Inspection on 07/01/09 for Solden Hill House

This inspection was carried out on 7th January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Solden Hill House 24/01/07

Solden Hill House 30/01/06

Solden Hill House 16/06/05

Solden Hill House 20/12/04

Solden Hill House 04/10/04

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Solden Hill House Banbury Road Byfield Daventry Northants NN11 6UA     The quality rating for this care home is:   two star good 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: Rajshree Mistry     Date: 0 7 0 1 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 41 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 41 Information about the care home Name of care home: Address: Solden Hill House Banbury Road Byfield Daventry Northants NN11 6UA 01327260234 01327263840 delia@soldenhillhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Solden Hill House Limited Name of registered manager (if applicable) Mrs Averil O`Hare Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 2 of these 21 may be named service users who are over 65 years. A total of 21 service users from the age of 18-65 years in the cateogry of LD may be accommodated in the home. No further service users over 65 may be accommodated in the home. No one may be admitted to the home in the category of LD when there are already 21 service users in this category in the home. No service users other than the one named may be admitted in the category of MD The ground floor bedroom to be used only for existing service users who become ill and are unable to mount the stairs. In the unlikely event that the service user requires this room in excess of twenty eight (28) days the Commission for Social Care must be notified. To include 1 existing service user with an additional Mental Disorder MD. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 41 care home 21 Over 65 0 21 Brief description of the care home Solden Hill House is situated in a rural location, just outside the village of Byfield to the southwest of Northamptonshire. The village of Byfield is accessible by public transport, which can be infrequent. The home has its own transport so people living at Solden Hill House can access the village facilities, as well as the facilities of the nearby towns of Daventry and Banbury. The home is one of two owned by Solden Hill House Ltd and is managed by Mrs A. OHare. The home provides personal care and support for 21 people with learning disabilities. The premises are set in their own grounds and split into two self-contained houses, Solden and Apps House. Each house provides a communal lounge and a separate dining room. Both houses have kitchen facilities and the main house has workshops and day centre accommodation. There is large communal area, which is used as a dining area for people attending the day centre facilities during weekdays and for other activities during the evening and at weekends. There are extensive well-maintained and attractive grounds that are fully accessible to the people living at the home. Solden Hill House also contains office accommodation for the administrative section of the organisation. The Regsistered Manager provided us with the range of fee charged: £563.38 to £1082.65 per week, which excludes personal expenditure such as toiletries and magazines. People considering using Solden Hill House are encouraged to contact the home directly. The full details of the home and any specific requirements can be obtained from the home in the form of the Statement of Purpose and the Service User Guide. This information can be viewed on the homes website. The latest Inspection Report from the Commission for Social Care Inspection is available at the home. Care Homes for Adults (18-65 years) Page 5 of 41 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: two star good 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We as it appears throughout this Inspection Report refers to the Commission for Social Care Inspection. This Inspection Report is available in as an Easy Read report style. This key inspection consisted of preparation by reviewing the last key Inspection Report dated 24th January 2007 and the review of the Annual Service Review dated 3rd March 2008. We looked at the information we had about the management of Solden Hill House, the concerns, complaints, safeguarding investigations and the Care Homes for Adults (18-65 years) Page 6 of 41 events that affected the well being of the people living at the home. The Registered Manager sent to us the completed Annual Quality Assurance Assessment (AQAA) document, which reflects the homes own assessment of the standards within the home. We sent out twenty surveys in easy read formats with pictures and symbols, to the people living at Solden Hill House, of which 65 were returned. People were supported by their key workers to complete the surveys. The responses and comments received indicated people were happy with the lifestyle they experienced, the choice of meals, opportunities to participate in education and social events, making decisions about their day, the support they receive from staff and were confident to raise concerns. We sent out twenty surveys to staff, of which 25 were returned. The responses and comments received indicated there was a stable staff team that work well as a team to support people and have good systems of communication. Staff indicated they are supported by the management through supervisions, team meetings and training updates for their role. All the comments received in the surveys from the people living at Solden Hill House and the staff are included in the relevant sections within this Inspection Report. We visited Solden Hill House on 7th January 2009, starting at 11:15hrs and finishing at 17:30hrs. The Registered Manager assisted us during the site visit. The main method of inspecting we use was case tracking. This means looking at the range of care and support needs people receive that ensures their rights, independence and choices are respected. This was done by selecting four people who have a range of support needs and levels of independence. We spoke the four people we case tracked along with other people living at the home. We made observations throughout the day of the interaction and communication staff had with the people living at the home. We read the care files of the four people we case tracked that had information about their care and support needs and interests that demonstrated the quality of lifestyle people experienced. We spoke with staff about their role and the skills they have to support the people living at the home. We spoke about the communication systems, training and the management support. We read the staff and volunteers recruitment and training files that demonstrated that staff have the skill mix and qualities to support the people living at Solden Hill House. We looked at the home environment. These included the private living area, communal living areas and the workshops. We also read the information people receive about Solden Hill House and looked at the information on the homes website. The policies, procedures and specific records viewed demonstrated the day-to-day management of the home. The Commission for Social Care Inspection has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. What the care home does well: Solden Hill House is a well established care home