Inspection on 21/04/09 for Summer Wood

This inspection was carried out on 21st April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Southfields

Thorndene

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Summer Wood 18 Magdalen Road Bexhill-On-Sea East Sussex TN40 1SB Lead Inspector Alexis Reilly Unannounced Inspection 21st April 2009 09:30 Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 2 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 Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summer Wood Address 18 Magdalen Road Bexhill-On-Sea East Sussex TN40 1SB 01424 221641 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Luisa Backhouse Mrs Luisa Backhouse Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 3. Date of last inspection N/A Brief Description of the Service: Summer Wood is a new service for three people with learning disabilities, owned and managed by Mrs Luisa Backhouse. Summer Wood is a large Victorian house and was once a Bed and Breakfast business, it is in the quiet service area of Bexhill, and is situated near the town centre, shops and public transport. The current weekly fees are £700.00. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection began at 9.30am and lasted for two hours finishing at 11.30am. Prior to this site visit the inspector spent time examining the registration report and associated documents. Summerwood is a newly registered service which has been open for six months; the service is very much in the developing stages. Ten requirements and one recommendation were issued as a result of this first inspection and the Registered Manager must address the requirements to ensure the service can move forward. Evidence was supporting to confirm the outcomes for service users in the home are positive ones. The inspector case tracked one service user during the inspection. The service user was not available to meet on the day of the inspection. However the inspector met with professional from the community and gained views about the service, these comments are included in the report. The inspector examined the plan of care and the associated documents such as risk assessments and activity plan for service users in the home. Other documents examined were copies of notifications, accidents and appointments, evidence of external reviews, the record of complaints and the complaints procedure. The pro forma for care plans, statement of purpose, service user guide and a sample of sheets which record the administration of medicines. The inspector spent time with the Registered Manager who is also the owner of the service, and discussed staff recruitment, induction and training of staff. The service does not currently employ staff. A full environmental tour of the home was carried out. What the service does well: The inspector received comments about the service from professionals in the community these included, ‘Manages x very well, knows when to get involved Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 6 and when to give X space. X has done very well in the placement and has stayed longer then anywhere else previously’. The Registered Manager has ensured the home is a comfortable place in which to live and is well maintained and decorated. What has improved since the last inspection? What they could do better: The Registered manager must ensure the service has an up to date statement of Purpose with the correct details in relation to number of placements offered and regulatory body. The Registered Manager must ensure that all service users are provided with a terms and conditions of contract. No formal care plan was available to view and no plans of weekly activities were available to view. The Registered manager must introduce formal care plans into the home, and use these for each service user. The Registered Manager must ensure a record of scheduled activities for each service user is available to view. Risk assessments must be comprehensive and relevant to the individual placed in the home. The Registered Manager must ensure that sensitive information is kept confidentially and not passed on. The Registered Manager must ensure the complaints procedure has the correct details of the CQC on and that all incidents of notice are sent to the relevant bodies including the CQC. The Registered Manager must also ensure that a formal system for quality assurance is used in the home, and that the Registered Manager uses this as a tool to move the service forward. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 7 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. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has had one admission since it became registered in October 2008. The Registered Manager had gained information about the service user and evidence was supporting in the form of review documents from the Adult placement team. However the Registered Manager must ensure their statement of Purpose is updated and that all service users receive terms and conditions of contract. EVIDENCE: The home has had one new admission since it became registered in October 2008. The Registered Manager was able to evidence that they had obtained background information and up to date review document’s prior to offering the prospective service user a place in the service. However the Registered Manager must ensure their statement of purpose is updated and correct. This is in relation to the number of places offered by the service and also the correct information must be included with regard to the regulatory body who register and inspect the service. The service user Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 10 placed had no terms and conditions of contract and the Registered Manager must ensure this is corrected. