoke Healthcare Ltd and the directors also own other care homes in the south west of England. In April 2009 the fee levels started from approximately 750 pounds per week but vary depending on the individual needs of each person. The Care Homes for Adults (18-65 years) Page 4 of 38 Over 65 0 37 Brief description of the care home home consists of a large detached three-storey building situated in its own grounds and close to Stoke village in Plymouth. It is within walking distance of local shops and close to bus services into central Plymouth and the railway station. The home has a people carrier for the use of the people who live in the home. All sixteen bedrooms in the occupied half of the home are single and located on each floor. Five of these have en suite showers and toilets. Bathing/showering and toilet facilities are available on each floor, close to the bedrooms and communal rooms. There are large lounge and dining rooms on the ground floor. Attached to the dining room is a conservatory and a designated smoking room. This half of the home is wheelchair accessible on the ground floor only although people may use the shaft lift in the other half of the home if required. Parking space is available inside the grounds and on the street outside the house. Information about the home and copies of inspection reports can be obtained from the manager. Care Homes for Adults (18-65 years) Page 5 of 38 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: zero star poor 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 inspection consisted of an unannounced visit to the home by one inspector between 11.50am and 4.10pm on Monday, 20th April 2009 and further visits took place from 1.25pm to 5.20pm on Tuesday, 21st April 2009 and 8.40am to 12.30pm on Friday 24th April 2009. We last inspected this service on the 31st October 2007. A thematic inspection focussing on the protection of vulnerable people took place on 7th May 2008 and random inspections took place on 11th July 2008 and 26th August 2008 following concerns being raised about the care of people in the home. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission. A tour of the premises took place and records relating to care, staff and the home were inspected. Seven people living in the home and five staff were spoken with during the visits. Care Homes for Adults (18-65 years) Page 6 of 38 Information, both verbal and written, was received from social and health care professionals as well as the police. The manager was present on the second and third day of inspection and the Responsible Individual for the company was available for consultation and discussion on the second day. Care Homes for Adults (18-65 years) Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: Before someone comes to live in a care home an assessment of all aspects of their health and social care needs, including any risk issues, must be carried out. This is to ensure that the home is suitable, that they are compatible with the other people who live in the home, and that the staff team are experienced, skilled, trained and competent to meet the persons needs. People need to be provided with information about the facilities and services in the home to help them make an informed choice about where to live. The information in this home, the Statement of Purpose and Service User Guide, need to be reviewed and updated to make sure that they contain all the information that will be helpful to people who are considering coming to live in the home, or who already live there. Once a person moves into a care home, or before, a care and support plan has to be developed with that person and/or relatives and representatives to agree on what care the person needs, any risks they may pose to themselves or others, and how the staff team should support them to lead safe and fulfilling lives. These plans must be personcentred, detailed and legible, clearly showing how peoples needs are to be met. The plans should include all aspects of personal, social, emotional, psychological, physical and mental health care needs, as well as short and long term goals and aspirations. These detailed plans are required to make sure that peoples needs are met in a consistent way by the staff team and to enhance personal development and promote independence. Where a person is assessed as presenting risks to themselves or others, these risks must be thoroughly assessed and risk management strategies put into place and documented. This is so that staff know what to do to keep people safe from self-harm, self-neglect, and to prevent abuse or harm to others. The promotion of independence can be enhanced if people participate in all aspects of life in the home, attend educational courses and find employment. Where people do not have access to their own money, because of behaviour associated with their mental health needs, and staff spend it on their behalf, accurate records should be kept so that there is a clear audit trail of where the money has gone to prevent the potential for abuse occurring. Personal information about people must be kept securely at all Care Homes for Adults (18-65 years) Page 8 of 38 times and all records should be signed and dated so that it is clear who wrote them and when. People living in care homes should have opportunities to go out of the home on a regular basis so that they can keep in touch with the local community and see any changes as they occur in the local area. Trips should be planned to suit peoples needs and preferences so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. Staff need to ensure that people have access to, and choose from, a range of leisure activities including the opportunity to go on a holiday of their choice. The routines in the home should promote independence, individual choice and freedom of movement, subject to risk assessment. People should be offered a key to their own bedroom and a key to the front door of the house unless this is assessed as posing