for up to 21 people with a learning disability. The two buildings are individually decorated and both have a large kitchen/dining area, where people can make drinks and snacks with the support from staff. People live in a comfortable, relaxed and in a homely environment. People have individual bedrooms that are personalised. People are involved in making decisions about their lifestyle and about the home. People participate in meetings where new ideas and social events are planned. People are happy to take responsibility to help around the home, from helping in the kitchen, setting the dining tables to emptying the dishwasher. People living at Solden Hill House are supported by staff to continue to participate in activities that they enjoy. The home has access to transportation, which allows people the flexibility and freedom to choose to participate in social events and outings. These range from attending college, day centres, leisure activities such as swimming, horse riding or going shopping. There is a large workshop in the main building where people can participate in doing arts and crafts. People have an active social live where they enjoy going out into the community, socialising, going for a pub meal and maintaining contact with family and friends. Peoples health care needs are met by staff who make sure people receive their medication on time and are supported to attend health check appointments. The home works closely with the health and social care professionals to ensure peoples health, well being and independence is promoted. People are confident to raise concerns with the staff and the Registered Manager. People have Advocacy support from family and other people that have been identified. Staff are trained to respond to concerns and issues that affect the people living at the home in relation to reporting suspicions or allegations of abuse. There is a stable staff team, experienced in working with people with learning disabilities, who promote individuals independence, rights and well-being. The recruitment process for staff and volunteers is good. Staff and volunteers are supervised and receive mandatory training that promotes peoples well-being. The comments received from the people we spoke with directly and comments received in the surveys, included: Yes, I very happy here We have fun and a laugh together I like it in the summer when we go to fetes, in the Christmas time, in September and October. In fact I like it all the time I like living at Solden Care Homes for Adults (18-65 years) Page 8 of 41 I dont want to ever leave Solden. I like to go to theatre with ... I have lived at Solden a very very long time. Yes, I always like to live here I like it here, I have my privacy and freedom I have my own bedroom and a key to it for privacy Im never unhappy We go to the theatre, cinema, swimming and shopping in Daventry What has improved since the last inspection? What they could do better: This was a positive inspection of Solden Hill House. We discussed with the Registered Manager, areas of improvements that would improve the quality of life and outcomes for people living at Solden Hill House. These were acknowledged and well received by the Registered Manager. Solden Hill House provides information on the website that uses pictures and symbols to convey the information about the home. However, this information: Service User Guide, Statement of Purpose and the Complaints Procedure should be made available in alternative formats, on paper as well, to suit the people that live at the home or are considering using the home. The care plans used could be improved by using a person centred approach, whereby individual are actively involved developing the care plan in a format that suits Care Homes for Adults (18-65 years) Page 9 of 41 individual needs and ability, such as use of pictures and symbols. Whilst at present no-one living at the home takes any controlled drugs, the home should seek advice from the Pharmacist to ensure the controlled drugs storage meets the new legislation under the Misuse of Drugs (Safe Custody) Regulation 1973. Solden Hill House could improve the knowledge and skills of the staff and volunteers working at the home on the new ways of working and best practice to support the people living at the home. The home should consider reviewing and updating the induction training in line with Skills for Care training and consider training the volunteers in the safeguarding procedures to ensure they are aware of their responsibilities. The Registered Manager should re-register and complete the Registered Managers Award training. This was a recommendation made at the last inspection of the service. Solden Hill House should consider developing the quality assurance surveys for people to complete in alternative formats such as easy read supported with pictures and symbols, to suit the people that live at the home. Solden Hill House should consider measuring the results of the homes quality assurance surveys against the homes statement of purpose. This would demonstrate if peoples experiences of Solden Hill House is different to the aims and objectives set out and help in the development of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 41 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 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using Solden Hill House have their care needs assessed, have opportunities to visit and have a planned move into the home to ensure these can be met. Evidence: We read the information people receive about Solden Hill House, which includes the Statement of Purpose and the Service User Guide. The purpose for Solden Hill House is clearly set out known as the aims and objectives, so people can choose if this is the right place for them. The information tells people about what services are available to people, the type of facilities, social and leisure opportunities and the skills of staff that support the people living at the home. It sets the process of how people are involved in choosing to move to the home and how people can make a complaint and the process. We discussed with the Registered Manager whether information about the home is available in alternative formats to suit the needs of people both already living at the Care Homes for Adults (18-65 years) Page 12 of 41 Evidence: home or considering to move to the home. The Registered Manager showed us the website, which people can look at, providing they have access to it. It was strongly recommended to develop information about the home in alternative formats on paper as well, such as in an easy read format, supported by pictures and symbols to convey messages. The information we received from the Registered Manager before the site visit stated there was a robust admission process including a full assessment of clients needs. We read the care files of the four people we case tracked. The care files had copies of the assessments of needs completed by the Care Management Team. The assessments of needs were detailed and looked at the holistic needs of individuals, including people that are involved in their well-being such as family, college and health care professionals and their individual preferences, interests and goals. This showed peoples individual needs and routines were made known so that they could be supported by the staff at the home. The care files contained signed contracts with