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence is supporting to show that the Registered Manager has worked in a positive manner with the service user placed; However the Registered Manager must ensure they have comprehensive care plans and risk assessments for each service user placed. Service users are able to make their own choices and decisions, and are treated as individuals. Contact with advocacy services is promoted. EVIDENCE: As part of the inspection the inspector case tracked one service users. As part of the case tracking the inspector would normally examine the person centred care plan document, risk assessments and activity plans for the individual. However in relation to this service user the Registered Manager had not created a care plan or activities schedule for the person. A copy of Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 12 the external review from the Adult Placement team was available to view, this helped the inspector make a judgement as to whether the needs identified in the assessment were used as a basis for a comprehensive care plan. The inspector spent time with the Registered Manager and gained views about the services from professionals in the community. The service user in residence was out on the day of the inspection. The Registered Manager had produced a pen picture of the service user in the home, this document was informative and easy to read and included relevant information about likes and dislikes, and had also highlighted particular areas which could be worked along with the service user to give them a greater opportunity to explore and develop new skills. However no formal care plan was available to view and no plan of weekly activities were available to view. The Registered Manager did have a care plan document which they had obtained from outside the service and this needs to be re branded with the homes name and introduced into the service and used as a plan of care for each service user in the home. The Registered Manager must also ensure that sensitive information about individuals is kept confidentially. The inspector examined the risk assessment for this individual and found it to be generic in its approach and not specific for the individual in question. Positive comments about provision of the service were received from professionals in the community these included ‘Manages x very well, knows when to get involved and when to give X space. X has done very well in the placement and has stayed longer then anywhere else previously’. Contact with advocacy services is promoted. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from freedoms and flexible routines. The Registered manager must ensure that work is done to encourage service users to become involved in activities on offer both within the home and the community such as educational, and where appropriate, employment opportunities. EVIDENCE: As part of the inspection the inspector case tracked one service users in the home. As part of the case tracking the inspector would normally examine the person centred care plan document, risk assessments and activity plans for the individual. However in relation to this service user the Registered Manager had not created a care plan or activities schedule for the person. A copy of the external review from the Adult Placement team was available to view, this Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 14 helped the inspector make a judgement as to whether the needs identified in the assessment were used as a basis for a comprehensive care plan. The inspector spent time with the Registered Manager and gained views about the services from professionals in the community. The service user in residence was out on the day of the inspection. Although no activity plan was available for the service user placed in the home the inspector evidence that the Registered Manager had recognised that the service user required encouragement and a positive approach in relation to engagement in activities. Evidence was also clearly supporting that the service user’s wishes are taken into consideration and they have choose. Personal relationships and family relationships are encouraged if these are helpful and appropriate. Evidence was supporting to confirm that meals are made with individual preferences taken into consideration and are varied and healthy. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager has a productive relationship with the community placement team and service user’s health care needs are reviewed and referrals made were appropriate. The procedure for administering medication was found to be in good order. EVIDENCE: As part of the inspection the inspector case tracked one service user in the home. As part of the case tracking the inspector would normally examine the person centred care plan document, risk assessments and activity plans for the individual. However in relation to this service user the Registered Manager had not created a care plan or activities schedule for the person. A copy of the external review from the Adult Placement team was available to view, this helped the inspector make a judgement as to whether the needs identified in the assessment were used as a basis for a comprehensive care plan. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 16 The inspector spent time with the Registered Manager and gained views about the services from professionals in the community. The service user in residence was out on the day of the inspection. The Registered Manager has the required cupboard and procedures in place for administering medication. The current service user self medicates. The Registered Manager appears to have a productive dialogue with the current Adult Placement team and this ensures that the individual’s health care needs are monitored and additional support obtained as required. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager must ensure the complaints procedure has the correct details of the regulating body. The Registered Manager must ensure they notify the CQC of all significant incidents in the home. The service has not currently recruited staff. EVIDENCE: As part of the inspection the inspector examined copies of notifications, and accidents and the record of complaints and the complaints procedure. The inspector spent time with the Registered Manager and gained views about the services from professionals in the community. The Registered Manager has failed to notify the CQC of significant incidents which have occurred in the home, however they had informed the relevant Adult Placement team. The Registered Manager must ensure the correct details of the CQC are on the complaints policy in the home. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a bright and clean home with an accessible garden EVIDENCE: Summer Wood has been totally refurnished and has accommodation over three floors, including communal areas on the ground floor. The communal area, which includes two lounges, are well furnished and equipped with leather sofas, and a large wall mounted LCD Televisions. The kitchen is well equipped and there is a separate dining room. The washing machine and tumble direr is placed in a large walk in cupboard. There is also a locked medicine cupboard. Service user’s bedrooms are on the second floor with two separate bathrooms. The top floor is used for the office, sleep over room and staff room. There is also a third bathroom which will be for the use of service users. The bedrooms Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 19 provide usable floor space all well extending the recommended 12sq m. All bedrooms have a single bed, wardrobe, chest of drawers, and easy chair. Each bedroom has a hand basin and there is a cloakroom on the ground floor. The property offers very comfortable accommodation for 3 residents. The property also has a secure back garden and front drive. The home was clean on the day of the inspection, the Registered Manager should ensure that they have comprehensive documents and policies in place in relation to infection control in the home. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is currently in the developing stages and does not employ staff, however evidence was supporting to confirm that the relevant training and supervision for prospective staff would be sourced and put into place. EVIDENCE: The service does not currently employ any staff as it is in the developing stages. Therefore this standard was not fully assessed. However evidence was supporting to confirm that the service has an induction checklist in place, supervision agreement and that the Registered Manager has a commitment to providing mandatory training for staff as and when they are employed. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence was supporting to confirm that the Registered Manager provides a good level of support for service users placed. However the Registered Manager must ensure that all the required documentation is in place and that documents used are comprehensive and contain correct information. The service is very much in the developing stages and the Registered Manager must address the requirements to ensure the service can move forward. EVIDENCE: As part of the inspection the inspector case tracked one service users in the home, spent time with a professional from the Adult Placement Team gaining views about the service. As part of the case tracking the inspector examined Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 22 the person centred documents and risk assessments, also evidenced were the external reviews from the adult placement team. Other documents examined were copies of notifications, and accidents and appointments, evidence of external reviews, the record of complaints and the complaints procedure. The Registered Manager who is also the owner of the home has over twenty years experience in social care, during which time they have worked as support worker, and senior support officer. However the Registered Manager must ensure they have the correct documentation in place and ensure they address the requirements in the report to enable the service to move forward. No staff are currently employed in the home apart from the Registered Manager however evidence was supporting to confirm that the pro forma for supervision contracts was in place and that the Registered Manager had a commitment for training staff once employed in the home. The inspector spent time with the Registered Manager and gained views about the service from professionals in the community. The Registered Manager has no formal process for gaining views about the service from service users or professionals and no formal quality assurance documents were in place in the home. The Registered Manager has a Degree in Counselling (1980) and studied for a Doctorate in Psychology (1985) they have NVQ3 and have completed the mandatory training. The Registered Manager plans to undertake the new Duel Award Leadership & Management for care services award. Information taken from the registration report and confirmation by the Registered Manager highlighted that the required health and safety documentation is in place, and that a full fire risk assessment has been undertaken and a Zero radio fire alarm system fitted. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Version 5.2 Page 24 Summer Wood DS0000072995.V375218.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 YA1 Standard Regulation 4(1)(a)(b)(c) (2), (3)(a)(b) Requirement Timescale for action 01/09/09 2 YA5 3 YA6 4 YA9 The Registered manager must compile in relation to the care home a written statement which shall consist of a statement of the aims and objectives of the care home. The Registered Manager must ensure that the information contained in the Statement of purpose is correct. 5(b) The Registered Manager 01/09/09 must produce a terms and conditions in respect of accommodation to be provided for service users including as to the amount and method of fees. 15(1)(2)(a)(b)(c)(d) The Registered Manager 01/09/09 must produce a written plan as to how the service users’ needs in respect of his health and welfare are to be met. 13(4)(a)(b)(c) The Registered manager 01/07/09 must ensure that unnecessary risks to the DS0000072995.V375218.R01.S.doc Version 5.2 Page 25 Summer Wood 5 YA10 17(1)(b) 6 YA12 16(m)(n) 7 YA22 22(7)(a)(b) 8 YA23 13(6) 9 YA37 10(1) health or safety of service users are identified and so far as possible eliminated. The Registered Manager must ensure that records are kept securely in the home, and that information is kept in confidence. The Registered Manager must consult service users about their social interest and make arrangements to enable them to engage in local, social and community activities – and have regard for the needs of service user’s activities in relation to recreation, fitness and training. The Registered Manager must ensure the complaints procedure includes the name, address and telephone number of the commission and the procedure that has been notified by the Commission to the registered person for making of complaints. The Registered Manager must ensure that measures are in place to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse in that the Registered Manager ensure that all significant events are reported to the relevant bodies in a timely fashion. The Registered Manager DS0000072995.V375218.R01.S.doc 01/07/09 01/09/09 01/09/09 01/07/09 01/09/09 Page 26 Summer Wood Version 5.2 10 YA39 24(1)(a)(b)(2)(3) must ensure the care home is run with sufficient care, competence and skill in that the required documentation is put into place to ensure the needs and safety of the residents are met. The Registered Manager must ensure a system is in place for reviewing at appropriate intervals and improving the quality of care provided at the care home. 01/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA30 Good Practice Recommendations The Registered Manager should ensure comprehensive policies and procedures are in place in relation to infection control within the home. Summer Wood DS0000072995.V375218.R01.S.doc Version 5.2 Page 27 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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). 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. 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