a risk to that person. People should also have lockable storage in their bedrooms to keep money and valuables safely. People should have opportunities to develop independent living skills such as preparing meals, shopping for food, budgeting money and doing their laundry unless individual risk assessments indicate this would be unsafe. Where medicines are kept in the home and administered by staff there must be robust arrangements in place for the recording, handling, safekeeping and disposal of medicines received into the home. This is to make sure that people are given the correct amount of medication at the correct times. Where medication is prescribed to be taken as required there needs to be clear, written guidelines for staff to follow to help them decide when someone may need additional medication and to ensure that people are not given medicines unnecessarily. Despite inadequate recruitment practices being identifed at the previous key, thematic and random inspections, these have deteriorated further since the last key inspection, rather than improved. A robust recruitment procedure is necessary to keep people who live in the home safe from harm. Therefore, before appointing a new staff member, all the required checks and references must be received and a full employment history obtained. This is to ensure that recruitment procedures are robust enough to provide support and protection to the people who live in the home. All new members of staff must receive a formal programme of induction training and ongoing training, particularly in relation to working with people with mental health needs. Staff have to be knowledgeable about peoples needs, and how to manage any risks associated with those needs, to make sure people receive the support they need and they feel safe living in the home. Staff also need to address immediately any concerns or complaints made by people in the home so they feel confident they are listened to. To make sure that staff receive the training they need, each person should have an individual training and development plan and there should be an overall plan for the home. Care staff should also have regular meetings with their senior/manager to include all aspects of practice, the philosophy of care in the home, the monitoring of work with individuals and career development needs. Documentation relating to health and safety practices needs to be kept in the home. This includes documentation relating to gas, electrical and fire safety. Also records need to be kept of all staff who have completed training in first aid, moving and handling, infection control, health and safety, food hygiene and fire safety awareness. There should be a system in place to ensure that all staff receive fire safety training as frequently as the homes fire risk assessment has identified as necessary for the safety of the people who live in the home. All incidents and accidents need to be documented in detail and anything which adversely affects the well-being or safety of people living Care Homes for Adults (18-65 years) Page 9 of 38 in the home must be reported to the Care Quality Commission. This is to ensure that appropriate action is taken when these incidents occur. The home has a quality assurance process in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be more comprehensive if it included an annual internal audit of the facilities and services in the home and, if a robust internal auditing system was in place, it would have identified the issues raised in this report. The company that owns the home must report any changes, such as a change of address, to the Care Quality Commission as soon as the change occurs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 38 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 11 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples support needs are not being thoroughly assessed prior to admission to ensure that the facilities and services in the home, as well as the staff team, can meet their needs. Evidence: The home has information to give to people who may intend to live at the home - the Statement of Purpose and Service User Guide. The purpose of a Service User Guide is that it should contain information about the home so that people know what to expect before they come to live there. This information was out of date, for example, it did not contain the name, qualifications and experience of the manager; it said that the staff team included an art psychotherapist and complementary therapist, which was not the case; and the telephone number for the Care Quality Commission was incorrect. The Statement of Purpose said that our criteria for admission into the home encompasses an in-depth pre-admission assessment by the Home Manager. However the file of the most recently admitted person to the home did not contain an Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: assessment by anyone from the home. The manager confirmed that this had taken place but the documentation could not be found during the inspection. A needs assessment had been carried out by a healthcare professional but the comments included in it indicated that Priory Gate may not be the best place for this person as the persons needs were not compatible with the needs of the other people living in the home. A detailed pre-admission assessment is necessary to ensure that peoples needs are clearly identified and to ensure that the staff team have the skills and competence to meet those needs. Any potential restrictions on choice and freedom, based on risk assessment, should be considered during this process and agreed with the person concerned however there was no information in the file to show that this had taken place. Care Homes for Adults (18-65 years) Page 13 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not provide enough detail to ensure that care and support is delivered in a consistent way by the staff team. Risks have not been properly assessed and there are no