the terms and conditions of the stay including agreements from the local authorities financially supporting the people living at the home. This demonstrated a formal agreement was in place. There were records of visits made before the person moved into the home, which showed people had the opportunity to visit and test drive the home to see if it was the right place for them. This showed the admission process was flexible and people were involved in choosing to move into the home, which made the process smoother for people. This supported the comments we received in the surveys from the people living at the home and included comments like: Came with mum and dad to visit I dont want to ever leave Solden I have lived at Solden Hill House a very, very long time. Yes, I always live here. We spoke with the people we case tracked and other people living at the home. They told us many of them have been living at Solden Hill House for many years and see this as their home. Staff told us they have known the people living at the home, having supported them for many years. Staff confirmed that they receive any new information on a daily basis that promotes peoples well-being and lifestyle. This was evident from the observations we made of staff interactions with the people living at the home, which was relaxed Care Homes for Adults (18-65 years) Page 13 of 41 Evidence: and showed trust. This supported the responses we received from the staff surveys, stating staff receive information about individuals and their care and support needs. The comments we received in the staff surveys included: Staff meetings daily - Mon-Fri and Day Book Notes and of course the grapevine Care plans are updated regularly by key workers - health is covered both by the care plans and separate medical notes i.e. changes of medication, daily issues e.g. communication from families, minor ailments (e.g. colds) are noted in the day book and information is also passed on at the regular morning meetings, which are held Mon-Fri, so staff are aware, when particular support is needed on an individual basis for the clients The manager attends the 5 morning meetings that we have each week. This gives all staff a chance to discuss issues re: clients or themselves, if needed. Care Homes for Adults (18-65 years) Page 14 of 41 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Solden Hill House make personal decisions and choices about their lifestyle and are supported by staff. Evidence: We read the care plans for the people we case tracked. The care plans outlined the level of care and supports needs of individuals. Whilst the care plans were not written in a person centred way, which means from the view-point of the individual, their preferences, routines and choice of lifestyle was made known. The care plans included Advocacy support from family and specific support provided by health care professionals. Each care plan included the individual weekly activity that they participate in. All varied ranging from attending college, swimming, social outing and attending individual sessions such as eurythmy (music and exercise therapy). This supported the comments we received from people during the site visit and surveys, indicating that they have their own weekly activity programme. Care Homes for Adults (18-65 years) Page 15 of 41 Evidence: We saw assessments of risks had been completed with individuals to ensure their health, safety and well-being. This included an assessment of risk for having a key to their bedroom. One person was happy at having the privacy of their bedroom, which was entered by the cleaner only. There was guidance for staff to follow with regards to diet, managing inappropriate behaviour and triggers to look for that would indicate the person is not happy and guidance given to supporting them in the best way. People identified their key workers and described to us how they are supported by their key worker. Staff we spoke with showed an awareness of individual risks and vulnerability and ways in which they help them. Staff said where necessary, there is support and input from health care professionals like the Community Psychiatric Nurse. The care plans read were reviewed regularly, which supported the comment received in the staff surveys: Care plans are regularly reviewed and updated. The Registered Manager told us people are involved in developing the care plans and the key workers explain the detail to them. It was evident from speaking with some people that they are involved in their care planning. However, people are unable to contribute effectively as the care plans are not available in formats that people can easily understand, with short words, pictures and symbols. This indicates that improvements could be made to ensure people can actively contribute. We observed people were making their own decisions from choosing to attend college, go shopping, help in the kitchen and setting the dining table for lunch. We were told by a number of people living at the home and others returning from activities, that they choose not to go to see the pantomime. People were happy to have their privacy and freedom. People described to us the range of experiences and opportunities they have had whilst living at Solden Hill House. This supported the responses and comments received in the surveys from people, indicating that they make daily choices about what they do. The comments received in the surveys and directly from people during the site visit included: I do what I want I like watch Rugby I dont have to do anythings I dont want to do I like going to the Cinema or for a pub lunch I like it here, I have my privacy and freedom Care Homes for Adults (18-65 years) Page 16 of 41 Evidence: We observed staff responding to peoples questions and it was evident that people living at the home were in control of when and how they are supported by the staff. It was evident there was a positive relationship staff had with the people living at the home that promoted peoples well-being as people were smiling, happy and appeared to be content. Staff told us, people living at the home have benefited from having a stable staff team, key working arrangement whereby people are confident their care and support needs are known. Staff confirmed whilst they have had regular mandatory training including health, safety, safeguarding adults procedures and food hygiene training. The information we received from the Registered Manager before the site visit supported our findings on the day of the site visit from talking with people and staff, making observations and reading records. The Registered Manager had identified individual areas that could be improved such as responding to requests for work experience and access to information about education and training possibilities for residents e.g. Gateway Award Sports Club. This showed the service continues to look at improving the quality of life people experience whilst living at the home. Care Homes for Adults (18-65 years) Page 17 of 41 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Solden Hill House are supported to enjoy and experience a lifestyle of their choice and opportunities that promote their well-being. Evidence: The information we received from the Registered Manager before the site visit stated residents attend further education, local activities, social events, outing/shopping in the wider community, having