clear risk management strategies in place to protect people from self-harm, self-neglect or abuse or harm to others. Evidence: The files of four people who lived in the home were inspected and these contained individual care and support plans. They had been recently reviewed and updated but the information on them was very brief and, in some cases, the handwriting was illegible so some words could not be read. One persons care plan did not cover essential areas such as personal and health care needs, hobbies and interests. The manager said that he had devised another more detailed care plan but this could not be found during the inspection and did not explain why the briefer care plan was still prominent in the persons file. There were no detailed risk assessments, devised specifically for living at Priory Gate, relating to this persons behaviour despite risks to other peoples safety and welfare being identified in a healthcare professionals Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: assessment. There were risk assessments from the previous care home but these were not relevant as they need to be service specific particularly in relation to the environment, they need to consider compatibility with the other people who live in the home and they need to take staff training, competence and skills into account. Another persons file contained a risk assessment relating to their behaviour that gave staff information on what to do in a particular situation. However staff had not followed this resulting in a person in the home being assaulted and sustaining a serious injury. The manager said this risk assessment was out of date as, prior to this incident, he did not consider this person to be a risk to others any more. However there was no evidence of a more up-to-date risk assessment and the incident showed that this person still posed a risk to others at particular times. Care plans also contained a lot of jargon such as people being elevated or instructing staff to use diversionary tactics but there were no explanations about what this meant for individual people. People living in the home said that they decided what to do each day but limitations on choice or freedom to prevent self-harm, self-neglect or abuse or harm to others were not clearly documented. Some spending money for people was kept in the home and we looked at the records for three people. Two of these were up to date and accurate but there were discrepancies with one persons money where staff spent it on her behalf because they had spent more money than they had been given. The procedure was that the administrator for the home gave senior staff a lump sum of money to spend on behalf of the person. They did obtain receipts but there was no procedure in place for the staff to record what they were spending on a daily basis. None of the care plans contained information about how peoples finances were managed. Care Homes for Adults (18-65 years) Page 15 of 38 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. People living in the home have limited opportunities for personal development or to maintain independent living skills. Activities are not arranged to meet peoples needs, wishes, choices and aspirations. Evidence: Discussion with people living in the home, as well as the manager, confirmed that noone was attending any form of education or training and no-one had either a paid or voluntary job at the time of inspection. One person was intending to start an arts course soon. Whilst some people went out on their own, several people needed staff support to leave the house. Discussion with two people living in the home indicated that very few activities were taking place so most people did nothing during the day and evening. The homes statement of purpose says that activities are arranged to suit differing needs and include musical events, games sessions, reminiscence and crafts but there was little information to show that any activities were taking place Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: and none were observed during the inspection. People had an activities report for January and February but these were not signed or dated so it was not clear which year these related to. The home used to have a structured activities programme so people knew what was planned in advance but discussion with the manager showed that each person decides on a daily basis what they want to do. The manager also said that a new activities co-ordinator had been recruited recently and some people saw art and massage therapists. The home owned a minibus so people could go on trips out if there was a staff member on duty who could drive and there were enough staff to take them. People who went out on their own used public transport. The manager said that most people living in the home did not go on holiday apart from one person who stayed with relatives occasionally. Relatives and friends are welcome to visit the home. People said they did not participate in many domestic activities apart from being expected to look after their own bedrooms. One person said that they could not do their own laundry because the laundry room contained substances that were hazardous to health. People living in the home said that the staff respect their privacy and staff were observed knocking on bedroom doors before entering. All bedroom and bathroom/toilet doors have locks fitted but people said they did not have keys to their bedroom door or to the front door of the home. There was a set menu in the home and each day there were three choices for the main meal at lunchtime, including a vegetarian option. A new chef had recently started and the meals were nicely presented and, due to the variation of meals seen, it was evident that people could choose what they wanted to eat. We also observed that meal times were flexible and people could eat their meals in an unrushed and sociable atmosphere. The people who lived in the home said they liked the food and that they