cinema passes provided. This supported the response received from the surveys, discussions with the staff and the people living at the home during the site visit and records that we read. On arrival at Solden Hill House, we were welcomed and questioned by two people living at the home, wanting to know who we were, why were we visiting and who did we need to see. By the time we walked towards the entrance, they had told us how Care Homes for Adults (18-65 years) Page 18 of 41 Evidence: long they had lived at the home, as they pointed to the key they have for their bedroom, some of the things they enjoy doing at the home and which staff were working. This was good initial evidence indicating people felt this was their home. During the site visit majority of the people living at the home had gone to see a pantomime and others had chosen to stay at home or continue participating in their weekly activity programme. Two people stood in front of the window looking out at the snow falling and the reindeers in the distance. One person was having a private eurythmy session in the large dining room / activity room. Eurythmy is a new activity introduced, which is music and exercise therapy for people to participate in groups or have individual sessions. We saw a number of people returning in different forms of transport from college and a shopping trips. There were photographs of social events held at the home, which showed people had opportunities to experience things. People we case tracked told us of a number of different things that they have done and plan to do. People felt independent and responsible in the home. They told us they go on holidays abroad, horse-riding, attending cookery classes, practicing their religion if they wish, swimming, theatre, cinemas and visit family. Staff told us that people benefit from being able to participate in the local community, educational and social events as the home has its own minibus, which is needed because of the rural location. This was further supported by the daily reports completed by they key workers detailing the well-being, activities and significant events for the individuals on that day. Solden Hill House has the main building and a purpose built building next door. The main building is the place where people prefer to spend their time, for weekday meals and social events. The main house has a workshop, where people do weaving, candle making and other arts and crafts. The Registered Manager pointed out the vegetable patch where vegetables are grown every year. We saw the poster made for a Birthday Party that was planned for Saturday. People said they were looking forward to the party, the birthday cake, food and dancing. Another person was looking forward to celebrating their birthday the following week and was deciding on the time for the disco. Other comments received directly from people during the site visit and included in the surveys from people were: I like going to the cinema or for a pub lunch We have fun and a laugh together I like it in the summer when we go to fetes, in the Christmas time, in September and Care Homes for Adults (18-65 years) Page 19 of 41 Evidence: October. In fact I like it all the time I like to go to theatre with .... I like dancing and horse-riding I was helping in the kitchen and I do cookery at college Im Christian. I know about other religions: Hindu, Islam, Jewish, Buddhist and Sikh Ive been on areoplanes to Italy, Edinburgh in Scotland We go to the theatre, cinema, swimming and shopping in Daventry. The information we received from the Registered Manager before the site visit stated three people attended an international conference with staff. Some people were aware of the people that attended the international conference with staff. We were told that the experience gained from the excursion was shared with the other people living at the home and they were able to recognise the differences in relation to services and opportunities people with a learning disability have available to them. The staff told us that after the experiences were shared with everyone, people were keen to attend future events. This showed that the people living at Solden Hill House are encouraged to participate and share learning internationally. People told us they have certain things they have to do and want to do like setting the dining table, emptying the dishwasher or helping with the shopping. We saw the household duty list in the smaller kitchen/dining room, which showed people are actively involved in household duties. The records we read showed people were supported to keep in contact with family and friends. People spoke about the important people in their lives, which included remembering family and friends that have gone to heaven. Staff recognised the need to ensure people had an understanding of friendships and relationships and would help people understand if they were asked to and would respond to inappropriate conduct that dis-respected people by talking to the person. Staff told us people can receive visitors at any time and go to visit family, as many did for Christmas. It was evident from observing people that Solden Hill House was very much their home, they appeared to be happy with the lifestyle. This showed outcomes for people were good. People are offered a good choice of meals, which is agreed with contributions and suggestions made by the people living at the home. Meals available are home-cooked, Care Homes for Adults (18-65 years) Page 20 of 41 Evidence: healthy and nutritious from homemade pies to burgers and chips. One person told us they do cookery classes and help in the kitchen regularly, whilst another person was seen setting the dining table, places and seating. People said they occasionally go for a pub lunch or have a Chinese takeaway at the home, as they rubbed their tummy. This showed people have a good choice and variety, which is decided by them. One person said .... is a great cook. Staff told us they have received training in food hygiene, which supported the information we received from the Registered Manager before the site visit and from viewing the staff training matrix. Care Homes for Adults (18-65 years) Page 21 of 41 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Solden Hill House have their personal and health care needs met by trained staff that promote independence and well-being. Evidence: The people we spoke with said they managed their own personal care and were supported to attend appointments to seek the General Practitioner or hospital appointments. This supported the responses we received from people indicating staff listened, acted and were available. We observed staff being around and available for people, should they need support or assistance. We saw people moving around the home independently, whether it be to find staff, go to their room or to the toilet. The information we received from the Registered Manager before the site visit stated they provide personal and health care support, enabling residents physical and emotional needs to be met,seek support from health care professionals as required and have a key worker system in place. People we case tracked talked about the support they receive from their key worker and the role of the key worker as they find. The care files we read had information about peoples individual health and personal Care Homes for Adults (18-65 years) Page 22 of 41 Evidence: care needs and support, which mainly stated that staff should prompt, remind and encourage people with their personal hygiene. It showed us that people are supported by other health care professionals such as the Community Psychiatric Nurse. The key worker we spoke with knew the individuals needs, level of ability and they way they preferred the support to be. The daily report sheets read confirmed people were encouraged by staff, have support from health care professionals and the care plans are reviewed regularly along with the record of the social worker review meetings. This supported the comments we received from the people we spoke with and the information we received from the Registered Manager before the site visit. The Registered Manager confirmed that medical profile and medical diaries have been introduced following the recommendations made at the last inspection. We saw the medical diaries, which detailed the health care appointments made for people. The care files listed the medication people were taking, allergies and the contact details of the General Practitioner (GP). The member of staff responsible for the medication, told us that they along with two other members of staff are responsible for making appointments and taking people to attend the health care appointments. They said we know which GP residents prefer to see with different issues and make sure appointments do not clash with individual activities such as college - not fair if they cant go to college because Ive made an appointment at the wrong time. The member of staff described the system of managing and administration medication, where staff had specific responsibilities. The comments we received from staff in the surveys included: Treats each service user as individual and they get the best quality of service and care possible Care plans are updated regularly by key worker - health is covered both by the care plans and separate medical notes i.e. changes of medication, daily issues, communication from families, minor ailments (colds) are noted in the day book and information is also passed on at the regular morning meetings, so staff are aware, when particular support is needed on an individual basis for the clients The medication is stored in individual cassettes prepared by the Pharmacist and is stored securely in a locked cabinet. Trained staff give people their medication. The staff training records viewed confirmed staff had received training in the safe administration of medication. The policies and procedures for managing and administering medication were in place and staff demonstrated that procedures were followed. Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: Two people we case tracked confirmed they received their medication on time. Both were able to tell us what medication they take, when and why they take it. This showed people were in control and had an understanding of how the medication helps them. People told us that they felt they were able to speak about personal and private matters with their key worker or particular GPs, that they preferred. We looked at the medication cassettes for the people we case tracked, all were signed and showed records accurately reflected the medication taken. This showed people were taking their medication on time, were aware of the purpose of the medication that promoted their health and well-being. Solden Hill House at present does not have people taking strong medication, known as controlled medication. We advised the Registered Manager to seek advice from the Pharmacist to ensure the controlled medication storage complies with the new legislation under the Misuse of Drugs (Safe Custody) Regulation 1973. Solden Hill House benefits from the active involvement from a representative of the Responsible Individual, who carries out the monthly visits and looks at records; talks with the staff and the people living at the home. We saw the Quality Audit reports of visits carried out annually to look at specific quality assurance areas, that includes health and personal care and related records. This demonstrated that the internal system and monitoring, ensures the home is run in the best interest of the people that live their, which promotes their health, safety and well being. The information we received from the Registered Manager before the site visit identified areas for improvements, which include updating and improving procedures and continuation of audit and reviewing of policies and procedures. Care Homes for Adults (18-65 years) Page 24 of 41 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Solden Hill House have their rights protected, confident concerns are addressed and protected from harm or abuse by trained staff. Evidence: The complaints procedure is displayed in the home, included in the information people receive about the home before or when they move into the home. The complaints procedure sets out the process of how the concern or complaint will be investigated. We advised the Registered Manager to ensure the contact details for the Commission for Social Care Inspection are updated. The Registered Manager told us the complaints procedure is available easy read format on the website, if people have access to it. We recommended that the complaints procedure should be made available in a paper version and in formats suitable for the people living at the home, which may include pictures and symbols. This would enable people to comment or raise concerns without having to rely on staff or other people to support them to express their views or concerns. The responses and comments we received from the surveys and directly from the people that we spoke with on the day indicated people were confident to tell the staff or the Registered Manager if there was a problem, concern or something that was making them unhappy. The comments received in the surveys and directly from the Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: people living at Solden Hill House included: I dont need to complaint Its the best way to speak to someone. I would speak to Averil, shes in charge Talk to anyone that works here I would tell ..., my key worker Im never unhappy, I dont like being unhappy From our observations, comments received from the people living at the home and the staff surveys, it was clear that people were confidant to complain and felt staff listened and acted on concerns. The staff surveys all confirmed that staff know how to respond to concerns raised by the people living at the home or their family or representatives acting on their behalf. Staff told us that having worked and supported the people living at the home, they know each individual, from their daily routines to how they may be feeling by the smiles or lack of smiles and through speaking with family and other important people in their lives that they confide in. This showed people had stability and support to make sure the were happy at the home. The information we received from the Registered Manager before the site visit stated there were two complaints received. We read the complaints record, which detailed the nature of the complaint, the investigation process and the conclusion. This demonstrated the complaints procedure was followed. The Commission for Social Care Inspection received no complaints or expressions of concerns about Solden Hill House or the care and support