could choose what they wanted. People were not involved in cooking their own meals as it has been deemed unsafe for them to use the main kitchen, however this risk had not been assessed on an individual basis for each person. There were facilities in the dining room for people to make their own drinks and snacks. People were not actively involved in shopping for food for the home. Care Homes for Adults (18-65 years) Page 17 of 38 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 who live in the home cannot be confident that personal support is provided in the way, and at the time, that they want and need. People cannot be confident that their physical and mental health care needs will be met. Evidence: The care and support plans of people living in the home were very brief and some words were illegible. The plan for one person did not contain any information about personal or health care needs although information from a previous home, daily records, and medication records, showed that the person needed assistance to maintain personal care and had physical health care needs. Because these were not mentioned in the care plan there was no guidance for staff about how these needs should be met. Information in the four peoples files we examined showed that people have some contact with representatives from Social Services, mental health services, doctors and district nurses. However information from healthcare professionals indicated that people were not receiving enough support from mental health services. Information from health and social care professionals, as well as the police, indicated that the staff were not knowledgeable about peoples mental health needs and how to manage any risks associated with those needs. Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: Discussions with people living in the home and staff, as well as observation, showed that people decide what time they get up and go to bed, have meals and bathe or shower. However peoples preferences about how they wish to be supported were not documented in peoples care plans therefore it was not clear that people were receiving a consistent and continuous level of support from the staff team. Medication was locked away safely and, overall, the practice of administering medication at the time of this inspection, demonstrated by a member of staff, was found to be safe. However the records showed that, on one day, a person had been given paracetamol as a homely remedy but this person also had paracetamol prescribed. Therefore it was evident that the staff member who administered the paracetamol had not checked the persons medication records. This lack of attention could lead to overdoses being administered if another staff member had also administered the prescribed paracetamol. We had also been notified of a medication error in 2008 where a person living in the home had been given too much medication over two days because the medication administration records had not been read properly. Appropriate action was taken by a senior member of staff as soon as they realised this had occurred. Where medication was prescribed to be taken as required there were no guidelines for staff to follow to help them decide when someone may need additional medication. Discussion with a staff member showed that they knew what to do in the event of someone refusing their medication and that unused or contaminated medication had to be returned to the pharmacy for safe disposal. However we found medication (paracetamol) in the home that had been prescribed for someone who had not taken it, the pharmacists label had been removed and the medication was being used as a homely remedy. This showed that medication audits were not being carried out to monitor all medicines received, administered, and leaving the home or disposed of to ensure there is no mishandling. Information in staff files and discussion with the manager showed that staff had received medication training from a local pharmacist recently. Care Homes for Adults (18-65 years) Page 19 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have not been protected from abuse, neglect and selfharm. People cannot be confident that any concerns or complaints will be acted upon immediately. Evidence: Discussions with people living in the home, as well as information from social care professionals who had also talked with people, showed that there were times when people have not felt safe living in the home. Whilst people said they liked the staff they were not sure that the staff could protect them from experiencing verbal and physical abuse from other people who lived in the home. There have been several incidents in recent months involving people who live in the home verbally and physically assaulting each other as well as people demonstrating behaviours that put other people at risk of harm and abuse. None of these incidents were reported to the regulating authority and Social Services were not informed of the safeguarding issues in the home. There was no evidence to show that the manager had looked into why these incidents had occurred and no risk management strategies had been put into place to prevent a re-occurrence. During the inspection one person told us that money had gone missing from their bedroom and the staff had been told but nothing had happened. The manager said he had only become aware of this the day before and had not had time to ask the person concerned about the details. All staff had undertaken, or were about to undertake, training provided by Local Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: Authority about what action to take to protect vulnerable people from risk of harm. However this had only occurred as a result of the safeguarding concerns that had been raised. Discussion with a staff member and the managed confirmed that they now knew what action to take should they suspect that any person in the home was being abused or treated disrespectfully. Care Homes for Adults (18-65 years) Page 21 of 38 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 live in a home that is spacious, clean and comfortable although the standard of the decor has deteriorated over time. Evidence: At the time of inspection people were only living in one half of the building, therefore it was only this half that was inspected. The home was spacious, comfortable and clean with no offensive odours although the decor was looking rather worn in places. The people living in the home said they liked having their own bedrooms and confirmed that they are responsible for keeping them clean, although staff will assist if necessary. The communal rooms consisted of a large lounge room, a smaller dining room and a conservatory with a designated smoking room. There were four bedrooms on the ground floor, ten on the 1st floor and two on the 2nd floor. The two bedrooms on the 2nd floor have a lounge room and kitchenette, as well as a shower and toilet. A person living in the home said that there had been a flood on the 2nd floor so it was in rather a mess but would be sorted out. All the bedrooms contained wash hand basins and five of them had en suite toilets and showers. Bedrooms were individually furnished and contained many personal possessions. People told us that they did not have any lockable storage space in their bedrooms to keep money or valuables. Bedroom doors were fitted with locks, that could be opened from the outside in an emergency because staff have a master key but people told us they did not have a Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: key to their own bedroom. There were bath/shower rooms and toilets on each floor close to bedrooms and communal rooms. Discussions with the people who lived in the home, as well as observation, showed that there were enough facilities to meet the needs of the people who lived there and the staff. All bathroom and toilet doors were fitted with locks that could be opened from the outside by staff in an emergency. The home had one level access shower room on the ground floor, which was accessible by people with mobility difficulties, but the homes statement of purpose says that there are two shower rooms on the ground floor. There was another room with a toilet on the ground floor that has the plumbing to provide a second level access shower if required, but there was no shower in it at the time of this inspection. The Responsible Individual told us during the random inspection in August 2008 that this shower would be installed as soon as possible. People told us that they were not allowed to prepare or cook meals in the homes kitchen because of health and safety. However there was a kettle, microwave, refrigerator, dishwasher and sink in the dining room for people to make their own drinks and snacks should they wish to. People told us that they were not allowed to prepare or cook meals in the homes kitchen because of health and safety. However there was a kettle, microwave, refrigerator, dishwasher and sink in the dining room for people to make their own drinks and snacks should they wish to. The laundry contained suitable equipment to wash and dry clothes and bedding. The people who lived in the home said they were not able to do their own laundry because the room contained cleaning substances that were hazardous to health. Discussions with staff members confirmed that disposable gloves and aprons were available for them to use when assisting people with personal care tasks and to prevent any risk of infection being transferred between people. The District Nurse said that no-one living in the home had a transmittable infection at the time of inspection. Therefore there were no concerns at this inspection about the risk of any cross infection, based on the needs of the people living in the home. The building stands in its own large grounds that were in the process of being landscaped and there were pleasant outside sitting areas for people to use, that could be accessed from the conservatory. Care Homes for Adults (18-65 years) Page 23 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the last inspection the standard of vetting and recruitment practices has declined with appropriate checks not being carried out and potentially leaving the people who live in the home at risk of harm. A large turnover of staff means that people are not provided with the continuity and consistency of support that they need to maintain their physical and psychological wellbeing. Evidence: Discussion with the manager confirmed that, at the time of inspection, for ten people living in the home, there were usually three care staff on duty from 8am until 8pm. They were supported by domestic, catering and administrative staff. There was also an activities co-ordinator who usually worked from 1pm to 5pm Mondays to Fridays, and the manager was usually in the home between 8am and 5pm on weekdays. At night, from 8pm, there were two waking staff members. Discussions with the manager and staff confirmed that additional staff were on duty if the needs of the people who lived there indicated that this was required. Information in the home showed that, since July 2008, there had been a large turnover of staff. The people in the home said they liked the staff, with one person describing the staff team as brilliant because they had helped her through a difficult time. We inspected the personnel files of four members of staff who had been recruited Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: since October 2008. The information in these files showed that proper recruitment practices had not been followed. For example, two people had started work in the home before two satisfactory written references were received; one person had started before receipt of a satisfactory check against the Protection of Vulnerable Adults list or a Criminal Records Bureau check; two people had not provided full employment histories; information from a previous social care employer about a persons dates of employment differed from that on the persons application form and had not been checked out; where people were nationals of other countries there was no evidence that police checks had been obtained from the country of origin; where people had criminal records and failed to disclose this on their application forms there was no information on their files to show that they had been interviewed in relation to these and assessed as safe to work with vulnerable people. For people who had started work before all the appropriate checks were received there was nothing to indicate that they were supervised by other experienced staff. The home had a nationally recognised induction programme for new staff based on the standards expected by Skills for Care, the organisation responsible for setting the training standards for care staff. However three newly recruited staff, whose personnel files indicated that they had no previous experience of working in care services, had not completed this induction. Discussions with staff confirmed that they have not received any training on de-escalation techniques, conflict resolution and management, control or restraint, breakaway techniques or working with people who have a history of sexually offending behaviour. Therefore the staff had not received any training that would equip them to stop people assaulting each other. Discussion with the manager confirmed that the staff team was expected to participate in various training courses such as first aid, health and safety, moving and handling, food hygiene, medication administration, fire safety and the protection of vulnerable adults. Information on staff files, as well as discussion with staff members, confirmed that they had participated in other training courses including topics such as depression and low mood, sleep problems, epilepsy and stress and anxiety. The home did not have an up-to-date training and development plan and staff members did not have individual trainnig plans although the manager said this would be addressed through one-to-one meetings that he was arranging with all staff. There was no evidence in the staff files we inspected to show that regular supervision meetings had takenplace, although there was information to show they have been arranged for the future. Care Homes for Adults (18-65 years) Page 25 of 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager does not have a good understanding of the areas in which the home needs to improve. The rights, health, safety and welfare of people who live in the home have not been protected and promoted by management practices. Evidence: The management of the home has changed since the last key inspection and there have been five managers since then that we are aware of. We have also become aware that the address of the company that owns the home has changed but we were not informed of this change. The present manager has worked in the home since July 2008 and was appointed to the managers role in January 2009. He has applied to be registered with the Care Quality Commission. One of the people who lived in the home said that she trusted the manager and that he was easy to talk to. During the inspection the manager was not able to find various pieces of documentation that he said existed such as a pre-admission assessment and a care plan for a particular person. This showed that individual peoples records were not being kept secure and in good order. Staff in the home were recording incidents and Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: accidents that happened to people but serious incidents, such as people living in the home assaulting each other, were not being reported either to the regulating authority, the police or Social Services. The home had a quality assurance system in place which included consultation with the people who live in the home as well as their relatives and representatives. However the quality assurance system did not include an annual internal audit of all the facilities and services in the home to ensure that the aims, objectives and statement of purpose of the home were being met. There was no documentation in the home to show that health and safety checks such as the servicing of gas appliances and the checking of portable electrical appliances had been carried out. No electrical wiring certificate for the home could be found to show the electrical systems were safe. The manager telephoned the person responsible for maintenance who said he would bring the necessary documentation to the home immediately but this did not arrive before we completed the inspection. Whilst the fire alarm system was tested regularly, other fire safety checks such as checking and testing fire extinguishers, fire blankets and emergency lighting were not documented. Discussions with three staff showed that they knew what to do in the event of a fire but the names of staff who had attended fire safety training had not been documented. The environmental service of the Local Authority had carried out a food safety inspection in November 2008 and the report said that there were good standards in place. There were monitoring processes and checks in place to reduce the risk of legionella. No evidence was available to show that staff have been trained in moving and handling, first aid, health and safety, food hygiene, infection control and fire safety although the manager said they were expected to undertake this training. All the radiators had low temperature surfaces to reduce the risk of people being burnt and the manager confirmed that the hot water is thermostatically controlled to reduce the temperature of the hot water to the baths so that people were not at risk of being scalded. The home kept accident and incident records but the information in these was scant and did not contain enough detail about what had occurred prior to the incidents and what action had been taken as a result. There was no evidence that the manager was monitoring