people receive. The information we received from the Registered Manager before the site visit stated there were a number of safeguarding referrals and one safeguarding investigation. Safeguarding means promoting the well being of people using the service from harm, risk or abuse. The Registered Manager showed us the records of the safeguarding referrals and investigation that showed peoples safety and well-being promoted. It was clear that the safeguarding procedures were followed involving the local authority care management team and health care professionals such as the GP, Community Psychiatric Nurse. Staff observed and spoken with demonstrated a good understanding of safeguarding issues and the types of abuse that could be experienced by the people living at the Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: home. Staff appeared confident and showed awareness of their responsibility to act and report any suspicions or bad care practices of staff. The staff training matrix showed staff had completed training in abuse and safeguarding procedures in March 2008. However, there was no record to demonstrate if volunteers working at the home received any form of abuse and safeguarding training or information. We recommended that volunteers receive training and information to make them aware of the procedures to follow should they witness an incident or suspect someone is at risk. The responses and comments received in the staff surveys, which included: Averil has an open door way of working and is accessible to residents and staff daily All staff are aware of the whistle-blowing policy and should feel confidant seeking help for a client if the need arises. Many families visit informally and would not hesitate to express their concerns, again if the needs arises and exchange of news/views happens between families and for the more newer families this can be reassuring factor The service treats all its clients as individuals looking to empower them as much as possible Confidentiality is kept at all cost. The other is professional practice is of a really high standard at out home People told us they get their money from the office. We spoke with the Administrator, who maintains records of money held in safekeeping for people. The Administrator described the system and showed us the financial records maintained for each person for each transaction made, which is always signed by two staff and sometimes some individuals may choose to sign the record. The monthly visits carried out by the representative of the Responsible Individual also randomly checks the financial records. This showed peoples money was kept safe and there is an internal system of checking and monitoring of records. The staff surveys responses indicated staff were recruited upon receipt of satisfactory checks such as criminal records bureau (CRB) disclosures and references. The staff recruitment records viewed for four staff all contained evidence that recruitment checks were carried out. Solden Hill House employs oversees volunteers, who also undergo recruitment checks with references and a CRB disclosure. Records viewed also showed the staff including the volunteer had completed the homes induction training to ensure people living at the home were supported by trained staff. Care Homes for Adults (18-65 years) Page 27 of 41 Care Homes for Adults (18-65 years) Page 28 of 41 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 clean, maintained and comfortable for them. Evidence: Solden Hill House is situated in a rural area surrounded by beautiful grounds and looks out on open fields. On the day of the site visit it was particularly picturesque, snow covered round with reindeers in the distance with snow continuing to fall. There is car parking to the front of the home and a larger car park set back from the houses. People benefit from having access to a minibus and other organised transportation that allows people to continue to participate in the community, which promotes their wellbeing. Accommodation is divided into to two areas, with the main house, is an old building comprising of the offices and other is a modern building known as the Apps House. Collectively, the two parts of the home accommodate 10 and 11 people, respectively. All the bedrooms are individual and people have shared communal bathrooms, shower rooms and toilets. Both houses have a large lounge and kitchen/dining room, where people, should they wish and be able to, prepare snacks and drinks with the support of staff. The main house has the main kitchen, where meals are prepared and served in the main dining room that doubles-up as an activity room. There is also a large Care Homes for Adults (18-65 years) Page 29 of 41 Evidence: workshop where people can do arts and crafts or weaving. Two people we spoke with said they preferred to have a key to their bedroom. They described their bedroom as a place that was private for them, furnished with bedroom furniture, pictures, photographs and television and/or stereo. The home is clean, tidy and furnished to a good standard, with complimentary decoration and furnishings that create a homely family atmosphere. This supported the survey responses we received from the people living at Solden Hill House, which included comments such as: ... does everything and it is all very comfortable Nice cleaning lady - ... I help to clean up in the kitchen when I help cook lunch. I keep my room tidy We saw people were involved and responsible for keeping the home clean and tidy or at least their bedroom. People told us they have duties in the home such as setting the dining table and emptying the dish washer. People told us they have their laundry done by the staff and have their clothes returned clean, fresh and ironed. We saw staff labeling peoples clothing, which showed people had their own clothing. It was evident that people felt responsible for keeping the home clean. We saw one person take the rubbish and put it in the bin and another person tidying the books on the table. We saw a member of staff responsible for keeping the home clean and tidy, cleaning bedrooms and communal areas. People told us that they were happy for their bedrooms being cleaned. We saw staff wearing gloves and aprons when they were supporting people and helping to prepare meals in the kitchen. The staff training records and training matrix viewed showed staff had completed in infection control, health and safety, food and hygiene and moving and handling. The home does not have any moving and handling equipment and at present have no-one that needs any physical help or support that would require the use of moving and handling skills or equipment. Care files had assessments of risks completed where people were involved in assisting in the main kitchen or the smaller kitchen where they can prepare snacks and drinks. This showed peoples independence was maintained, promoted and were positively involved in the home as it is their home. The information we received from the Registered Manager before the site visit stated the kitchen of the Apps House and the communal areas have been refurbished, new shelving and flooring has been replaced and several bedrooms have been decorated. Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: Solden Hill House have an annual servicing and maintenance contract that ensures the home is safe and well maintained. They identified plans for improvements that would improve the home environment and the surroundings for people living at Solden Hill House. These included looking to re-surface the driveway, replacing the flooring and to decorate bedrooms as required. Solden Hill House has an internal system of monitoring and quality assurance. There are monthly visits carried out by a representative of the Responsible Individual and the annual quality audit checks. We read the report of the monthly visits, which showed the home environment is checked and issues of concerns are raised with the Registered Manager to address. This demonstrated the home recognises and is responsible for maintaining a safe and good home environment for the people living there. Care Homes for Adults (18-65 years) Page 31 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Solden Hill House are supported by staff who have undergone good recruitment process and training to support and promote peoples well-being. Evidence: People living at Solden Hill House appeared to enjoy a positive relationship at home, with staff on duty and the Registered Manager at the time of the site visit. People were seen returning home from various places to be greeted by the staff. Staff were seen listening and responding to questions ask they were asked. This supported the survey responses we received from the people living at the home, stating staff listened, acted and treated them well. Everyone living at Solden Hill House has a key worker that supports them, helps them with their confidence, developing and maintaining skills to having opportunities to experience new things. People talked about the role of their key worker, how they are supported by them. The comments received included: We have fun and a laugh together ...., Ive known her since 1969, she looks after me at Solden Care Homes for Adults (18-65 years) Page 32 of 41 Evidence: I like all the staff also They are good - thumbs up There is a stable staff team at the home and have volunteers that actively contribute and participate to support people and to gain experience and learning. On the day of the site visit, there appeared to be more staff on duty, as a large number of people had gone to see a pantomime. The Registered Manager told us two new staff have been recruited to compliment the staff team and benefit people who have full and busy lifestyles. We wanted to find out how staff recruitment promotes the health and well being of the people living at Solden Hill House. The staff survey responses received indicated the employer carried out employment checks before starting work. We looked at the staff recruitment records including the records of a volunteer. All the files contained the receipt of satisfactory references and a check known as, criminal records bureau (CRB) disclosure, to make sure a persons suitability to work with vulnerable people. This supported the staff survey responses and the information received from the Registered Manager before the site visit. We wanted to find out how training completed by the staff helped them to support the people living at Solden Hill House and gave them a better understanding of learning disability and Asperger syndrome. The induction training is an in-house training that looks at the policies, procedures and key training such as health and safety, fire, infection control, food hygiene, moving and handling. Staff told us they found it difficult to access training specifically for working with people with a learning disability or Asperger Syndrome. We saw the staff training matrix that showed staff had received a range of training dependent of their responsibilities. Training included infection control, medication, dementia, epilepsy first aid, specialist training known as breakaway (practice and theory) and abuse. This supported the comments received in the staff surveys: Our manager ensures that all staff members are fully trained and she is always willing to listen if there is a particular training that a staff member has indicated i.e. therapeutic work shops All courses information is freely available to all staff including non-statutory and we are free to suggest relevant courses we know about. Course information is on the notice board for all to see Care Homes for Adults (18-65 years) Page 33 of 41 Evidence: As well as the mandatory training courses, e.g. first aid, manual handling, dementia, etc, which are consistently taken, staff are give options to attend courses that might interest them e.g. music therapy, nutrition. We have had courses on makaton to help those service users who have hearing difficulties We discussed with the Registered Manager how staff training is maintained in line with changes in best practice and development of staff. We advised that they consider looking at training organisations such as the Skills for Care, to ensure staff receive training in line with the current best practice, look at specific disability issues and promoting peoples independence and well being. This was well received by the Registered Manager. The information we received from the Registered Manager before the site visit stated 14 staff had attained the National Vocational Qualification (NVQ) in care, level 2 and above. The Registered Manager corrected this figure to 16 staff, which equates to 48 . The staff survey responses and from discussion with the staff on duty, we found out that some staff had attained NVQ level 3 and others NVQ level 4. Staff we spoke with confirmed they have staff meetings and individual supervision meetings with the Registered Manager. This supported the responses we received by staff in the staff surveys indicating they receive regular supervisions and have daily staff meetings. The comments received in the staff surveys included: The manager attends the 5 morning meetings that we have each week. This gives all staff a change to discuss issues re: clients or themselves, if needed. The manager is readily available for personal discussions in the privacy of her office or she would not hesitate to point out inappropriate working methods or offer advice for more effective methods. She is very aware of staff are under stress / need more support or perhaps a well done! Our observations made during the site visit and discussions with the staff on duty showed they have a good awareness of peoples needs. Staff recognised peoples strengths, levels of confidence and responses that would indicate uncertainty and how best to support them through the knowledge gained from training. This showed peoples health, safety and well-being is promoted by the conduct of staff. Care Homes for Adults (18-65 years) Page 34 of 41 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Solden Hill House benefit from a well managed home, contribute their views through the quality assurance systems and have an internal monitoring system that measures the service. Evidence: The Registered Manager Averil OHare has been managing the home for many years having experience of working with people with a learning disability. The Registered Manager told us she had attended training in Deprivation of Liberty course the previous day, recognising the work and changes that will affect the management and outcomes for the people living at the home. It was recommended at the last inspection of the service that the Registered Manager completes the Registered Managers Award. The Registered Manager told