these to look at the cirumstances of each incident and look for any patterns that may emerge so that the staff team can take action to prevent a recurrence. Care Homes for Adults (18-65 years) Page 27 of 38 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 Two written references must 01/12/2008 be obtained for all staff members including, where applicable, a reference relating to the persons last period of employment, which involved work with children or vulnerable adults, of not less than three months duration. Care Homes for Adults (18-65 years) Page 28 of 38 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 2 14 No person must be admitted 19/06/2009 to the home without a detailed assessment of their needs being carried out. The Registered Person must confirm in writing to the person that having regard to the assessment the care home is suitable for the purpose of meeting their needs in respect of health and welfare. This is to ensure that people are only admitted to the home if the faciliites, services and skills of the staff team can meet their needs. The assessment should also determine compatibility with the other people living in the home. 2 6 15 Each person in the home must have a detailed, legible, care and support plan clearly showing how all their needs in respect of 19/06/2009 Care Homes for Adults (18-65 years) Page 29 of 38 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 health and welfare are to be met. This is so that peoples needs are identified and met in a consistent way by the staff team. 3 9 13 Where a person is assessed as presenting risks to themselves or others, these risks must be thoroughly assessed and risk management strategies put into place and documented. This is so that staff know what to do to keep people safe from self-harm, selfneglect, and prevent abuse or harm to others. 4 10 17 The records relating to the care of people living in the home must be kept securely at all times. This is so that people know that information about them is handled properly and that confidentiality is respected. 5 19 12 Arrangments must be put into place, through training staff or other means, to ensure that staff have an accurate and up-to-date knowledge of peoples mental health needs and 19/06/2009 19/06/2009 19/06/2009 Care Homes for Adults (18-65 years) Page 30 of 38 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 how to manage any risks associated with those needs. This is so that people living in the home receive the support they need from skilled and competent staff. 6 20 13 Arrangements must be put in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is so that people are administered the correct amount of medication at the correct times. 7 22 22 All complaints and concerns raised by people who live in the home must be listened to and acted upon. If people are not able to make verbal complaints then staff should be knowledgeable about the way different people may communicate a complaint and act on it. This is so that people living in the home feel confident that all complaints and concerns will be taken seriously and addressed. 8 23 13 Arrangements must be 19/06/2009 made, by training staff or by other measures, to prevent 19/06/2009 19/06/2009 Care Homes for Adults (18-65 years) Page 31 of 38 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 people who live in the home being harmed or suffering abuse or being place at risk of harm or abuse. This is so that people feel safe living in the home and can rely on staff to protect them from others. 9 34 19 No person must be employed in the care home before all the required checks and references have been received and are satisfactory. These include two written references including one where the person has worked in a care capacity with adults or children where appropriate, a check against the Protection of Vulnerable Adults list, a Criminal Records Bureau check, a police check from the country of origin if the person is not a British national and a full employment history. If a person is employed in the home prior to receiving a satisfactory check from the Criminal Records Bureau, this person must be supervised by a designated staff member at times, and must not escort people who 19/06/2009 Care Homes for Adults (18-65 years) Page 32 of 38 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 live in the home away from the premises. Where people have been convicted of a criminal offence, they must be interviewed in relation to that offence and an assessment carried out to decide their suitability to work with vulnerable people. This is to ensure that suitable people are employed and protect the people who live in the home from risk of harm. 10 35 18 All staff must receive training appropriate to the work they are to perform including structured induction training. This is to ensure that at all times suitably qualified, competent and experienced staff are working in the home to maintain and protect the health and welfare of the people who live there. 11 41 17 Documentation relating to 19/06/2009 people who live in the home must be kept secure and be available for inspection at all times. This is to make sure that personal information about 19/06/2009 Care Homes for Adults (18-65 years) Page 33 of 38 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 people is kept safely and available for inspection at any time. 12 42 13 Documentary evidence must 19/06/2009 be kept in the home to show that fire safety equipment is serviced, checked and tested on a regular basis. This is to make sure the fire safety equipment is in good working order and is located in the correct positions. 13 42 13 Documentation must be sent 19/06/2009 to the Care Quality Commission to verify that gas and electrical systems are regularly serviced and inspected. This is to ensure that the home is protecting the health and safety of the people who live there. 14 42 37 The Care Quality 19/06/2009 Commission must be informed, in writing, without delay, of any serious injury to a person living in the home and any event in the care home which adversely affects the well-being or safety of any of the people living there. This is to ensure that appropriate action is taken Care Homes for Adults (18-65 years) Page 34 of 38 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 when these incidents occur and that proper records are being kept. 15 43 39 Where the registered 19/06/2009 provider is an organisation, the Care Quality Commission must be informed, in writing, of any changes to the organisations address. This is to make sure that we are able to contact the organisation at the correct address. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide should be kept up to date so that it contains all the information people may need to help them decide whether they want to live in this home. Care and support plans should be written clearly and legibly in plain English without the use of jargon so that the people concerned, as well as staff, can understand them so they know how support should be delivered to individuals by staff. Care and support plans should be person-centred and include all aspects of personal, social, emotional and physical and mental health care needs, as well as short and long term goals and aspirations. This is so that staff can provide whatever support is necessary to help people achieve these goals to enhance personal development. Where people do not have access to their own money, because of behaviour associated with their mental health needs, and staff spend it on their behalf, accurate records Page 35 of 38 2 6 3 6 4 7 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 should be kept so that there is a clear audit trail of where the money has gone to prevent the potential for abuse occurring. 5 7 If people need support to manage their finances, the reasons for, and manner of, this support should be documented. This is so that staff provide the right type of assistance for each person. People living in the home should have opportunities to develop social, emotional, communication and independent living skills such as preparing meals, shopping for food, budgeting money and doing their laundry, unless individual risk assessments indicate this would be unsafe for people. They should have opportunities to learn and use practical life skills, for example, assertion and confidence training. This is so that people have opportunities for personal development so that they can achieve their goals and aspirations. People should have opportunities to find and keep appropriate jobs, continue their education or training and/or take part in valued and fullfilling activities. This is so that people take part in age, peer and culturally appropriate activities. Staff should support people to become part of, and participate in, the local community in accordance with assessed needs and individual support plans. This is so that people are actively supported to become part of the local community and follow individual hobbies, interests and lifestyles. Staff should ensure that people have access to, and choose from, a range of leisure activities including the opportunity to go on a holiday of their choice. The routines in the home should promote independence, individual choice and freedom of movement, subject to risk assessment. People living in the home should be offered a key to their own bedroom and a key to the front door of the house unless this is assessed as posing a risk to that person. Where medication is prescribed to be taken as required, there should be clear, written guidelines for staff to follow to help them decide when someone may need additional medication. This is so that people are not given additional Page 36 of 38 6 11 7 12 8 13 9 14 10 16 11 20 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 medication when it may not be absolutely necessary. 12 26 All bedrooms should have lockable storage space, that cannot easily be removed from the room, for people to keep money, valuables and medication safely. The shower should be installed in the second shower room on the ground floor. This is so that people have access to more bathing facilities when they need them. All staff should receive training and work towards formal qualifications in relation to working with people with mental health needs and those who may also have offending behaviours. A training and development plan for the home should be produced to make sure that the overall plan will meet peoples individual and joint needs. All staff should have an individual training and development assessment and receive a minimum of five paid training and development days (pro rata) each year. This is to ensure they have the skills to meet the assessed needs of the people living in the home. Care staff should have regular, recorded, supervision meetings at least six times a year with their senior/manager to include all aspects of practice, the philosophy of care in the home, monitoring of work with individuals and career development needs. The quality assurance system should be developed to include an annual internal audit of the facilities and services in the home to ensure that the aims, objectives and statement of purpose are being met. All records should be signed and dated so it is clear who wrote them and when they were written. Records should be kept of all staff who have completed training in first aid, moving and handling, infection control, health and safety and food hygiene. The names of staff who have been trained in fire safety awareness should be documented. There should be a system in place to ensure that all staff receive fire safety training as frequently as the homes fire risk assessment has identified as necessary for the safety of the people who live in the home. Page 37 of 38 13 27 14 35 15 35 16 35 17 36 18 39 19 20 41 42 21 42 Care Homes for Adults (18-65 years) Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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