us she has still not completed the course and will have to re-register. This indicated that the Registered Manager may not fully value the training and the benefits that could be gained from attending the course that would have a positive impact on the Care Homes for Adults (18-65 years) Page 35 of 41 Evidence: management of the home. The information we received from the Registered Manager before the site visit indicated management of the home is effective and responsive and residents benefit from a well run service. The staff and the people living at the home said they were supported by the Registered Manager. Staff told us they had clear roles and responsibilities and that communication between staff was good. This was consistent with the responses and comments received in the surveys we received, which included: Averil has an open door way of working and is accessible to residents and staff daily She is excellent in maintaining a professional relationship with all staff members and is always accessible Have recently completed NVQ level 4 care and taken on the role of acting manager for the unit The service treats all its clients as individuals looking to empower them as much as possible The management team is committed to providing not only a homely environment where each client feels a valuable member of the community but extending that reach into the community Solden does everything it can to ensure that its service users lead valued and productive lives - ensuring that staff treat clients as individuals and dont become complacent in their approach. Managers are even more aware of the individual needs of clients and are quick to ensure that staff are kept up to date. There was evidence of good working relationships with the social and health care professionals to provide the level of support individuals need. Some areas for improvements were already identified by the Registered Manager in the information we received before the site visit. These include staff training and to review and monitor the homes good practice procedures. This showed the service recognises that they must continue to improve and develop the service. The staff told us they have daily staff meetings where information, updates and changes affecting the people living at the home are shared, along with training updates. We saw the new recording sheets for the daily staff meetings, which mainly focused on the people living at the home. The staff told us they have regular Care Homes for Adults (18-65 years) Page 36 of 41 Evidence: supervision meetings with the Registered Manager, which supported the comments in the surveys as supervision meeting records are remain confidential. We saw the monthly visit reports completed by a representative of the Responsible Individual for the home. The visit reflected the checks and audits carried out, discussions with the staff and the people living at the home and shortfalls identified shared with the Registered Manager. We were shown the annual quality audits carried out that looks at specific areas of the home and the management. This showed there is an internal system of monitoring the management of the home. Solden Hill House has a quality assurance system whereby, people living at the home are given surveys to complete. We found the surveys were not available in alternative formats to suit individual people, as some people could understand questions with the use of pictures or symbols. Therefore, the majority of the responses that were returned were completed by people with the support of the key workers. We found out that the home is looking to develop surveys for relatives and health care professionals. This shows that the home recognises the value of comments from people to improve the quality of the service provided at Solden Hill House. We wanted to know how the results from the surveys are shared with the people living at the home and if they are measured. The Registered Manager had not considered sharing the results with the people living at the home or measure the quality of the service and look at how changes would improve the service people receive. We suggested that they should consider measuring the results from the quality assurance against the statement of purpose to see if people actually experience the service as intended, looking at the outcomes and benefits to people living at Solden Hill House. This was acknowledged and accepted by the Registered Manager and assurance given to conclude the quality assurance process. The information provided by the Registered Manager before the site visit details the regular maintenance of equipment and checks within the home such as heating, lighting, fire and fire equipment. People told us they have regular fire drills and tests and occasionally have had to leave the building when someone has burnt the toast. The health and safety checks are also audited as part of the monthly visits by the representative of the Responsible Individual. Care Homes for Adults (18-65 years) Page 37 of 41 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 38 of 41 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 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 It is good practice to develop documentation and information about the home in alternative formats, such as easy read format supported with pictures and symbols, to suit the needs of people living at the home or considering using the home, to help them understand processes easily. Care plans could be improved by making them person centred and available in alternative formats that suits the needs of people who would be able to contribute and influence the support they receive that results in outcomes that improve their quality of life people experience. The Registered Person should seek advice from the Pharmacist to ensure the controlled drugs storage complies with the new legislation under the Misuse of Drugs (Safe Custody) Regulation 1973. The complaints procedure could be more accessible and developed in alternative formats that would suit individual needs, using pictures, symbols and easy read text. Training and information in the safeguarding procedures should be given to volunteers working in the home to ensure they are aware of their responsibility to ensure the health, safety and well-being of the people living at the home. Page 39 of 41 2 6 3 20 4 22 5 23 Care Homes for Adults (18-65 years) 6 32 It is recommended that the homes induction programme is reviewed and updated, considering the Skills for Care training, which promotes the current best practice to ensure staff have the right skills and training to support the people living at the home. The Registered Manager shouldre-register and complete the Registered Managers Award. This remains a recommendation from the last inspection The home should consider developing quality assurance questionnaires in alternative format to suit individual needs, where they can understand with short words, pictures and symbols, to express their opinion about the service they receive and experience. The homes quality assurance results should be measured against the statement of purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the statement of purpose evolves as the service develops. 7 37 8 39 Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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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